BPH Urological Assessment

Benign prostatic hyperplasia or hypertrophy is a very common condition in our community.

Approximately 20% of men end up undergoing surgery for this condition in their lifetime¹.

This frequency increases with age².

Patients usually present with either obstructive or irrative symptoms.

The obstructive symptoms are hesitancy, poor flow, straining to void, and the feeling of incomplete empty.

The irrative symptoms are frequency, going very often, urgency or rushing to go and pass urine, and nocturia, getting up at night.

Some patients may also present with recurrent urinary tract infections, recurrent haematuria, blood in the urine, or even urinary retention, the bladder blocking off.

We generally assess the severity of these symptoms by using a symptoms score.

This is an American Urological Symptoms Score³, or International Prostate Symptoms Score⁴.

There are seven questions that we ask patients, and these are scored between zero to five, and they’re really divided into those obstructive and irrative symptoms, and we get a score out of thirty-five that the patient fills out, independently of the doctor, so we get an objective assessment of the severity of these symptoms, and how they’re impacting on this particular patient’s life.

You can divide them between zero and seven, seven to eighteen and eighteen to thirty-five, with 18-35 being severely symptomatic, 7-18 being moderately symptomatic, and 0-7 being mild.

We then investigate patients by doing a number of tests.

We would usually do some blood tests to check for kidney function, we do a PSA to check for prostate cancer, and we do a flow test to assess how fast urine is coming out.

To do a flow test, a patient passes urine into a toilet, and we measure the amount the patient passes and the speed, and then we can compare that to the normal population and see if there’s obstruction or not.

In some patients, we do an urodynamic evaluation⁵, which is a pressure test on the bladder.

That involves putting a catheter in the bladder, filling the bladder with fluid, getting the patient to pass urine, measure the pressure the bladder squeezes out, how fast urine comes out, and from that we can tell if there’s a significant blockage from the prostate.

We also can tell with that test if there’s instability, that is the bladder contracting by itself.

A very important part of the assessment is also the clinical examination, where we feel the prostate, we feel the size, and we most importantly check for any nodules or thickening which may indicate prostate cancer.

Generally, we also do an ultrasound to check what the residual volume is.

This is very important because if there’s a large amount of urine left behind, that can be a sign of the bladder failing.

It can be a sign that we may need to do some treatment to prevent further damage or problems occurring.

One of the other tests that we also do is a urine test to check for any infections.

If the condition is left, patients can develop chronic retention with the bladder⁶, blocking off and not functioning, and occasionally patients can develop renal failure with blockage up to the kidneys.

So once we’ve done all these tests, we get an assessment of the severity of the symptoms, and our management is then based on the severity of the symptoms.