BPH symptoms and diagnosis

Dr. Kevin Zorn, MD, FRCSC, FACS, Urologist

BPH otherwise called benign prostate hyperplasia is a non cancerous condition that most men at some point will encounter, certainly starting at the age of 50, 50% of men have it and then going up to about 80% By age 70 and 80. At this point the prostate will undergo a natural growth where grows outward as well as inwards and compresses the inner lumen of the channel called the urethra, through which men pass urine. So, ultimately there is a growth, a compression, increased resistance and obstruction of urinary flow due to this benign process of prostate growth.

There are a number of symptoms men may experience. There is a questionnaire called the IPSS, or ‘international prostate symptom score’. It is comprised into two main groups of symptoms. The first one is ‘obstructive’ which is when men notice a slower or weakened urine stream, a sensation that they don't fully empty when they urinate. Some men will do a double void, so they'll pee and then stop, they'll pee and then stop. This sort of intermittency is another symptom.

There is also nocturia where men will wake up more because they're not fully emptying their bladder. And as a compensatory mechanism of the obstruction, kind of like when you go to the gym every day, your muscles get bigger and stronger, so does the bladder. The bladder walls can become thickened, and men will start to experience frequency and sometimes urgency. These are called irritative voiding symptoms. So, a mixture of both the obstructive and the irritative are the most common symptoms and are why patients seek medical attention.

Most men start by seeing their family physician, where some basic assessments may be done such as a urinalysis testing the PSA, possibly an ultrasound to see the details of the bladder, such as the thickness of the bladder walls, or if there are any bladder stones. Other test may include basic bloodwork to screen for kidney function or creatinine, a urine analysis, and a urine culture to exclude any signs of infection or underlying pathologies. Once these tests are complete and BPH is suspected, the patient may be referred to a urologist.

The next steps are done with a urologist. Aside from a well executed history, a physical exam and the IPSS questionnaire, we will do some basic non-invasive tests, for example, the Euro-flow, or Euro Cup. This is a non-invasive urodynamic study, in which a man will come in and urinate in a special tube which measures the flow rate, time it takes to urinate, and the amount of urine voided. It will produce a curve that shows us whether the pattern looks non obstructive or obstructive. We then do an ultrasound to see if the patient has emptied the bladder, which is called a post void residual or bladder scan.

These tests usually tell us whether there is some degree of obstruction. If we're worried that there needs to be something beyond first line medical therapy, we may do what's called cystoscopy to assess the anatomy of the prostate. This gives us a good view of the prostate anatomy and will also give us an idea of what's happening inside the bladder, for example, are there signs of fatigue or exhaustion in the bladder, will you get diverticulum, bladder stones or other sequelae of the prolonged BPH obstruction.

Presenter: Dr. Kevin Zorn, Urologist, Montreal, QC

Local Practitioners: Urologist