Benign Prostatic Hyperplasia Diagnosis: Prostate Pain And Cystoscopy

Posted on March 2, 2009 by mkr in Mens Health

The person having benign prostatic hyperplasia (BPH) should be watched at the time of urination. The loss of projectile stream and dribbling of urine are good findings in favor of this diagnosis.

1. Examination of urine

The urine should be examined for evidence of infection, blood and for presence of sugar (to exclude diabetes). The urine should be cultured and tested for sensitivity to different antibiotics.

2. Examination of blood

Serum urea and creatinine should be performed to assess renal function besides the usual blood count, hemoglobin estimation and ESR.

3. Examination of prostate specific antigen (PSA)

PSA is a glycoprotein, whose function is to facilitate liquefaction of semen.

It is now being used as a marker for prostatic disease. It is measured by immunoassay technique and the normal upper limit is about 4nmol/ml.in benign hyperplasia the level goes up to 4-10nmol/ml.

4. Straight X-ray

It is of not much help.

5. Excretory urography

It is highly important and should be performed in all cases except where there are signs of renal failure and where the blood urea is above 60mg%. This investigation helps to establish whether bladder outflow obstruction is present or not. The intra-vesical pressure, the bladder capacity and recordings of residual urine may be obtained easily.

Voiding pressure and flow rate may be measured. Bladder outlet may be visualized if a video unit is attached to it. Intravesical
encroachment of the prostate may be revealed by a smooth filling defect at the bladder neck.

6. Cystoscopy

This investigation is of great value. With this urethra is inspected and enlargement of the prostatic lobes can be assessed. Residual urine can be measured. Marion’s sign is always positive. In normal individual, the internal urethral meatus and ureteric orifice are not visible in the same cystoscopic field. But in case of prostatic enlargement, this is possible, as the urethral opening is pushed up into the bladder.

7. Ultrasonography (USG)

This can detect the size of prostate most accurately. This can also indicated if there is swelling of kidney due to BPH. Due to progress made in USG need for excretory urography has diminished.

8. Trans-rectal ultrasound scanning

This imaging technique offer accurate estimation of prostatic size. It is probably more effective in detection of associated early prostatic cancer. It is used when PSA levels are high or the surface of the prostate is hard and irregular.

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