0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52
Benign Prostatic Hyperplasia 229■Unrelated surgeries or anesthetic interventions worsening symp-
toms
■Prior surgery or other treatment for BPHSigns & Symptoms
■On digital rectal examination (DRE), soft, non-tender, non-nodular
gland; estimate in increments of 10 ml (range 20–>100 ml)
■Check anal sphincter tone during DRE to rule out gross neurologic
deficits.
■Check suprapubic area for distension suggestive of retention.tests
Basic Blood Tests
■Serum prostate specific antigen (PSA): evaluate if elevated. Recent
evidence suggests that any value >2.5 ng/ml should be further
assessed by urologist.
■Serum creatinine to assess baseline kidney function; continue eval-
uation if elevated by imaging (ultrasound), etc.Basic Urine Tests
■Urinalysis to check for infection or hematuria; continue appropriate
evaluation if indicated
■Specific Tests: Urine
■Urinary flow rate recording: maximum flow rate
➣<10 ml/sec: clear indication for obstruction
➣10–15 ml/sec: suspicious for obstruction
➣>15 ml/sec: unlikely to be obstructed
■Residual urine measurement after voiding: prefer to use noninvasive
methods such as ultrasound
■Calculate voiding efficiency: voided volume/(residual+voided vol-
ume)×100.
➣Voiding efficiency <50%: suspect significant obstruction
➣Residual urine >300 ml total: suspect near-complete urinary
retention and consider urgent treatmentdifferential diagnosis
■All causes of LUTS and/or obstructed voiding
➣Other prostate conditions (prostatitis and prostate cancer)
➣Urethral stricture disease
➣Neurogenic bladder (MS, parkinsonism, diabetes, etc)