From the Guidelines
A comprehensive BPH diagnosis questionnaire should include the International Prostate Symptom Score (IPSS) as its foundation, as recommended by the AUA guideline on management of benign prostatic hyperplasia 1. This questionnaire asks patients to rate symptoms like incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia on a scale from 0 (not at all) to 5 (almost always). The total score categorizes symptoms as mild (0-7), moderate (8-19), or severe (20-35). Additionally, include a quality of life question asking how the patient would feel if their urinary symptoms remained unchanged for the rest of their life, rated from 0 (delighted) to 6 (terrible) 1. Beyond the IPSS, ask about:
- The onset and progression of symptoms
- Previous urinary tract infections
- Hematuria
- Sexual function
- Medication history (particularly those affecting urination like antihistamines, decongestants, and anticholinergics)
- Family history of prostate conditions
- Fluid intake patterns
- Caffeine and alcohol consumption
- Neurological conditions This comprehensive approach helps differentiate BPH from other conditions with similar symptoms such as prostate cancer, urinary tract infections, or neurogenic bladder disorders, allowing for appropriate treatment planning based on symptom severity and impact on quality of life 1. It is also important to consider physical examination, including digital rectal examination (DRE) and focused neurologic examination, as well as urinalysis to screen for hematuria and urinary tract infection (UTI) 1. Measurement of the serum prostate-specific antigen (PSA) should be offered to patients with at least a 10-year life expectancy and for whom knowledge of the presence of prostate cancer would change management 1. Optional diagnostic tests, such as urinary flow-rate recording and measurement of post-void residual urine (PVR), may be appropriate in certain cases, but are not necessary prior to the institution of watchful waiting or medical therapy 1.
From the Research
BPH Diagnosis Questionnaire
The following questionnaire is based on the American Urological Association Symptom Index or International Prostate Symptom Score, which are validated, self-administered symptom questionnaires used to assess BPH severity 2.
- Onset, duration, and severity of lower urinary tract symptoms:
- How long have you been experiencing lower urinary tract symptoms?
- How often do you experience these symptoms?
- How severe are your symptoms?
- Medication use:
- Are you currently taking any medications that may be contributing to your symptoms?
- Have you tried any medications for your symptoms in the past?
- Physical examination findings:
- Have you had a digital rectal examination?
- Have you been assessed for bladder distention or neurologic impairment?
- Laboratory tests:
- Have you had a serum prostate-specific antigen measurement?
- Have you had a urinalysis to check for infection, genitourinary cancer, or calculi?
- Symptom assessment:
- How often do you experience urinary frequency, urgency, or weak stream?
- How often do you experience straining to urinate or incomplete emptying of the bladder?
- How often do you experience nocturia (waking up at night to urinate)?
- Quality of life:
- How do your symptoms affect your daily activities and quality of life?
Assessment of BPH Severity
The severity of BPH can be assessed using the International Prostate Symptom Score (IPSS), which is a validated questionnaire that evaluates the severity of lower urinary tract symptoms 3, 4.
- Mild symptoms:
- IPSS score 0-7
- May not require treatment
- Moderate symptoms:
- IPSS score 8-19
- May require lifestyle modifications, medications, or surgery
- Severe symptoms: