Male lower urinary tract symptoms and benign prostatic obstruction: what do patients want?

Patients’ preferences and expectations depend on cultural, geographical, societal, economic, and national factors [1]. Therefore, data pooled from different studies in different countries should be interpreted with caution when applied to the individual patient. Patients rarely seek help for benign prostatic obstruction (BPO) unless acute urinary retention occurs, but they are rather referred for bothersome lower urinary tract symptoms (LUTS) associat- ed with benign prostatic enlargement (BPE) [2]. The long- standing issue of treatment outcome in patients with or without BPO remains unsolved; probably all parties are right, as the resolution of BPO is certainly associated with improvement in symptoms and quality of life, but this is also true for patients without an urodynamic diagnosis but with BPO associated with prostate infection and inflamma- tion [3]. Evidence suggests that inflammation is what causes retention in patients with small prostates [3]. Per- sonal experience suggests that patients are not interested in the diagnosis of bladder outlet obstruction; they care about improving their symptoms and quality of life and prevent- ing disease progression. We often forget that guidelines apply to the standard patient but we often consult patients requiring personalised management. Although evidence- based medicine does not support the widespread use of pressure-flow studies, their use may be required for a knowledge-based intervention. Whether in digital or paper form, voiding diaries are of the greatest clinical value and