Prevalence of benign prostatic hyperplasia in general practice and practical approach of the Tunisian general practitioner (Prevapt study)

BACKGROUND: Benign prostatic hyperplasia (BPH) is one of the most common conditions associated with ageing in men. BPH presents as lower urinary tract symptoms (LUTS). AIM: The aim of this study is to assess the prevalence of LUTS suggestive of BPH in 50 years or older men in general medicine and to evaluate the management of these patients by general practitioners. METHODS: This cross-sectional, prospective, multi-centre epidemiological survey, included all men with an IPSS (international prostatic symptoms score) > or =8. The management by general practitioners was analysed including complementary examinations and treatment. RESULTS: Among 4602 outpatients recruited by 88 general practitioners, 434 patients had an IPSS > or =8 and were included in the study. The prevalence of LUTS/BPH was 16.1%. The prevalence showed a linear increase with age. The prevalence was 7% at the age 50-59 years, 17.4% at the age 60-69 years and 33.4% in 70 years and over men. LUTS were the main reason of consulting general practitioner in 45.4% of cases. 72.6% of patients were with moderate symptoms (IPSS 8-19) and 26.4% of patients were with severe symptoms (IPSS 20-35). Quality-of-life score was 0-2 in 10.3% of patients, 3-4 in 52.2% of patients and 5-6 in 37.5% of cases. The management by general practitioner was then a watchful waiting in 14.7% of cases, to refer the patient to an urologist in 13.7% of cases, to ask for complementary examinations in 71.6% of cases and to treat in 73.4% of cases. Only 37.4% of patients with suspect prostate malignancy were referred to the urologist. In cases of treatment alpha blocker was the treatment choice in 77% of the cases. CONCLUSION: LUTS/BPH are frequent in Tunisia. It occurs in one third of men over 60 years and one fifth of men over 70 years. With the progressive ageing of Tunisian population, this pathology may constitute a public health problem. It is therefore urgent to elaborate recommendations concerning the management of this disease, specifying the role to play by the urologist and the general practitioner.