Enlarged Prostate

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Evaluation and staging

A thorough history and physical examination are the most important aspects of a man's prostate evaluation. The International Prostate Symptom Score (IPSS), comprised of the questionnaire seen below, can be very helpful in this assessment. This score helps assess the severity of symptoms.

  Never Less than 1 time in 5 Less than half the time About half the time More than half the time Almost always
1. Over the past month or so, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
2. Over the past month or so, how often have you had to urinate again less than two hours after you finished urinating?
3. Over the past month or so, how often have you found you stopped and started again several times when you urinated?
4. Over the past month or so, how often have you found it difficult to postpone urination?
5. Over the past month or so, how often have you had a weak urinary stream?
6. Over the past month or so, how often have you had to push or strain to begin urination?
7. Over the last month, how many times did you usually get up to urinate from the time you went to bed at night until the time you got up in the morning?

TOTAL:



An IPSS score of 0-7 is considered mild, 8-19 moderate, and 20-35 severe.

Urologist sometimes perform urodynamics to help assess the severity of BPH. This safe outpatient test evaluates the bladder's response to the obstructing prostate. It helps to ensure that a man's urinary symptoms are in fact due to prostatic obstruction (as opposed to other causes), and helps to guide therapy. It also helps to predict the likelihood that a man will resume his pre-BPH urinary habits after treatment. Urodynamics is performed by placing a catheter in the penis and filling the bladder with water. The catheter is connected to a machine that measures the bladder's response to being filled with fluid. Also the rate of urine flowing out of the bladder (flow rate) is measured.

Depending upon the specific clinical situation, a urologist may also order other imaging tests, including trans-rectal, renal or bladder ultrasound, as well as a CT scan.

Labarotory tests such as urinalysis and culture, serum (blood) electrolytes to test renal function, and serum prostate specific antigen (PSA) may also be ordered.