Benign prostate hyperplasia (BPH) is highly prevalent and ever rising in an ageing population, becoming the leading cause of lower urinary tract symptoms in men. We know from autopsy studies that it can be present in 1 in 2 men in their 6th decade of life, and as high as 80% of men in their 9th decade of life. It has therefore been an area of major research and innovation leading to several novel treatments available to choose from with differences in indications, outcomes and side effects. With all these novel techniques at our disposal, it is increasingly vital that we are equally keeping up with our patient counselling. In an era of patient centred decision making and with such an abundance of novel treatments for BPH, it has become increasingly laborious to facilitate choice of management both for the patient and clinicians. 

We aim to design and implement a smart decision aid tool for BPH treatment selection which incorporates the recent NHS Decision Support Tools leaflet for BPH, latest in literature about the novel techniques outcomes and tailored to patient priorities and baseline factors. Once validated, this aid tool can be implemented in outpatient clinics during or before patient visits for a more efficient and evidence-based counselling and selection of appropriate surgical treatment for BPH.

We have designed an online questionnaire, easily incorporated onto the hospital's clinical IPads, which consists of four questions aimed at the outcomes and side effects of the treatments available; asking the patients how much they prioritise recovery time, sexual function, duration to being catheter free and durability of the procedure (not requiring a repeat within 5 years). 

This is assessed individually using a likert score from 1 to 5, tallied and analysed with computer based alogirthms to match it to the closest surgical intervention with desired outcomes. This is then portrayed and highlighted to both the clinician and the patient in addition to any alternative surgeries with close outcomes to the prioritised ones. 

We finally asked at the end of the consultation both the patient and clinician about their satisfaction with the BPH aid tool and any feedback, collating that data.

There was improvement in overall patient satisfaction with the consultation and confidence in their choice of treatment. The clinicians reported more efficient consultations and higher satisfaction in the counselling process after using the smart BPH aid tool. Feedback was very positive with insight into expanding the platform to record further information available from  procedure outcomes and potential utility in auditing and data collection.

Using the prototype of the smart tool, patients reported better understanding of their surgical BPH options and more engagement with the clinician during clinic. The clinicians were mainly impressed by improved level of knowledge retention and more confidence about patient’s level of understanding l.

The smart BPH decision tool can be a powerful tool when used by an expert to counsel patients about their need for BPH surgery, leading to higher overall satisfaction and confidence in the decision made by both the patients and the clinician. This platform can be built on to become a holistic BPH electronic diary that follows the patient journey with further follow up investigation data and outcomes post procedures.

https://www.england.nhs.uk/wp-content/uploads/2023/11/Decision-support-tool-making-a-decision-about-enlarged-prostate.pdf
Huffman PJ, Yin E, Cohen AJ. Evaluating Patient Preferences in Benign Prostatic Hyperplasia Treatment Using Conjoint Analysis. Urology. 2022 Jun;164:211-217. doi: 10.1016/j.urology.2022.01.012. Epub 2022 Jan 19. PMID: 35063462.
https://www.sciencedirect.com/science/article/abs/pii/S0302283820309672