Prostatism is a term to be avoided because it is misleading and immediately invokes the suggestion that the patient’s urinary symptoms are related to the prostate glands. Symptoms are notoriously unreliable and give a poor indication of diagnosis in patients with lower urinary tract dysfunction. A large number of patients referred to a Urological clinic because of the symptom complex of frequency, urgency, nocturia, hesitancy and a poor urinary stream. The introduction of urodynamic investigation of these patients revealed that hesitancy and a poor stream were the only symptoms significantly associated with proven bladder outflow obstruction. Frequency, urgency and nocturia are irritative symptoms and suggest an element of detrusor instability. Nocturia may be related to nocturnal polyuria and this can only be identified if the patient records an accurate frequency and volume chart.

The careful assessment of the male patient with lower urinary tract symptoms is a very important task for the Urologist. The preliminary investigations include uroflowmetry, their recording of their frequency and volume chart, a plain x-ray of the urinary tract and the routine blood and urine tests.

In one study 60 male patients with lower urinary tract symptoms were assessed in the Urological Department. Forty-one of the patients had acceptable peak flow rates of 13 ml/seconds or more. Of the 19 patients with a reduced urine flow rate, 4 improved spontaneously and no longer required treatment. Two had urethral strictures, which required dilatation, leaving 13 patients out of the original total of 60 who required prostatectomy.

The modern urologist is presented with an ever-increasing number of possible therapeutic measures to treat patients with bladder outflow obstruction. The gold standard remains prostatectomy but some concern has been raised about the mortality and morbidity of transurethral prostatectomy compared to open prostatectomy. Are the differences merely due to the pre-operative selection?

Apart from prostatectomy, the other surgical approaches include balloon distension of the prostate, stenting, laser surgery, cryosurgery or hyperthermia. Medical treatment can no longer be dismissed without due consideration; 5 alpha-reductase or an alpha-adrenergic block have been shown to offer relief symptoms but how does one select the most appropriate patient?