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EDITORIAL COMMENT

Generally, prior research among men diagnosed with BPH by a physician has shown no correlation between measures of symptom severity, such as the AUA symptom score, and basic measures of the physiological or anatomical severity of BPH. including peak urine flow, residual volume, bladder pressure a t peak flow or prostate size. In community b a e d studies that enroll men with wider ranges of these parameters (but seldom include pressure-flow studies), signif- icant relationships have emerged but they are still quantitatively weak. A possible conclusion from such data is that measures of symptom severity and physiological anatomical severity are reflect- ing fundamentally different domains of lower urinary tract pathol- ogy (not all of which is BPH). However, some new findings are beginning to challenge this perspective.

In this unique study among male volunteers in several Japanese communities the authors found a stronger correlation between s y m p tom severity and an ultrasonographic parameter believed to reflect the presence and severity of BPH, that is presumed circle area ratio (R = 0.15, p <0.0001) than between symptom severity and total prostatic volume (R = 0.07, p = 0.03). Nevertheless, these relation- ships were still weak in an absolute sense. Using age and presumed circle area ratio as predictors, a multivariate model could only ex- plain approximately 44 of the variation in total AUA scores among study subjects.

This article should be considered together with recent reports by Kaplan e t al, who have shown in clinical populations relatively strong correlations between transition zone index (the ratio of trans- ition zone volume to total volume) and symptom severity (R = 0.75, p = 0.001),' and between a novel urodynamic parameter, detrueor contraction duration, and symptom severity (R = 0.61, p <0.003).* These research teams are on the cutting edge of the effort to define the links between anatomical and physiological evidence of BPH and the symptoms that give the condition i t s morbidity. Further research is needed to determine whether this new generation of meas- urements, considered together, will explain even more of the varia- tion in lower urinary tract symptoms among older men.

Michael J . Barry Medical Practices Evahatwn CentPr Massachusetts General Hospital Boston, Massachusetts

1. Kaplan, S. A., Te, A. E., Pressler. L. B. and Olsson, C. A.: Transition zone index as a method of assessing benign pros- tatic hyperplasia: correlation with symptoms, urine flow and detrusor pressure. J. Urol.. 1&1: 1764, 1995.

2. Kaplan, S. A. and Reis, R. B.: Significant correlation of the American Urological Association symptom score and a novel .~ ~

vey. Prostate, suppl., 2 69, 1989.

Denton, S. E., Holtgrewe, H. L., Lange, J. L., McClennan, 31. McConnell, J. D., Barry, M. J., Bruskewiz, R. C., Bueschen, A. J., urodynamic parameter: detrusor contraction duration.

J. Uml., 166: 1668, 1996.