A Multifaceted Assessment of Benign Prostatic Hyperplasia Practice and AUA Guideline Adherence

Introduction: Guidelines for benign prostatic hyperplasia (BPH) were initially formulated by the AUA to provide evidence-based reasoning for the management and care of men suffering from lower urinary tract symptoms due to BPH. Recommendations for a urinalysis and validated symptom questionnaire (AUA Symptom Score [AUASS]/International Prostate Symptom Score [IPSS]) have been long standing, making these data points a metric for examining guidelines adherence. Methods: A survey assessed providers’ awareness of AUA BPH guidelines and practice patterns, and was sent to a randomly selected portion of the AUA membership. The AUA Quality (AQUA) Registry was queried to assess testing and practice patterns. Results: Of 4884 invitations sent, 404 responses were received. Most survey respondents (91.8%) indicate they intend to get a urinalysis at initial evaluation. AQUA data found urinalysis was obtained in only 22.8% of patients. Symptom questionnaire use increased with increasing guideline familiarity, with 95.7% of those who are “extremely familiar” routinely using AUASS/IPSS compared to only 69.4% who are “somewhat familiar” (P < .005). Utilization increased by a factor of 2.7 (P < .005) for each increment in familiarity. The lowest use of AUASS/IPSS was in the group within 5 years of finishing training (P ¼ .069). Conclusions: Discrepancies are noted between our practice survey and AQUA data. The AUASS/IPSS is less commonly used by providers with less guideline familiarity and in providers with the least clinical experience. The intent to obtain urinalysis is high; however, actual testing is unfortunately infrequent. These findings could point toward the need for increasing education of providers with regard to clinical guidelines.