The diagnosis of prostatic obstruction ordinarily presents little difficulty. It has long been known, however, that advanced degrees of bladder neck obstruction occasionally develop so quietly that the true condition may not be suspected until severe uremia is present. This is the type referred to as "silent" prostatism. Although these patients are numerically few, they are particularly important because marked changes in the bladder and upper urinary tract have usually occurred before an accurate diagnosis has been made, and therapy is correspondingly more difficult and less effective. All three of the main causes of prostatic obstruction, benign hyperplasia, fibrous contracture, and carcinoma, may, on occasion, develop in this insidious manner. Actually, some symptoms of urinary obstruction are almost always present but may be so mild that they are ignored or lightly passed over by the patient, who thus unwittingly helps delay recognition of the condition.
In a six-year period, 16