A 70-yr-old man comes to his internal medicine physician with a complaint of waking to urinate. This has been present for several years but has gradually increased in frequency from 2 times/night to 6 times/night. He is not urinating more during the day. He states that when he does urinate, he has to strain to initiate a stream and that his stream is "not like it was when he was 20 years old." He denies incontinence, dysuria, hematuria, flank pain, fevers, or any other complaints. He is otherwise relatively healthy and has not seen a physician in several years.