clinical diagnosis

Last edited 12/2018 and last reviewed 07/2021

diagnosis

In men who presents with bothersome lower urinary tract symptoms (LUTS), history, physical examination, and laboratory tests can be used to establish the severity of symptoms, evaluate for causes other than BPH and to guide treatment.

  • 1. History -establish predominant type of lower urinary tract symptoms (LUTS)
    • can establish other causes of LUTS
    • medical conditions - poorly controlled diabetes, neurological disorders, urinary tract infections, chronic abacterial prostatitis, overactive bladder
    • medications - diuretics, anticholinergics, antidepressants
    • lifestyle factors - caffeine, alcohol, excess intake of liquids.

  • 2. Types of LUTS
    • Storage - frequency, urgency, urge incontinence, nocturia. Causes alternative to BPH would include overactive bladder, polyuria (including DM), neurological conditions (post-CVA, MS), medications (diuretics, vasodilators), caffeine and alcohol intake
    • Voiding - hesitancy, poor stream. Causes alternative to BPH would include urethral stricture (especially in younger men or with history of previous surgery), meatal stenosis (history of balanitis)
    • Post-micturition dribble - due to a sump in urethra resulting - if incomplete emptying of the bladder is present, a residue of urine forms in the urethra ('sump')

  • 3. Document severity (symptom score sheets such as the International Prostate Symptom Score (IPSS) may be used

  • 4. Frequency volume chart will demonstrate nocturnal polyuria (output of over 1/3 at night)

  • 5. physical examination
    • abdominal examination
      • assess for a palpable bladder and other abdominal masses
      • examine the external urinary meatus to exclude stenosis o rectal examination
      • DRE should assess perianal sensation, anal tone, prostate size and for any prostatic irregularity - see notes
      • nervous system to exclude a neurological lesion (1,2)

Notes (3):

  • refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their prostate feels malignant on digital rectal examination
  • consider a prostate-specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in men with:
    • any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention
    • or erectile dysfunction
    • or visible haematuria
  • refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their PSA levels are above the age-specific reference range

Reference:

Related pages:

International Prostate Symptom Score (IPSS)

urinary frequency volume chart