If you are having trouble urinating or getting up frequently to pee in the middle of the night, you may have benign prostatic hyperplasia (BPH) or an enlarged prostate. You will need to book an appointment with your doctor to determine whether this is the case.
They will make their diagnosis based on the following:
- Your personal and family medical history
- A physical examination
- Medical tests
Personal and Family History
Taking your personal and family history is the first thing your healthcare provider will do to help diagnose an enlarged prostate. They will ask about symptoms and how theyaffect your quality of life, among other questions, such as:
- Have you had any significant illnesses or surgeries?
- What symptoms do you have, and how often do they occur?
- Do you have a history of urinary tract infections?
- What, if any, prescription and over-the-counter medications do you take?
- How much liquid do you usually drink every day?
- Do you drink caffeine and alcohol?
A Physical Exam
A physical exam can also help diagnose BPH. During this exam, the doctor may check for a swollen or tender scrotum, tap on specific areas of your body and see if there are enlarged lymph nodes in the groin. They may feel your prostate by performing a digital rectal exam. You will probably find this a little uncomfortable, but you won't require an anesthetic. Your doctor might also order a blood test to check that your kidneys are functioning properly.
Your doctor may refer you to a urologist (a doctor specializing in urinary problems and the male reproductive system) to carry out some medical tests. These may include:
Urinalysis - a test of your urine. You will need to provide a urine sample in a special container. The urologist can either test the sample during your visit or send it away to a laboratory for analysis. A urinalysis involves checking the content, concentration and appearance of urine. Once the results come in, you may need to undergo further testing to find the source of the problem.
PSA - your doctor may advise you to have a prostate-specific antigen (PSA) test to rule out cancer. Prostate glands make a protein called PSA to liquefy semen and help sperm swim freely. Men with prostate cancer often have higher PSA levels in their blood. However, a high PSA level doesn’t necessarily mean a man has cancer. There are other causes, such as BPH, aging, inflammation and prostate infections.
The American Urological Association (AUA) BPH Symptom Index - this is a seven-question survey that rates the severity of your symptoms to give you a "BPH Symptom Score Index." The questions include:
- How often have you felt like you weren't able to fully empty your bladder when you finished peeing?
- How often do you have to get up and use the bathroom at night?
- Over the past month, how often have you had to urinate less than every 2 hours?
Each question is assigned points from 0 (none at all) to 5 (almost always).
Urodynamic tests - a group of tests that look at how well the urethra and bladder store and release urine. The tests can be performed in an outpatient setting, and some may require local anesthesia.
Your urodynamic tests may include the following:
- Uroflowmetry: This test measures how quickly the bladder releases urine, known as the flow rate. During the test, you will pee into a special container or toilet. A slow flow may indicate a urinary tract blockage or weak bladder muscles.
- A post-void residual measurement: This evaluates how much urine is left in your bladder after you go to the toilet. After peeing, the doctor will insert a catheter into your urethra to remove any remaining urine, which is then measured.
- Urodynamic pressure: This test measures urine flow rate plus the amount of pressure that needs to be on the bladder for you to pee.
Cystoscopy - the doctor inserts a tubelike instrument (called a cystoscope) through the tip of the penis to examine the inside of the bladder and urethra. Patients are given a local anesthetic, but in some cases, sedation and a general anesthetic may be required.
Transrectal ultrasound - a device called a transducer uses harmless sound waves to make a picture of the bladder. The doctor inserts the transducer into the rectum, which is next to the prostate. As the device is moved around, it shows different sections of the prostate. The images will show if there are any abnormalities, such as tumors. This test can be performed in a doctor's office or a hospital.
Biopsy - this involves taking a small piece of the prostate to examine it closely under a microscope. You may be given a local or a general anesthetic. The doctor will use imaging techniques such as ultrasound to guide the biopsy needle during the test.
Treating An Enlarged Prostate
If you have been diagnosed with an enlarged prostate and it is severely impacting your quality of life, we can help. At the Midwest Institute for Non-surgical Therapy (MINT), we perform prostate artery embolization (PAE), a minimally invasive outpatient procedure that helps improve lower urinary tract symptoms caused by BPH. The treatment safely reduces the amount of blood flowing to the prostate, which consequently shrinks, bringing symptom relief.
For more information and to schedule a consultation, please get in touch with us today. We have recently added a new clinic in Chicago, IL.
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