Diagnosis of Benign Prostatic Hyperplasia (BPH)
by Ricker Polsdorfer, MD
You will be asked about your medical history. A physical exam will be done. The symptoms of BPH are similar to other conditions such as a urinary tract infection, prostate cancer, prostatitis, bladder cancer, or incomplete bladder emptying due to neurogenic bladder. These will be evaluated by your doctor.
A digital rectal exam will be done to assess the size of your prostate and check for any abnormalities, such as inflammation or masses. For this exam, your doctor inserts a gloved finger into the rectum. From here, the surface of the prostate can be felt.
Further testing may include the following:
General tests —These may include renal function tests with measuring of blood creatinine and a urinalysis, which is usually done with a dipstick.
Prostate specific antigen (PSA) —PSA is a protein made by the prostate gland. PSA levels may increase when prostate cancer is present, but other noncancerous conditions like BPH can also cause an increase in PSA. These tests may be used in conjunction with other tests to determine if your symptoms are caused by a cancer or BPH.
Residual urine determination —This is a means of measuring the amount of urine left in your bladder after you have urinated. The amount of urine you cannot pass is important because it can lead to an infection or other kidney problems. For this test, an abdominal ultrasound will determine the volume of remaining urine in your bladder. Alternatively, if a precise determination of the volume is indicated for clinical reasons, a tube called a catheter may need to be inserted into your bladder after you have urinated.
Urine flow study —This involves testing to determine how easily and rapidly your urine flows and how much pressure the bladder generates to empty itself. This will likely be done by a urologist who specializes in diseases of the urinary tract.
Cystoscopic examination —A cystoscope is a long, thin instrument that is inserted through the penis and into the bladder. This test is usually done when the diagnosis of BPH is in doubt. The cystoscope has a lens and light that allow the urologist to see the urethra, prostate, and bladder. Certain procedures can also be performed while under anesthesia using this instrument, such as opening up the passageway through the prostate.
Cystometrogram —This test measures urine flow and bladder pressure. It is usually done in those who fail drug treatment or are being considered for a surgical procedure.
Transrectal ultrasound —An ultrasound is a safe way to visualize internal organs. The closer the probe is to the target organ, the better the pictures. Therefore, the ultrasound probe is inserted into the rectum to take photos of the prostate, which is just millimeters away.
American Urological Association (AUA) Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia. Available at:
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Accessed September 8, 2017.
Benign prostatic hyperplasia (BPH). EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated September 1, 2017. Accessed September 8, 2017.
Pearson R, Williams PM. Common questions about the diagnosis and management of benign prostatic hyperplasia. Am Fam Physician. 2014;90(11):769-774.
Prostate enlargement: benign prostatic hyperplasia. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/health-topics/urologic-disease/benign-prostatic-hyperplasia-bph/Pages/facts.aspx. Updated September 2014. Accessed September 8, 2017.
Last reviewed September 2018 by EBSCO Medical Review Board Adrienne Carmack, MD
Last Updated: 9/8/2017
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