Diagnosis of Benign Prostatic Hyperplasia

Abstract

Benign prostatic hyperplasia (BPH) can lead to lower urinary tract symptoms (LUTS), which can have a significant impact on a patient’s quality of life. BPH is most easily identified on physical exam with digital rectal examination (DRE), as well as transrectal ultrasound or MRI. The size of the prostate does not correlate well to the degree of LUTS in all patients, however. Objective measurements of a patient’s urinary symptoms include the AUA-SI and IPSS templates. Urinalysis, postvoid residual (PVR), and uroflow should be performed in the clinic setting during the evaluation of BPH. Routine laboratory evaluation is not indicated in the standard patient that presents with LUTS thought to be secondary to BPH. However, in some clinical scenarios, a PSA and renal ultrasound may be appropriate. Urodynamic studies should be considered in patients with equivocal findings on noninvasive studies. Routine cystoscopic evaluation is not recommended during the initial workup of LUTS secondary to BPH, but may be offered if surgical treatment is being considered. Transrectal ultrasound volume measurements are the most widely accepted measurements of prostate volume. Upper urinary tract imaging is not recommended in the routine evaluation of men with LUTS unless hematuria, UTI, renal insufficiency, or history of urolithiasis or UTI is present.