IMPLICATIONS OF THE MOST BOTHERSOME PROSTATISM SYMPTOM FOR CLINICAL CARE AND OUTCOMES RESEARCH

OBJECTIVES: Because treatment of benign prostatic hyperplasia (BPH) is based largely on patients' symptoms, understanding and measuring the impact of these symptoms from the patient's perspective is critically important for clinical care. Such knowledge also is crucial for compar ing patient-weighted outcomes because the increasing array of medical and surgical BPH treatments differ in their impact on specific symptom s. Our purpose was to determine the most bothersome symptom in older m en seeking evaluation for symptomatic BPH and to examine whether age, comorbidity, or urodynamic evidence of prostatic obstruction were impo rtant covariates. DESIGN: Prospective evaluation of a consecutive seri es. SETTING: Veterans Affairs urology clinic. PARTICIPANTS: 115 men (a ge 69 +/- 6 years) presenting for initial evaluation of prostatism. ME ASUREMENTS: Scores on standard symptom index and patients' reports of the most bothersome symptom. Bladder outlet obstruction was assessed b y multichannel videourodynamic evaluation. RESULTS: An ''irritative'' symptom (frequency, urgency, or nocturia) was cited as most bothersome significantly more often than an ''obstructive'' symptom (weak stream , hesitancy, etc.) (53 vs. 35%, P < .05); older men were significantly more likely to name an irritative symptom as most bothersome (chi(2) for trend = 6.63, P < .025). Even among men with prostate obstruction, most cited an irritative symptom as the most bothersome, regardless o f the severity of obstruction. These associations were not confounded by comorbid conditions or medications that independently may cause sym ptoms. CONCLUSIONS: Because irritative symptoms are most bothersome, h ave a diverse differential diagnosis, and do not respond as well to BP H treatment, neither providers nor researchers should rely solely on g lobal assessments of symptom severity and bother in assessing men with voiding symptoms. Additional focus on individual symptom impact and e tiology is needed, especially in older men.