Urologic 'nuisances': how to work up and relieve men's symptoms.

Common urologic complaints in the midlife man include bladder outlet obstruction, bladder hyperactivity, and large urinary output. Obstruction can result from benign prostate hypertrophy or some other problem distal to the bladder neck, such as urethral stricture. Hyperactivity can be induced by stress and caffeine or can suggest neurologic disease or bladder neoplasia. Large urinary output suggests excessive fluid intake, diabetes insipidus or mellitus, or mobilization of fluid from the use of diuretics or reclining at night. Sexual dysfunction may be caused by stress, but it is more often linked to peripheral vascular disease. Screening for prostate cancer is controversial; the benefit of PSA testing is most clear in patients at elevated risk (eg, due to race or family history).