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Diagnostic procedures by Italian general practitioners in response to lower urinary tract symptoms in male patients: a prospective study

SUMMARY Background: The aim of this prospective, multicentre, observational study was to evaluate the initial diagnostic procedures for lower urinary tract symptoms (LUTS) carried out by Italian general practitioners (GPs). Methods: Data were collected from 445 GPs in Italy regarding the initial clinical decisions and diagnostic procedures adopted for the management of 1399 male patients with LUTS aged > 50 years. Results: 50.3% of patients were managed by the GP, 4.9% were referred to the urologist immediately and 44.8% after carrying out some diagnostic procedures. A digital rectal examination was performed in only one-third of the patients, many of whom were not subsequently referred to the urologist (26.4%). Laboratory tests that are usually recommended (i.e. PSA, urinalysis and serum creatinine) were undertaken in 98.3% of patients, while tests that are generally considered optional (such as flowmetry) were undertaken in up to 64%. Other generally not recommended investigations, such as ultrasonography, were carried out in 77.2%. The mean time to diagnosis was significantly shorter when the urologist was not involved (36.0 days for GP only management vs 51.4 days for immediate referral and vs 43.4 days for delayed referral (p = 0.0003). Conclusions: Our findings show a propensity for the majority of Italian GPs to deal with LUTS patients in a primary setting without immediate referral to the urologist. In principle, this trend could be beneficial for the patient (i.e. by reducing time to diagnosis) and cost saving for the national health system. However, the diagnostic procedures selected by the GPs were not in line with best-evidence practice recommendations. Shared-care protocols involving both GPs and urologists may contribute to better implementation of the guidelines on the management of LUTS and benign prostatic hyperplasia in Italy.