Benign Prostate Hyperplasia (BPH)

BPH is diagnosed by establishing the presence of storage voiding, and irritative symptoms in the absence of findings suggesting non-BPH LUTS causes. The diagnosis involves a thorough history, physical examination, and imaging to rule out other possible causes. The history evaluates both storage (frequency, urgency, nocturia) and voiding symptoms (weak urinary stream, hesitancy, intermittency, post-void dribbling). Presence of hematuria, incontinence, or urinary retention should prompt further urology work up. It is also important to elicit any history of neurological disease, cigarette smoking, urethral trauma, or certain medications. A digital rectal exam (DRE) should be performed as a part of the physical examination. A urinalysis should be ordered to identify pyuria, glucosuria, proteinuria, ketonuria, or bacteriuria, which may suggest alternative diagnoses. A PSA is also useful to evaluate prostate volume when considering certain treatments. A cystoscopy is not needed, unless planning surgical treatment or evaluating urethral strictures.

Differential Diagnosis: Urethral strictures, bladder neck contracture, bladder cancer, cardiovascular disease, neurologic disease, endocrine disease, polydipsia.