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April 8, 1998

Clinical Crossroads: A 73-Year-Old Man With Symptomatic Benign Prostatic Hyperplasia

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(14):1070. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-14-jac80003

To the Editor.—Although the Clinical Crossroads by Dr Barry1 was entitled "A 73-Year-Old Man With Symptomatic Benign Prostatic Hyperplasia [BPH]," the patient presented with a chief complaint of storage (or filling) lower urinary tract symptoms (urinary frequency and nocturia). Of the differential diagnoses entertained, BPH was stated as the most likely diagnosis. Although I do not disagree with this assessment, it is important for clinicians to realize that the pathophysiology of lower urinary tract symptoms (filling or voiding) is poorly understood. Aged women, who obviously do not get BPH, have similar perceptions of voiding difficulties compared with aged men when their perceptions are quantitated with the American Urological Society Symptom Score.2-4 As also pointed out in the article, "The traditional view of the mechanism by which the histologic process of BPH leads to lower urinary tract symptoms has been that the expanding prostatic adenoma results in bladder outlet obstruction." However, because several empiric observations detailed by Barry seemingly contradict this viewpoint, other mechanisms probably exist.