Benign Prostatic Hyperplasia Symptoms and Assessment

Introduction to BPH Symptoms

• BPH primarily presents with lower urinary tract symptoms (LUTS) that include both storage symptoms (urgency, frequency, nocturia) and voiding symptoms (weak stream, hesitancy, intermittency, straining, and sensation of incomplete emptying) 1, 2

Storage Symptoms

• Urgency: Sudden compelling desire to pass urine which is difficult to defer 1, 3
• Frequency: Need to urinate more often than usual during daytime 1, 2
• Nocturia: Need to wake up at night one or more times to urinate, often the most bothersome symptom 1

Voiding Symptoms

• Weak urinary stream: Reduced force of urination 1, 2
• Intermittency: Urine flow that stops and starts during micturition 1, 2
• Sensation of incomplete emptying: Feeling that the bladder is not completely empty after urination 1, 2

Symptom Assessment

• The American Urological Association recommends using the American Urological Association Symptom Index (AUA-SI) or International Prostate Symptom Score (IPSS) for objective assessment of symptom severity 4, 5
• Mild symptoms: Score 0-7 4
• Moderate symptoms: Score 8-19 4
• Severe symptoms: Score 20-35 4

Complications of Untreated BPH

• Bladder stones: Formation of calculi in the bladder 4
• Renal insufficiency: Rare but serious complication in advanced cases 4

Clinical Pearls

• BPH symptoms typically begin after age 40, with prevalence reaching 60% by age 60 and 80% by age 80 2
• Frequency-volume charts are particularly useful when nocturia is the predominant symptom 6

Common Pitfalls

• Failing to assess post-void residual urine can miss important information about bladder function 6