Fast Five Quiz: Benign Prostatic Hyperplasia Key Aspects

Bradley Schwartz, DO


January 12, 2021

A medical history should be taken to qualify and quantify voiding dysfunction. Identification of other causes of voiding dysfunction and medical comorbidities is essential to properly assess the condition and to determine conditions that may complicate treatment.

According to the American Urological Association (AUA) guidelines, if a patient has predominant significant nocturia and is awakened two or more times per night, a frequency volume chart (also called a voiding diary) covering 2-3 days is recommended. Nocturnal polyuria is diagnosed when more than 33% of the 24-hour urine output occurs at night. Patients with bothersome symptoms should aim for a urine output of 1L per 24 hours.

Ultrasonography (abdominal, renal, transrectal) and intravenous urography are useful for helping determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary retention or signs of renal insufficiency. Generally, they are not indicated for the initial evaluation of uncomplicated LUTS secondary to BPH.

Although PSA testing should be offered to any patient with at least a 10-year life expectancy in whom the diagnosis of prostate cancer would change management, it is not routinely recommended in the investigation of BPH. PSA levels may be raised in various conditions and could cause undue anxiety and/or unnecessary further investigations.

According to AUA guidelines, the routine measurement of serum creatinine levels is not indicated in the initial evaluation of men with LUTS secondary to BPH.

Read more about the workup of BPH.


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