DIFFERENTIAL-DIAGNOSIS OF PROSTATISM - A 12-YEAR RETROSPECTIVE ANALYSIS OF SYMPTOMS, URODYNAMICS AND SATISFACTION WITH THERAPY

Purpose: We determined the incidence of voiding symptoms, urodynamic e tiology and satisfaction with therapy in a large cohort of men with pr ostatism during a 12-year period. Materials and Methods: We retrospect ively analyzed the records of 2,845 consecutive men who underwent urod ynamic evaluation between January 1982 and December 1994. Patients wer e divided into groups 1 and 2 according to the years of study (between 1982 and 1988, and between 1989 and 1994, respectively). Parameters o f evaluation included prevalence and distribution of voiding symptoms, urodynamic etiology of symptoms and satisfaction with therapy (medica l or surgical). Results: There was 843 evaluable patients 50 to 94 yea rs old (mean age 63.2). Group 2 patients were younger, and had a 22% h igher prevalence of nocturia and a 12% higher prevalence of daytime fr equency. The prevalence of all other symptoms was the same in both gro ups. On urodynamics 523 patients (62%) had demonstrable evidence of bl adder outlet obstruction of whom 345 (66%) had concomitant detrusor in stability. Of the 843 patients 647 (77%) had detrusor instability, whi ch was the sole diagnosis in 199 (24%). We noted low pressure/low flow in 137 patients (16%) and impaired detrusor contractility in 152 (17% ), including 57 (7%) in whom the latter condition was the only diagnos is. Urodynamic findings remained the same during the entire 12-year pe riod. Global satisfaction and symptomatic improvement were better with surgical than medical therapy, although the degree of satisfaction wa s independent of the urodynamic etiology of symptoms. Conclusions: Sym ptomatic men with prostatism are presenting with a greater prevalence of significant nocturia and daytime frequency than in the past with no change in urodynamic findings. In addition, patient level of satisfac tion remains greater with surgical than medical therapy regardless of the urodynamic presence of bladder outlet obstruction.