Until recently the usual surgical response to urinary symptoms and an enlarged prostate has been to recommend prostatectomy. What are the risks of adopting instead a policy of watchful waiting? We did not know. Which operation has the lower long term mortality: transurethral resection or open surgery? Once again we do not know with certainty. What of the other adverse outcomes of prostatic surgery, such as permanent sexual or urinary dysfunction: how much do these matter to patients? More fundamentally, what criteria do we use to judge the success of a surgical or medical intervention for “prostatic” symptoms - urinary flow rates (objective) or patients' symptoms (subjective)?

Benign prostatic hyperplasia caught the attention of health services researchers because of its strikingly different treatment rates both between and within countries^1,2; they then uncovered just how much was unknown about the condition and its treatments. Now through outcomes research, they are offering answers to many of the questions posed above. What outcomes research has to offer patients with benign prostatic hyperplasia formed the basis of a paper given by Albert Mulley of the Massachusetts General Hospital to a conference last week organised by the BMA, the BMJ Publishing Group, and the …