Question

A 70-year-old gentleman comes with lower urinary symptoms. You suspect benign enlarged prostate.
What history and relevant examination will help you in diagnosing BPH?

Hint:

A smooth, enlarged prostate on DRE with lower urinary tract symptoms is highly suggestive of BPH. Further evaluation with PSA can help rule out prostate cancer.

Answer 1

Step 1: History Taking.
- Urinary Symptoms: Ask the patient about symptoms such as:
- Increased Frequency: More frequent urination, especially at night (nocturia).
- Urgency: A sudden, strong urge to urinate.
- Weak Urine Stream: Difficulty starting the flow of urine or a weak, intermittent stream.
- Incomplete Emptying: Sensation of incomplete bladder emptying after urination.
- Straining: Difficulty in initiating urination, or having to strain to pass urine.
- Duration and Severity: Understand the duration of symptoms and their impact on the patient's quality of life.
- Medical History: Inquire about conditions such as diabetes, hypertension, and cardiovascular disease, which may influence the management of BPH.
- Medications: Ask about medications, particularly those affecting the prostate or urinary tract (e.g., alpha-blockers, diuretics).
- Family History: A family history of BPH or prostate cancer can increase the likelihood of the condition.

Step 2: Physical Examination.
- Digital Rectal Examination (DRE): This is crucial for evaluating the size, consistency, and tenderness of the prostate. In BPH, the prostate is typically enlarged, smooth, and non-tender.
- Abdominal Examination: Check for bladder distension or signs of urinary retention.
- Neurological Examination: To assess for any potential neurological causes of lower urinary tract symptoms.

Step 3: Conclusion.
A thorough history and physical examination, including DRE, are essential for diagnosing BPH. Consider further tests, such as PSA levels, for a more definitive diagnosis.