Urology

Urological Conditions

Benign Prostatic Hyperplasis (BPH)

Diagnosing BPH

Diagnosis of BPH usually begins with the doctor taking your medical history and asking a series of questions about how often you experience the symptoms associated with the condition. Your answers are evaluated using the American Urological Association (AUA) BPH Symptom Score Index; the index helps the doctor decide how severe the condition is.

You will also have a physical exam, including a digital rectal exam (DRE), in which the doctor physically feels the size, shape, and consistency of your prostate by inserting a gloved, lubricated finger into your rectum.

In most cases, your doctor will also order a blood test to check the levels of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) in your blood. The prostate produces PSA to help liquefy semen. Higher than normal levels of PSA in the blood can indicate BPH, prostatitis (prostate inflammation), or the possibility of prostate cancer. However, PSA readings can be “false positive” (higher than normal even though there’s no prostate cancer) or “false negative” (the reverse), so they must be interpreted carefully and sometimes in conjunction with other tests.

Other possible diagnostic tests include:

Urinary cytology. Urine test that examines cells from the bladder lining that are in the urine to screen for bladder or kidney cancer.

Cystoscopy. Use of a cystoscope (a thin, telescope-like instrument with a fiber-optic lighting system and a special lens) to look into the urethra and bladder; the scope is inserted into the urethra while the patient is under local anesthesia.

Intravenous pyelogram (IVP). A form of x-ray that allows a urologist to clearly see pictures of the urinary system; a special dye (called a "contrast agent") is injected into a vein and passes quickly into the urinary system, making it easier to see any abnormalities.

PVR (post-void residual volume test). Measures how much urine remains in the bladder after urinating.

Ultrasound of the kidney and/or prostate. Uses sound waves projected into the body to create pictures of the organs and areas being examined.

Urodynamic pressure-flow test. Measures the volume and pressure of urine in the bladder and evaluates the flow of urine.

Uroflowmetry (urine flow study). Measures how fast urine flows during urination, how quickly and completely the bladder can be emptied.