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Vol. 36. Issue 5.
Pages 265-275 (May 2012)
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Vol. 36. Issue 5.
Pages 265-275 (May 2012)
Special article
Consensus on the clinical impact of the new scientific evidence available on benign prostatic hyperplasia
Consenso sobre el impacto clínico de la nueva evidencia científica disponible sobre hiperplasia benigna prostática
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J.M. Cózar-Olmoa,??
Corresponding author
cozarjm@yahoo.es

Corresponding author.
, C. Hernández-Fenándezb, B. Miñana-Lópezc, J.H. Amón-Sesmerod, M. Montlleó-Gonzáleze, A. Rodríguez-Antolínf, F. Caballero-Martínezg
a Hospital Virgen de las Nieves, Granada, Spain
b Hospital Universitario Gregorio Marañón, Madrid, Spain
c Hospital Morales Meseguer, Murcia, Spain
d Hospital Universitario Rio Ortega, Valladolid, Spain
e Fundació Puigvert, Barcelona, Spain
f Hospital Universitario 12 de Octubre, Madrid, Spain
g Universidad Francisco de Vitoria, Madrid, Spain
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Tables (4)
Table 1. Summary of statistical results on diagnosis and stratification of the patients with BPH in which the level of group consensus reached is established (see table legends in a footnote to the table).
Table 2. Summary of statistical results on medical treatment of patients with BPH in which the level of group consensus reached is established (see legends in a footnote to the table).
Table 3. Summary of statistical results of surgical treatment in which the level of group consensus reached is established (see legend in a footnote to the table).
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Abstract
Objectives

To study the technical opinion of an expert panel and reach a consensus of professional criterion in relation to the most recent scientific evidence in benign prostatic hyperplasia (BPH) in the scopes of diagnosis, progression criteria, medical treatment and surgical treatment.

Material and methods

Systematized review of the literature of the last 10years in BPH by means of a scientific committee and elaboration of a 64-question questionnaire divided into three strategic areas: (1) Diagnosis and stratification of the patients with BPH considering the progression risk factors, (2) novelties in the medical treatment and (3) new contributions in the surgical and minimally invasive treatment in BPH. A panel of 50 urologists standing out for their knowledge in BPH distributed throughout the national geographic area was chosen, establishing the Delphi methodology for the study through the application of two successive online surveys.

Results

The 50 experts consulted completed the two groups of the questionnaire. In the first, a consensus of criterion was observed in 50 out of the 64 questions analyzed, achieving a consensus in 59/65 (92.5%) in the second round, which included aspects of morbidity of the lower urinary tract symptoms (LUTS), diagnostic tests necessary in the initial evaluation of the specialist, stratification of the patients in relation to the risk of progression, strategies of step-by-step medical therapy and combination in patients with risk of Acute Urinary Retention (AUR) or surgery and of the indications of surgical therapy and the role of new less invasive treatments.

Conclusions

In a condition of the high prevalence of BPH, in which we have seen important changes in its entire spectrum in recent years, the obtaining of an elevated consensus to which a large number of reference specialists in this condition have contributed will be of great importance for the usual clinical management of this disease.

Keywords:
Benign prostatic hyperplasia
Consensus
Delphi
Resumen
Objetivos

Explorar la opinión técnica de un panel experto y alcanzar un consenso de criterio profesional en relación a la más reciente evidencia científica en HBP en los ámbitos del diagnóstico, los criterios de progresión, el tratamiento médico y el tratamiento quirúrgico.

Material y métodos

Revisión sistematizada de la literatura de los últimos 10 años en HBP por medio de un comité científico y elaboración de un cuestionario de 64 preguntas repartidas en tres áreas estratégicas: 1.- Diagnóstico y estratificación de los pacientes con HBP atendiendo a los factores de riesgo de progresión. 2.-Novedades en el tratamiento médico y 3.- Nuevas aportaciones en el tratamiento quirúrgico y mínimamente invasivo en HBP. Se seleccionó un panel de 50 urólogos destacados en el conocimiento de la HBP repartidos por toda la geografía nacional instaurando para el estudio la metodología Delphi mediante la aplicación de dos encuestas sucesivas on line.

Resultados

Los 50 expertos consultados completaron las dos rondas del cuestionario. En la primera se apreció un consenso de criterio en 50 de las 64 cuestiones analizadas, logrando en la segunda ronda un consenso en 59/64 ítems (92,5%) que incluyen aspectos de morbilidad de los STUI, pruebas diagnósticas necesarias en la evaluación inicial del especialista, estratificación de los pacientes en relación al riesgo de progresión, estrategias de terapia médica escalonada y de combinación en pacientes con riesgo de RAO o cirugía y de las indicaciones de terapia quirúrgica y el papel de los nuevos tratamientos menos invasivos.

Conclusiones

En una patología de la alta prevalencia de la HBP, donde hemos asistido en los últimos años a cambios de calado en todo su espectro, la consecución de un elevado consenso al que han contribuido un amplísimo número de especialistas de referencia en esta patología, será de gran importancia para el manejo clínico habitual de esta enfermedad.

Palabras clave:
Hiperplasia Benigna de Próstata
consenso
Delphi

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