Benign Prostate Hyperplasia

Diagnosing benign prostatic hyperplasia (BPH) is complex due to the prostate's interaction with adjacent organs and the nonspecific nature of its symptoms. It is essential to determine the cause of the problems and, above all, rule out bladder cancer. Secondly, it will be necessary to understand the extent of the prostate problems, their severity, and potential complications in order to establish the most accurate diagnosis and address them with the most appropriate treatment.

Generally, we establish three levels of diagnosis:

• Initial diagnosticsThis is the test we perform on all men with symptoms suggestive of prostate problems. It is usually done with a renal and prostate ultrasound and a PSA blood test.
• Diagnosis in case we want to rule out other causes For prostate symptoms that were not clearly explained by previous tests, we can perform a urine cytology or cystoscopy to rule out bladder cancer. For urethral stricture, urethroscopy or voiding cystourethrography (voiding cystourethrography) is very useful. If the ultrasound suggests the presence of bladder stones, we can perform a CT scan and cystoscopy.
• Some patients with urinary symptoms due to benign prostatic hyperplasia need to undergo supplementary testsThese may include: prostate biopsy if prostate cancer needs to be ruled out; cystoscopy if we want to appreciate the anatomy of the prostate internally; transrectal prostate ultrasound to determine the size of the prostate more accurately, usually in preparation for surgery; and, in selected cases, urodynamics to learn more about prostate obstruction and its impact on urination.

Thus, the diagnosis begins with an assessment of your medical history and the performance of a series of questions and tests:

• Measuring symptoms through a questionnaireThe most commonly used is the so-called IPSS (Prostate Symptom Scale).
• Physical examination using rectal examination to assess the size, shape, and consistency of the prostate.
• Urine analysis to rule out an infection or other conditions that can cause similar symptoms.
• Blood Tests To rule out kidney problems and measure the levels of a substance produced in the prostate called prostate-specific antigen (PSA). Levels of this substance increase in cases of prostate enlargement, although elevated levels can also be due to recent procedures, infection, surgery, or prostate cancer.
• Urinary flow test (uroflowmetry): This involves urinating into a container connected to a machine that measures the force and volume of urine flow. The results help monitor the progression of the condition and determine whether it is improving or worsening over time.
• Bladder ultrasound to determine if there is any urine left after emptying the bladder.

To rule out the presence of a bladder tumor, urethral stricture, urinary tract infection, bladder stones, or overactive bladder, tests such as renal, bladder, and prostate ultrasound and urine cytology will be performed. In this regard, urethrocystoscopy may be useful if urethral stricture or the presence of a bladder tumor is suspected—either by ultrasound or following an abnormal cytology result.

Once the above has been ruled out, it will be determined whether benign prostatic hyperplasia (BPH) may be causing complications secondary to obstruction, such as bladder stones, recurrent urinary tract infections, chronic urinary retention, hydronephrosis, or chronic kidney disease. For this purpose, we use ultrasound and perform a blood test to determine kidney function.

Additionally, the risk of prostate disease progression will be calculated using PSA levels and prostate volume (measured by ultrasound). Men with prostates larger than 40 cc and PSA levels >1,5 have a higher risk of symptom progression within five years and will therefore require more intensive treatment. In men with smaller prostates or lower PSA levels, especially those with fewer symptoms, a more conservative approach to treatment is possible.

Finally, tests are performed to help detect bladder obstruction. The simplest is urinary uroflowmetry, which measures the volume of urine passed per unit of time.

In cases where greater diagnostic power is needed, urodynamics can be performed. This is a more invasive test that involves inserting a small bladder and rectal catheter to measure bladder and abdominal pressures.