BLADDER-OUTLET OBSTRUCTION - ASSESSMENT OF SYMPTOMS

Assessment of symptoms plays a central role in the evaluation of men w ith suspected bladder-outflow obstruction (BOG) secondary to benign pr ostatic hyperplasia (BPH). It is on the basis of symptoms that treatme nt designed to relieve outflow obstruction is recommended. However, a variety of studies have suggested that a considerable proportion of me n presenting with suspected outflow obstruction are not obstructed as determined by pressure-flow criteria. The relationship between many so -called ''obstructive'' symptoms and BOO has not yet been defined. Fur thermore, all previous studies have defined BOO on the basis of urethr al resistance factors, which are now regarded as outdated. Using curre nt concepts of urethral pressure-flow relationships, we studied in det ail the relationship between the ''obstructive'' symptoms of BPH, obje ctive evidence of abormal voiding and BOG. Only the symptoms of hesita ncy and poor flow were found to be significantly related to BOG. The s ymptoms of straining to void, intermittency, terminal dribbling and fe eling of incomplete bladder emptying were not specific for BOG. Object ive evidence of an intermittent flow pattern and of terminal dribbling do, however, have a high specificity and positive predictive value fo r BOG. The assessment of men with lower-urinary-tract symptoms must in clude objective tests of voiding function. A better understanding of t he pathophysiology of lower-urinary-tract symptoms should lead to an i mproved symptomatic outcome of prostatectomy.