AUA 2004 - Uros still Mistakenly Prescribing Antibiotics

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Program#/Poster#: 104

Presentation Title:
CHRONIC PROSTATITIS - A NATIONWIDE SURVEY OF ALL UROLOGISTS IN SWITZERLAND

Presentation Time: 5/8/2004 1:00:00 PM

Author Block: Sebastian Zbrun, Martin Schumacher, Urs E. Studer, Werner W. Hochreiter. University Hospital of Bern, Bern, Switzerland

Introduction and Objective: To document the current perception and management of Chronic Prostatitis (CP) by urologists in Switzerland.

Methods: In May 2003, we sent a questionnaire to all 154 urologists practicing in Switzerland at that time. The questionnaire consisted of 19 questions concerning prevalence, etiology, diagnostic assessment, treatment and prognosis of CP. The returned questionnaires were statistically analyzed.

Results: Of the 154 questionnaires sent, 76 were returned (49%). Respondents see a median of 10 CP patients per month, 3 of them being newly diagnosed cases. This would correspond to a prevalence of 255 and an incidence of 76 per 100'000 inhabitants for CP in Switzerland. Twentyone percent of respondents believe in an infectious etiology of CP, whereas 28% think that infection is not the etiology of CP. For routine diagnostic assessment, the most commonly used tests are digital rectal examination, dipstick urinanalysis, ultrasound for post-void residual urine assessment and microscopic urine analysis (91%, 75%, 73% and 67% of respondents, respectively). Microscopic and microbiologic analysis of post prostatemassage urine (VB3) as well as symptom assessment by the National Institute of Health--Chronic Prostatitis Symptom Index NIH-CPSI are less frequently used (46%, 34% and 12% of respondents, respectively). The predominant treatment prescribed for CP is antibiotics (75%). Ninetythree percent of respondents who regard infection as etiology of CP routinely use antibiotics as firstline therapy. Surprisingly, also 80% of respondents who do not believe in an infectious etiology prescribe antibiotics. When asked about the therapeutic consequences of VB--analysis, almost half of respondents would prescribe antibiotic treatment in the absence of leucocyturia. Treatments with non-steroidal antiinflammatory drugs or alpha-blockers are less frequently adopted as firstline therapy (30% and 17% of respondents, respectively). The mean overall success rates of initial therapy reported (all treatments included) is 60%, but the mean recurrence rate after 6 months reported is 48%.

Conclusions: One of 5 urologists believes in an infectious etiology of CP. However, 3 of 4 urologists prescribe antibiotic treatment as firstline therapy. Only a minority of respondents routinely perform prostatemassage with analysis of VB3 when suspecting CP, and antibiotic treatment is often prescribed even without evidence of inflammation in VB3. To our knowledge, this is the first European study of this kind.