Factors Influencing Nonabsolute Indications for Surgery in Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: Analysis Using Causal Bayesian Networks
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Purpose: To identify the factors affecting the surgical decisions of experienced physicians when treating patients with lowerurinary tract symptoms that are suggestive of benign prostatic hyperplasia (LUTS/BPH). Methods: Patients with LUTS/BPH treated by two physicians between October 2004 and August 2013 were included in thisstudy. The causal Bayesian network (CBN) model was used to analyze factors influencing the surgical decisions of physiciansand the actual performance of surgery. The accuracies of the established CBN models were verified using linear regression (LR)analysis. Results: A total of 1,108 patients with LUTS/BPH were analyzed. The mean age and total prostate volume (TPV) were 66.2(±7.3, standard deviation) years and 47.3 (±25.4) mL, respectively. Of the total 1,108 patients, 603 (54.4%) were treated byphysician A and 505 (45.6%) were treated by physician B. Although surgery was recommended to 699 patients (63.1%), 589(53.2%) actually underwent surgery. Our CBN model showed that the TPV (R=0.432), treating physician (R=0.370), bladderoutlet obstruction (BOO) on urodynamic study (UDS) (R=0.324), and International Prostate Symptom Score (IPSS) question3 (intermittency; R=0.141) were the factors directly influencing the surgical decision. The transition zone volume(R=0.396), treating physician (R=0.340), and BOO (R=0.300) directly affected the performance of surgery. Compared to theLR model, the area under the receiver operating characteristic curve of the CBN surgical decision model was slightly compromised(0.803 vs. 0.847, P<0.001), whereas that of the actual performance of surgery model was similar (0.801 vs. 0.820,P=0.063) to the LR model. Conclusions: The TPV, treating physician, BOO on UDS, and the IPSS item of intermittency were factors that directly influenceddecision-making in physicians treating patients with LUTS/BPH.
Abstract
Purpose: To identify the factors affecting the surgical decisions of experienced physicians when treating patients with lowerurinary tract symptoms that are suggestive of benign prostatic hyperplasia (LUTS/BPH). Methods: Patients with LUTS/BPH treated by two physicians between October 2004 and August 2013 were included in thisstudy. The causal Bayesian network (CBN) model was used to analyze factors influencing the surgical decisions of physiciansand the actual performance of surgery. The accuracies of the established CBN models were verified using linear regression (LR)analysis. Results: A total of 1,108 patients with LUTS/BPH were analyzed. The mean age and total prostate volume (TPV) were 66.2(±7.3, standard deviation) years and 47.3 (±25.4) mL, respectively. Of the total 1,108 patients, 603 (54.4%) were treated byphysician A and 505 (45.6%) were treated by physician B. Although surgery was recommended to 699 patients (63.1%), 589(53.2%) actually underwent surgery. Our CBN model showed that the TPV (R=0.432), treating physician (R=0.370), bladderoutlet obstruction (BOO) on urodynamic study (UDS) (R=0.324), and International Prostate Symptom Score (IPSS) question3 (intermittency; R=0.141) were the factors directly influencing the surgical decision. The transition zone volume(R=0.396), treating physician (R=0.340), and BOO (R=0.300) directly affected the performance of surgery. Compared to theLR model, the area under the receiver operating characteristic curve of the CBN surgical decision model was slightly compromised(0.803 vs. 0.847, P<0.001), whereas that of the actual performance of surgery model was similar (0.801 vs. 0.820,P=0.063) to the LR model. Conclusions: The TPV, treating physician, BOO on UDS, and the IPSS item of intermittency were factors that directly influenceddecision-making in physicians treating patients with LUTS/BPH.
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