Benign Prostatic Hyperplasia (BPH) Diagnosis

December 7, 2022

Benign prostatic hyperplasia, or BPH, is the medical term used to describe the non-cancerous or benign enlargement of the prostate as a man ages. It is suspected that hormonal changes are to blame as a man gets older. BPH is marked by symptoms such as frequent urination, incomplete emptying, urinary hesitancy or urgency, decreased flow, blood in the urine, and other lower urinary tract symptoms. However, these same symptoms can be indicative of several urinary tract issues, including urinary tract infections (UTIs), and prostatitis (inflammation of the prostate). Determining which affliction is causing issues can be challenging if there are no tell-tale signs such as a burning sensation during urination which can indicate an infection is present. Confirming a benign prostatic hyperplasia BPH diagnosis is a job for a urologist or primary care physician (PCP) who has access to specially designed exams and tests used to diagnose and evaluate if BPH is present. Prostatic hyperplasia is a condition that affects most men if they live long enough, but luckily an enlarged prostate doesn’t impact all men the same. Some men may develop an enlarged prostate, but not have any BPH symptoms, whereas other men will have every symptom possible. When prostate tissue grows enough due to benign prostatic hyperplasia, BPH symptoms become bothersome. This is when most men begin noticing enough lower urinary tract symptom issues that urine flow begins being affected.

The methods by which benign prostatic hyperplasia is diagnosed are many. There are symptom questionnaires, tests, exams, and doctor-initiated questions used to evaluate if BPH could be present and to determine if a benign prostatic hyperplasia (BPH) diagnosis is warranted. A general practitioner (GP), internist, or urologist will first review the symptoms being experienced, then ask about their frequency, severity, and how much they impact the quality of life. Then the doctor will perform an examination of the prostate via a digital rectal exam (DRE) to check for an enlarged prostate, determine the approximate size, and feel for any lumps or growths on the surface of the prostate, which could signify cancer is present. Since the prostate is situated just in front of the rectum, it is easily accessible via a DRE to be analyzed for any abnormalities, including benign prostatic hyperplasia.

Tests to Determine BPH Diagnosis

Men who are at greater risk of developing benign prostatic hyperplasia will typically have a family history of BPH, be diabetic, exercise infrequently, be overweight or have erectile dysfunction issues. To try and prevent prostatic hyperplasia from the start, or to hold off BPH as long as possible, it’s advantageous to exercise frequently, maintain a normal weight and eat a balanced diet. These behaviors won’t guarantee that a man won’t get an enlarged prostate due to BPH, but they can help and the extra effort promotes an overall healthier lifestyle.

In the U.S., after a DRE is performed, and a review of symptoms is discussed, a doctor may want to perform, or order, one or more of the following tests to determine if BPH is present or if another condition is causing issues. These tests can more definitively determine whether benign prostatic hyperplasia is the cause of the lower urinary tract symptoms being experienced or whether something else is causing a problem. These BPH tests are typically quick but can take more time if a 24-hour voiding diary is ordered.

Urine test

By providing a urine sample, a lab can determine if there is a kidney, bladder, prostate, or urinary tract infection that could be causing urine flow issues.

Blood test 

Creatinine and blood urea nitrogen are waste products that, in high enough concentrations, could signal that the kidneys aren’t functioning as well as they should be.

  • PSA test

    Prostate-specific antigen (PSA) is a protein that the prostate manufactures and circulates throughout the body via the bloodstream. The PSA test measures levels of the prostate-specific antigen in multiple ways, but the total PSA and the free PSA (fPSA) tests are the two most ordered. Higher levels of PSA are typically found in men with an enlarged prostate, but higher PSA levels can also be caused by a prostate infection, recent ejaculation, prostate procedures, or prostate cancer. A PSA test alone can’t determine if BPH or cancer is present, but it is one tool that can be helpful. It’s important to note that high PSA levels are a marker for cancer but not a definitive diagnosis. When PSA numbers start to climb, it is a good idea to consult with a doctor.

Urodynamic tests

 A doctor may order a series of tests that will measure how efficiently urine is held and released in both the bladder and urethra. These tests can more definitively determine if benign prostatic hyperplasia is present

  • Uroflowmetry

     A urinary flow test that measures how quickly urine is released from the bladder through the urethra. This is known as the urine flow rate. During the uroflowmetry test, a patient urinates into a specialized container or toilet that measures the velocity of urine exiting the body. A slow flow rate can indicate a weakened bladder, a partially restricted bladder, an enlarged prostate, or urinary tract blockage.
  • Post-void residual volume test

    This test measures the amount of urine that remains in the bladder after urination. It determines whether the bladder can be fully emptied on its own or not. Ultrasound or a catheter inserted into the bladder measures the volume of urine remaining in the bladder.
  • Urodynamic Pressure

    This is a test that employs a meter that measures how much pressure needs to be exerted on the bladder to urinate. It can also determine the urine flow rate. The urodynamic pressure test will determine if an enlarged prostate is inhibiting flow out of the bladder.
  • 24-hour voiding diary

    The measuring and recording of the intake of liquids and urine output over 24 hours. This test can help determine fluid balance, bladder capacity, bathroom trip frequency, and other ways of telling how well the bladder is performing.

Urologic Procedures for BPH Diagnosis


A urologist can employ this instrument to determine if an enlarged prostate is presenting problems or if there are any other issues with the prostate, bladder, or urethra. Local anesthesia is given before a cystoscope (tube-like instrument) is inserted into the urethra and then into the bladder. The cystoscope has a lens or camera at the end so the doctor can view the bladder, urethra, and prostate to see where urine flow is being affected.

Transrectal ultrasound (TRUS)

Using sound waves, a transrectal ultrasound, also called a prostate sonogram, produces echoes or wave patterns that bounce off of the prostate and surrounding tissue and a computer reads them and provides a video image of the prostate to the doctor. This can also be done via pelvic ultrasound.


If PSA numbers are going up or there are additional concerns, a doctor may order a prostate biopsy to rule out cancer so a BPH diagnosis can be definitively confirmed. After receiving pain medicine, an ultrasound, MRI, or CT scan will be utilized to get a live image of the prostate. A thin needle will then be inserted into the prostate to remove small samples from around the region(s) of possible concern. The samples will then be shipped to a lab for analysis to confirm whether the issue is an enlarged prostate due to BPH, cancer, or both.

Diagnosis of benign prostatic hyperplasia, or BPH, in its early stages helps decrease the risk and frequency of other problematic issues such as urinary tract infections (UTIs), prostatitis, bladder and kidney problems, and incontinence. Lower urinary tract symptoms that involve prostate tissue can be quite bothersome and even life-altering if urine flow is completely shut off. Fortunately, there are numerous tests and urologic procedures for diagnosing an enlarged prostate caused by BPH, so the best combination can be utilized to determine whether BPH is the issue or another condition is causing lower BPH symptoms.

All surgical treatments have inherent and associated side effects. Individual’s outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. Further, there may be other risks as in other urological surgery, such as anesthesia risk or the risk of infection, including the potential transmission of blood borne pathogens. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. Prior to using our products, please review the Instructions for Use, Operator’s Manual or User Manual, as applicable, and any accompanying documentation for a complete listing of indications, contraindications, warnings, precautions and potential adverse events. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.

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