[Micturition complaints in older men]

There is no correlation between the size of the prostate and the degree of infravesical obstruction or related micturition disorders. If, however, benign prostatic hyperplasia results in bladder outlet obstruction, secondary detrusor hyperreflexia may develop. This bladder dysfunction persists postoperatively in a quarter of the patients treated. When in senile men the symptoms of detrusor instability or detrusor hyperreflexia are in the foreground, then it is very important from the point of view of differential diagnosis to know exactly whether the detrusor dysfunction is due to either outlet obstruction or cerebral insufficiency. Measurement of the sacral latency might be able to answer this question. If the voiding complaints are secondary to outflow obstruction and the neurophysiological parameters of the sacral reflex arc are within normal limits, then it may be assumed that the associated bladder instability (together with the bladder outlet obstruction) may disappear after prostatectomy or TUR of the prostate. In the case of a prostatic carcinoma with outflow obstruction, it seems preferable to start endocrine therapy, rather than to perform a TUR of the prostate. In a large number of cases, endocrine therapy will be able to reduce the size of the prostate and relieve the outflow obstruction. In patients with excessive operation risks, simple endoscopic bladder neck incision or suprapubic puncture cystostomy may prove valuable alternatives to TUR of the prostate.