The assessment of patient complaints.

The objective documentation of patient symptom level is one of the most essential part of its recommendation for the diagnosis, evaluation, work-up, and eventual treatment of patients with prostatism. The AUA Symptom Score is an appropriate system, and should be adopted as the standard instrument during evaluation and follow-up. However, it should be remembered that the symptoms of BPH are not specific. In fact, age-matched women have similar symptoms and equal severity of symptoms when evaluated with the AUA symptom score instrument (Chai, Belville et al., 1993; Chancellor and Rivas, 1993; Lepor and Machi, 1993). This does not take away from the usefulness of the AUA symptom score which was not developed to diagnose BPH, but rather to measure objectively the severity of symptoms, and to follow the progression or improvement of symptoms following treatment. Thus, disease specificity is not a prerequisite for the usefulness of a symptom score used in this capacity. Additional evaluation by urodynamics may be necessary in selected cases. It should be emphasized that optimal treatment decisions for individual patients will also need to take into account how a given level of symptoms affects that patient's quality of life (bothersomeness).