A68-year-old man presents to the physician with a complaint of urinary frequency. he states that he has noted increased urgency and frequency for approximately 1 year, but his symptoms have become progressively worse. he states that currently he seems to have to urinate "all the time" and often feels as if he has not completely emptied his bladder. he must get up to urinate three or four times each night. in addition, in the last month, he sometimes has postvoid dribbling. he denies fevers, weight loss, or bone pain. his medical history is notable only for hypertension. his medications include atenolol and aspirin. the family history is negative for malignancy.
on examination, he appears healthy. his vital signs are notable for a blood pressure of 154/192 mm hg. prostate is diffusely enlarged without focal nodule or tenderness. benign prostatic hyperplasia is suspected.
questions:
1. how would you make the diagnosis of benign prostatic hyperplasia?
2. what factors are known to be responsible for the pathogenesis of this disorder?
3. how would you classify this patient's symptoms? what is the mechanism by which benign prostatic hyperplasia causes these symptoms?

Grilled ham and cheese sandwich: caution: if you’re underaged then have a responsible adult supervising you to prevent any injuries.1. preheat a pan or griddle over medium heat. spread each bread slice with mustard — crust to crust is a must to get full coverage so that each bite is identical. if you don’t like mustard then use whatever else you like.2. use a trio of cheeses in a grilled cheese to achieve perfect harmony: 1 slice of american cheese for gooeyness, 1 slice of aged cheddar for sharpness and 1 slice of provolone or mozzarella for stringiness. if you don’t like these cheeses then use whatever else you like.3. ribbon your meat onto your sandwich to create dramatic height and a smoother bite down. don't just lay the meat flat — it makes for a flat sandwich.4. add anything else you'd like to the sandwich — (just make sure you season them with a bit of salt and 5. spread mayo on the outside of a grilled cheese before it goes into the pan or onto the griddle, which ensures that it will be perfectly golden brown every time.6. place on the griddle; dome your grilled cheese with a metal bowl to create a vortex of heat and ensure the cheese melts without over-toasting the exterior for a maximum of 3 minutes. flip, cover again and cook until the cheese is melted and the sandwiches are golden brown for a maximum of 3 minutes. hope this : )