Controversies about the clinical assessment of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a common disorder which places a considerable burden on older men and health care expenses. With advances in medical technologies and the foreseeable demographic changes in the Western world, the financial and epidemiological impact of this chronic disease is expected to increase further. The management of BPH is controversial, and this article critically reviews the clinical applicability and validity of the various measures available for assessment. Few objective modalities are indicated in the routine evaluation of BPH. There is a poor correlation between objective and subjective indicators and both measures reveal a substantial variation over time. This fluctuation is mainly attributed to the natural history of the disease. The clinical value of combining objective and subjective parameters into an analytic process seems small. Disagreements about the clinical value of BPH assessment modalities have caused inconsistent practices and consequently provision of changeable health care quality. Patients seek urological counseling and relief because of burden of illness. Quality care is provided by clinicians being perceptive to patients' preferences. Provision of quality care does not inevitably generate increasing health service expenses.