Diagnosis of Benign Prostatic Enlargement
The doctor and nurses do a series of tests to understand what causes your symptoms. This is called a diagnosis.
The symptoms listed in the previous section can point to many diseases and not only BPE. This is why you may need to take several tests before the doctor can make a diagnosis.
First, the doctor or nurse will take your medical history and do a physical examination. Then they may do urine and blood tests, take images of your bladder and prostate, and perform other tests if needed.
This section offers general information about diagnosis and situations can vary in different countries.
The doctor will take a detailed medical history and ask questions about your symptoms. You can help your doctor by preparing for the consultation:
- Make a list of previous surgical procedures
- Make a list of the medication you are taking
- Mention other diseases you suffer from
- Describe your lifestyle (exercising, smoking, alcohol, and diet)
- Describe your current symptoms
- Note how long you have had the symptoms for
The doctor may also ask you to fill out a questionnaire to understand your symptoms, how often they happen, and how much they affect your quality of life. There are several questionnaires available including IPSS, ICIQ Male LUTS, the Danish Prostate Symptom Score (DAN-PSS). The most-used questionnaire is the International Prostatic Symptom Score (IPSS). It consists of seven questions about you symptoms which can be scored between 0 and 5, from mild to severe.
Your doctor or nurse will do a general physical examination. They will be looking for:
- A distended bladder (your bladder may stretch if it does not empty completely)
- Skin damage on the penis and scrotum (a sign of urinary incontinence)
- Discharge from the urethra (a sign of infection)
- Abnormalities in the penis, scrotum, and testicles
In addition, your doctor will do a rectal examination with a finger to feel the size, shape, and consistency of the prostate (Fig. 1). This test is known as digital rectal examination (DRE).
You will need to give some of your urine for testing. The test will show if you have a urinary tract infection and if there are traces of blood in the urine.
As part of making the diagnosis your doctor will do a blood test to check your kidney function. The doctor may also recommend to check if your blood has higher levels of prostate-specific antigen (PSA). PSA is a protein produced by the prostate and it may increase in men with a benign prostatic enlargement, prostatic inflammation, or prostate cancer. The doctor will explain the possible consequences of this test before making this recommendation.
Your doctor may ask you to keep a bladder diary. Here you will note down how much you drink, how often you urinate, and how much urine you produce. The bladder diary is important because it helps your doctor to understand your symptoms better.
You can easily measure the volume of urine at home with the help of a measuring jug. You may use a stopwatch to record the time it took you to urinate. Note down the amount of urine (in millilitres) and the time it took to urinate (in seconds) (Fig. 2). You can print a bladder diary from the library.
What measuring your urine flow at home can tell you:
- Normal urine flow is above 15 millilitres per second
- If your flow of urine is 10 millilitres per second or less and you experience symptoms, you should see your urologist
Measuring at home is never as accurate as at the hospital or clinic. Make sure to consult your doctor about your urine flow rate.
This is a simple test which electronically records the flow of urine. It is easily done in privacy at the hospital or clinic. You will urinate in a container, called a uroflowmeter (Fig. 3). This test helps your doctor to check if the enlarged prostate causes a blockage in the lower urinary tract.
Imaging of the urinary tract
You will get an ultrasonography (also known as ultrasound), which uses high-frequency sounds to create an image of your bladder and your prostate.
The doctor or nurse will scan your bladder using ultrasound to check how much urine is left in the bladder after urinating. This information helps to see if your symptoms are caused by chronic urinary retention, which can be a complication of BPE.
An ultrasound may also be used to measure prostate volume. This may help to select the best treatment option for you.
A urodynamic test is done to get more information about your urination cycle and how your bladder muscles work. During the test, your doctor inserts catheters in your urethra and rectum to measure the pressure in your bladder and abdomen.
The bladder is slowly filled with sterile water through the catheter in the urethra. In this way, the filling of the bladder with urine is simulated. When the bladder is full, you will urinate into a uroflowmeter.
The test results are shown on a screen which is connected to the catheters. Sometimes the test has to be repeated to get accurate results but the catheters will already be in place for the second test.
Your doctor may decide to give you this test if:
- You have a neurological dysfunction
- You have had pelvic or prostate surgery
- You have much urine left in the bladder after urination
- If BPE is uncommon in your age group
- If the urologist needs more information to understand the cause of your symptoms