Some reports indicate that as many as 30 percent of men who undergo surgery for benign prostatic hyperplasia (BPH), also known as benign prostatic enlargement (BPE), are found not to have urethral obstruction, meaning their symptoms were caused by something other than BPH. That’s why a careful medical history, a physical examination, and laboratory tests are required for an accurate diagnosis.
A medical history helps doctors identify conditions that can mimic BPH, such as narrowing of the urethra (urethral stricture), bladder cancer, bladder stones, bladder infection, or problems withholding or emptying urine due to a neurological disorder (neurogenic bladder). Another condition that can be confused with BPE is overactive bladder.
Strictures can result from urethral damage caused by trauma, catheter insertion, or an infection such as gonorrhea. A history of blood in the urine suggests bladder cancer, whereas pain in the penis or bladder area may indicate bladder stones or infection.
Neurogenic bladder is a possible diagnosis if a man has diabetes or a neurological disease such as multiple sclerosis, Parkinson’s disease, or stroke, or if he has experienced a recent deterioration in sexual function.
A thorough medical history includes questions about previous urinary tract infections and prostatitis. The doctor will also ask about the use of over-the-counter and prescription medications (particularly cold or sinus medications), nutritional supplements, and herbal remedies, some of which can either worsen or improve symptoms of BPH.
To detect any urinary irregularities, the physical examination may begin with the doctor observing the patient urinating. The lower abdomen is checked for the presence of a mass, which could indicate an enlarged bladder due to retained urine. A digital rectal exam is performed to assess the size, shape, and consistency of the prostate. This examination, which involves the insertion of a gloved, lubricated finger into the rectum, is mildly uncomfortable. The detection of hard or firm areas in the prostate raises the suspicion of prostate cancer.
If an individual’s medical history suggests neurological disease, the physician may look for abnormalities such as a loss of sensation or weakness in the lower body, which may indicate that the urinary symptoms are due to a neurogenic bladder.
A frequency/volume chart may provide the doctor with important information about your condition, especially if nocturia (frequent nighttime urination) is the main symptom. To use a frequency/volume chart, a man needs to record the time and amount of urine he passes each time he urinates over the course of several days. The doctor will provide instructions regarding how to collect and measure the urine.
Urinalysis—examination of a urine sample under a microscope—is performed in all patients who have lower urinary tract symptoms. Urinalysis is often the only laboratory test needed when symptoms are mild and the medical history and physical examination suggest no other abnormalities.
A urine culture (an attempt to grow and identify bacteria in a laboratory dish) is performed when a urinary tract infection is suspected. In the presence of severe or chronic symptoms of BPH, blood tests to detect abnormalities in creatinine, blood urea nitrogen, and hemoglobin are used to rule out the presence of kidney damage or anemia.
A prostate-specific antigen (PSA) test is generally recommended. PSA values alone are not helpful in determining whether symptoms are due to BPH or prostate cancer because both conditions can cause elevated levels. However, knowing a man’s PSA level may help predict how rapidly his prostate will increase in size over time and whether problems such as urinary retention are likely to occur.