382 RISK FACTORS FOR ACUTE URINARY RETENTION

lower urinary tract symptoms for 2 years also predicted acute urinary retention. Of a wide spectrum of putative clinical risk factors use of drugs with adrenergic or anticholinergic side effects appeared to increase risk of acute urinary reten- tion.

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EDITORIAL COMMENT

Despite the millions of men who have undergone major operative intervention to correct lower urinary tract symptoms during the last century, it has only been in the last few years that the urological literature has presented data on the pathophysiology and natural history of this common disorder of aging men. This carefully con- ducted enormous study supplements our newly emerging core knowl- edge by clearly documenting the enhanced risk of acute urinary retention associated with age, symptom severity and adrenergic or anticholinergic medications.

The mailed questionnaire format did not allow the authors to evaluate prostate volume, which others have reported to be another profound predictor of future adverse events, including acute urinary retention. We now know that lower urinary tract symptoms can be due to an array of disorders, only 1 of which is true BPH with progressive transitional zone prostatic enlargement. In previous years many of us were taught that prostate volume and symptoms had little to do with future adverse events or treatment selection. Our new knowledge reveals tha t both are vital factors in predicting the natural progression of disease, the likelihood of complications and most importantly the selection of therapy, especially medical therapy when prostate volume is pivotal.

Even with careful and proper patient selection, none of the new device therapies or existing medical therapies equals the favorable outcomes of surgical intervention. Despite our previous lack of knowledge regarding the pathophysiology and natural history Of lower urinary tract symptoms and BPH, which is now being cor- rected, urologists during past decades have been offering the most effective therapy without knowing why.

H. Logan Holtgrewe 473 Fair Oak Drive Severnu Park, Maryland