title: Implications of the most bothersome prostatism symptom for clinical care and outcomes research.
abstract: OBJECTIVE
  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 comparing patient-weighted outcomes because the increasing array of medical and surgical BPH treatments differ in their impact on specific symptoms. Our purpose was to determine the most bothersome symptom in older men seeking evaluation for symptomatic BPH and to examine whether age, comorbidity, or urodynamic evidence of prostatic obstruction were important covariates.
  
  
  METHODS
  Prospective evaluation of a consecutive series.
  
  
  METHODS
  Veterans Affairs urology clinic.
  
  
  METHODS
  115 men (age 69 +/- 6 years) presenting for initial evaluation of prostatism.
  
  
  METHODS
  Scores on standard symptom index and patients' reports of the most bothersome symptom. Bladder outlet obstruction was assessed by 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 of the severity of obstruction. These associations were not confounded by comorbid conditions or medications that independently may cause symptoms.
  
  
  CONCLUSIONS
  Because irritative symptoms are most bothersome, have a diverse differential diagnosis, and do not respond as well to BPH treatment, neither providers nor researchers should rely solely on global assessments of symptom severity and bother in assessing men with voiding symptoms. Additional focus on individual symptom impact and etiology is needed, especially in older men.
authors.affiliation: Gerontology Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: DuBeau
authors.forename: S V
authors.initials: SV
authors.lastname: Yalla
authors.forename: N M
authors.initials: NM
authors.lastname: Resnick
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D015897:Comorbidity; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011470:Prostatic Hyperplasia / Q000150:complications / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy