Urinary symptoms in the community: how bothersome are they?

To measure the level of reported urinary symptoms presumed to be associated with benign prostatic hyperplasia (BPH) among men aged 40 years and over in the community, and to assess how bothersome these symptoms are perceived to be.

All ambulant men aged 40 years and over who were registered in a general practice (703) were invited to attend the health centre to complete a questionnaire containing the Maine prostatectomy scale and the International Continence Society-BPH questionnaire, and to undergo uroflowmetry.

The prevalence of symptomatic BPH (as defined by a numerical score > or = 11 on the Maine score, a urinary peak flow of < 15 ml/s, and failure to void > or = 150 ml on three separate occasions) was 284/1000 for men aged 40 years and over. This prevalence increased from 179/1000 in men aged 40-49 to 500/1000 in men aged 70 years and over. The most commonly reported symptoms were those typically associated with BPH (terminal dribble, hesitancy, intermittency, urgency). The symptoms that caused men the greatest degree of bother were frequency, nocturia and those causing incontinence or social embarrassment.

The high prevalence of urinary symptoms assumed to be related to BPH in men in the community does not necessarily suggest that these men will require treatment. Common symptoms, typically associated with BPH, were tolerated. Further research is required to investigate the natural history of urinary symptoms, the relationships between symptoms and bladder outflow obstruction secondary to BPH, and to determine the most appropriate management for men in the community, ranging from 'watchful waiting' (monitoring without treatment) to medical or surgical treatment.