CORRELATION OF AMERICAN-UROLOGICAL-ASSOCIATION SYMPTOM INDEX WITH OBSTRUCTIVE AND NONOBSTRUCTIVE PROSTATISM

The precise role of the American Urological Association (AUA) symptom index in the management of benign prostatic hyperplasia (BPH) is not w ell established. The AUA symptom index has been recommended only for q uantifying the symptoms of BPH but not for its diagnosis. However, to our knowledge the ability to discriminate obstructive from nonobstruct ive BPH using the AUA symptom index has never been investigated. To es tablish the relationship between the AUA symptom index and prostatic o bstruction 125 men (mean age 67.7 t 8.4 years) with voiding dysfunctio n presumably related to BPH were analyzed. Patients were given the AUA symptom questionnaire, following which video urodynamic studies were done, including micturitional urethral pressure profilometry for speci fically diagnosing outlet obstruction. The patients were divided into 2 groups: group 1-78 with primary BPH dysfunction and group 2-47 with prostatism of ambiguous etiology. The mean AUA symptom index in group 1 (15.5 +/- 7.1) was not statistically different from that in group 2 (14.8 +/- 7.9). In both groups the mean AUA symptom index in the patie nts with obstruction (15.3 +/- 7.2 for group 1 and 13.9 +/- 7.9 for gr oup 2) was not statistically different from that in the nonobstructed group (17.0 +/- 5.4 and 16.1 +/- 7.9, respectively). Of the severely s ymptomatic patients 22% did not have obstruction whereas all mildly sy mptomatic patients did. No significant correlations were found between the severity of obstruction and the AUA symptom index in either group . These observations indicate that the AUA symptom index cannot discri minate obstructed from nonobstructed BPH cases, not all severely sympt omatic BPH patients will have outlet obstruction, a significant propor tion of mildly symptomatic BPH patients can have outlet obstruction an d voiding dysfunctions in elderly men, regardless of the etiology, pro duce similar symptoms.