Benign Prostatic Hyperplasia (BPH)

Diagnosis

Mayo Clinic urologists diagnose benign prostatic hyperplasia (BPH) by first gathering a patient's comprehensive medical history. If a physician suspects BPH, different tests and procedures are performed to analyze the patient's condition. Test results generally are available within 24 hours.

Digital Rectal Exam

Your physician may perform a digital rectal exam (DRE), gently inserting a lubricated gloved finger into the rectum. The physician can detect some prostate abnormalities, such as enlargement, by feeling the prostate gland through the rectal wall. This test is also used for prostate cancer screening.

Urine Analysis

Mayo physicians may rely on urine analysis to detect BPH, as well as infections, prostatitis, cystitis and other conditions that may be aggravated or caused by BPH.

Prostate-Specific Antigen (PSA) Blood Test

Higher than normal levels of prostate-specific antigen in the bloodstream may indicate BPH, prostate cancer or prostatitis.

Urinary Flow Test

Urologists measure the strength and amount of urine flow to track changes over time.

Post-void Residual Volume Test

Physicians use either an ultrasound or a tube inserted into the urethra to check whether the bladder is failing to completely empty itself during urination. An ultrasound is more comfortable for the patient than inserting a tube into the bladder, but may not indicate conclusively if the bladder fully empties.

Ultrasound

Physicians may use ultrasound imaging to estimate prostate gland size. In addition, ultrasound can help detect problems such as a kidney obstruction, stones in the kidneys or prostate, or, when coupled with a biopsy, a tumor in the prostate. An ultrasound is especially useful when a patient has experienced allergic reactions to other imaging procedures that require contrast dyes injected into the veins. Physicians typically use noninvasive abdominal ultrasound and transrectal ultrasound (an ultrasound probe inserted in the rectum) in BPH diagnosis.

Urodynamic Studies

If your urologist thinks your symptoms may be related to bladder problems other than BPH, urodynamic studies may be performed. In urodynamic studies, a catheter is threaded through the urethra and into the bladder. Water is then injected through the catheter to measure the bladder's internal pressure and contractions, which can help physicians determine how well bladder and sphincter muscles are functioning and better diagnose possible conditions.

Cystoscopy

During a cystoscopy, a urologist inserts a thin telescopic instrument containing a lens with a light system (cystoscope) into the urethra, providing a view inside the urethra and bladder. Cystoscopy, performed under local anesthesia in a doctor's office, can detect various problems and abnormalities, including BPH.

Intravenous Pyelogram or CT Urogram

In this procedure, dye is injected into a vein, and an X-ray is taken of the kidneys, bladder and ureters. The image helps detect urinary tract stones, tumors or blockages above the bladder.

Retrograde Pyelography

In retrograde pyelography, physicians order X-rays of the urinary tract after contrast dyes are injected into the ureters via a catheter. The X-rays can reveal areas within the urinary tract where urine flow appears constricted.