SCREENING & DIAGNOSIS
The American Urological Association (AUA) Symptom Index provides an objective assessment of BPH symptoms that helps to decide on treatment.
However, this index cannot be used for diagnosis, since other diseases can cause symptoms similar to those of BPH.
Therefore, a careful medical history, physical examination, and laboratory tests are required to exclude such conditions as
urethral stricture (narrowing of the urethra) and bladder irritation from causes other than BPH. In fact, some reports indicate
that as many as 30% of men who undergo prostatic surgery following the usual evaluation do not show evidence of urethral obstruction from BPH.
A medical history will give clues to conditions that can mimic BPH, such as possible stricture, bladder cancer or stones, or abnormal
bladder function (problems with holding or emptying urine) due to a neurologic disorder (neurogenic bladder). Strictures can result
from urethral damage caused by prior trauma, instrumentation (for example, catheter insertion), or an infection, such as gonorrhea.
Bladder cancer is suspected if there is a history of blood in the urine. Pain in the penis or bladder area may indicate bladder stones
or infection. A neurogenic bladder is suggested when an individual has diabetes or a neurologic disease such as multiple sclerosis or
Parkinson's disease, or describes a recent deterioration in sexual function. A thorough medical history should also include questions
about previous urinary tract infections or prostatitis (inflammation of the prostate that may cause pain in to lower back and the area
between the scrotum and rectum, chills, fever, and general malaise), and any worsening of urinary symptoms when taking cold or sinus drugs.
The physician will also ask whether any over-the-counter or prescription medications are being taken, because certain varieties can make
voiding symptoms worse in men with BPH.
The physical examination may begin with the doctor observing urination to completion to detect any urinary irregularities.
The doctor will manually examine the lower abdomen to check for the presence of a mass, which may indicate an enlarged bladder
due to retained urine. In addition, a digital rectal exam (DRE) which allows the physician to assess the size, shape, and consistency
of the prostate, is essential for proper diagnosis. This important examination involves the insertion of a gloved finger into the rectum,
but is only mildly uncomfortable. The detection of hard or firm areas in the prostate raises the suspicion of prostate cancer.
If the history suggests possible neurologic disease, the physical may also include an examination for neurological abnormalities
that indicate the urinary symptoms result from a neurogenic bladder.
A urinalysis, which is obtained in all patients with symptoms of BPH, may be the only laboratory test if symptoms are
mild and no other abnormalities are suspected from the medical history and physical examination. A urine culture is added
if a urinary infection is suspected. With more severe chronic symptoms of BPH, blood creatinine of blood urea nitrogen (BUN)
and hemoglobin are measured to rule out kidney damage and anemia. Measuring prostate specific antigen (PSA) levels in the blood
to screen for prostate cancer is recommended as well as the DRE. PSA testing alone cannot determine whether symptoms are due to
BPH or prostate cancer because both conditions can elevate PSA levels.
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