Background: The shift towards primarily pharmacological management of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) has led to an increasing proportion of patients being treated in the primary care setting.
Method: Two related studies were undertaken in Portugal. The first was a survey of primary care family physicians regarding the management of LUTS/BPH. The second was a cross-sectional study of the records of patients with suspected or confirmed LUTS/BPH managed by the surveyed physicians.
Results: One hundred and sixty-three physicians were surveyed between 16 June 2012 and 10 February 2013 and 2,988 patients were identified (mean age 68 years). While 80 % of physicians would order diagnostic tests for patients reporting symptoms, only 2.5 % would initiate treatment based on reported symptoms alone. Only 1 % would refer patients directly to a urologist for diagnosis, and 75 % would only refer patients after an inadequate response to treatment in the primary care setting. Management practices varied according to physicians' age and experience. Nocturia was both the most common and the most bothersome symptom. Erectile dysfunction was reported by 51 % of patients and 81 % had hypertension, hypercholesterolaemia and/or diabetes mellitus. Diagnosis and treatment of LUTS/BPH differed for older patients, those with comorbidities and those with more severe nocturia at presentation.
Conclusion: Primary care physicians in Portugal usually diagnose and treat patients with LUTS/BPH rather than refer them to a urologist. Physicians' age and experience, and patients' age, comorbidities and symptom severity affect the management of LUTS/BPH in primary care in Portugal.