The symptoms of BPH can be classified as obstructive and irritative Table 01. Obstructive symptoms include straining to initiate urination, hesitancy in starting the stream, intermittency of urination, dribbling after urination, a weak urine stream, and a sensation of incomplete bladder emptying. Irritative symptoms include frequent urination during the daytime and nighttime, and a strong sense of urgency to urinate.
Table 1. Symptoms of BPH
Obstructive symptoms Irritative symptoms Hesitancy Frequency of urination during the day Straining to start the stream Frequency of urination at night Weak urine stream Urgency to urinate at all times Terminal dribbling after urinating Intermittency of urination
Some BPH symptoms are also symptoms of bladder or prostate cancer and bladder infection. Patients with symptoms of BPH must have these other possible disorders ruled out by a series of simple diagnostic tests, including a urine test for red cells and white cells, a serum prostate-specific antigen (PSA) test, and, of course, a digital rectal exam. Another disorder the doctor will check for, although it is somewhat less common than the aforementioned disorders, is prostatitis. Prostatitis may raise the serum PSA in the absence of prostate cancer. Therefore, to rule this disorder out, a patient should have a prostatic massage followed by collection of either a seminal fluid specimen to be examined for white blood cells, or a first-voided urine sample to be examined for white blood cells and possibly for organisms.
Your doctor may give you the international prostate symptom scale (ISPS) test Table 02. Your score on the International Prostate Symptom Scale (ISPS) test can be helpful in gauging the severity of the condition. This scale was recently published by the American Urological Association (AUA). Scores of 8 or less indicate mild disease, 9 to 19 indicate moderate disease, and 20 and above indicate severe disease. The symptom score is a good guide for initiation of therapy, since patients with mild disease are usually just monitored carefully and not treated, whereas patients with moderate disease usually begin treatment. Patients with severe disease are almost always treated.
Table 2. International Prostate Symptom Score
? Not at all Less than 1 time in 5 Less than half the time About half the time More than half the time Almost always Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating? 0 1 2 3 4 5 Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating? 0 1 2 3 4 5 Over the past month, how often have you found you stopped and started again several times when you urinated? 0 1 2 3 4 5 Over the past month, how often have you found it difficult to postpone urination? 0 1 2 3 4 5 Over the past month, how often have you had a weak urinary stream? 0 1 2 3 4 5 Over the past month, how often have you had to push or strain to begin urination? 0 1 2 3 4 5 Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning? 0 1 2 3 4 5 Total international prostate symptom score ? ? ? ? ? ? Quality of life resulting from urinary symptoms Delighted Pleased Mostly satisfied Mixed?about equally satisfied and dissatisfied Mostly dissatisfied Unhappy If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? 0 1 2 3 4 5
Adapted from Berry SJ, Coffey DS, Walsh PC: The development of human benign prostatic hyperplasia with age. J Urol 1984, 132: 474-479.
Risk factors for this condition are unclear. BPH is equally prevalent in all races except for Asians, in whom it is less common. Asians, including Indians, Chinese, and Japanese, may be protected from the factors resulting in BPH by their dietary habits, which are largely vegetarian with much lower fat intake. The Asians also consume a large quantity of soy products, which have been thought to have factors such as isoflavones, which may inhibit growth of the prostate. No study has found a clear connection between BPH and smoking, obesity, alcohol consumption, liver dysfunction, or vasectomy. Evidence is beginning to suggest that BPH has a genetic component.
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