Diagnosis and treatment patterns of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia in Murjani General Hospital, Central Kalimantan, Indonesia

Abstract

BackgroundThe aim of this study was to describe the diagnosis and treatment patterns of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and evaluate their appropriateness in an area without an urologist and with limited resources, such as the area covered by Murjani General Hospital, Sampit, Indonesia.MethodsThis descriptive study used data collected from medical records of patients who were diagnosed with LUTS suggestive of BPH in Murjani General Hospital between September 2013 and August 2015.ResultsThere were 89 patients. Their mean age was 64.5 years. The most common chief complaint was inability to void (59.6%), followed by frequency (10.1%). Diagnostic evaluations such as symptom scoring (1.1%), frequency–volume chart (0%), digital rectal examination (3.4%), urinalysis (5.6%), and prostate-specific antigen (0%) were used rarely or never, while renal function assessment (37.1%) and imaging of the prostate (68.5%) and upper urinary tract (65.2%) were used more often. Overall, the treatment that was administered most often was indwelling catheterization (25.8%); only 19.1% visited a urologist following a referral by the physician, although 41.6% were referred to a urologist. There were 40.4% of patients with an indication for surgery, mostly in the form of recurrent or refractory urinary retention (83.3%). In this group of patients, only 38.9% received appropriate treatment in the form of open prostatectomy by a general surgeon (16.7%) or were referred to a urologist (22.2%), while 50% of them were managed with chronic indwelling catheterization.ConclusionAll patients received substandard diagnostic evaluations, with a pattern of preference toward imaging studies over more basic examinations for LUTS–BPH. The high frequency of indwelling catheterization in overall and inappropriate treatment in the group of patients with an indication for surgery showed that patients received suboptimal treatment. Improvements in various aspects are required to optimize the management of LUTS suggestive of BPH in Murjani General Hospital.

Ethical and Professional Dilemmas encountered by Doctors in the National Health Insurance System

“…However, this situation will be even more complicated when several medical procedures cannot be carried out completely due to limited medical management and funding. 11,12 There is also need for further review of the total health expenditure. Currently, most of the health expenditures are still focused on curative and rehabilitative efforts which are very costly.…”

“…At first-level health facilities, the low capitation per patient has limited the choice of therapy and examination. 11,12 Transparency in deciding drug formularies, conformity with Evidence-Based Medicine guidelines, and socialization of formularies to all health facilities are very important in developing optimal drug formularies. 24 Harmonization between drug formularies in the e-catalogue, national formulary, and hospital formulary is needed.…”