Diagnostic Work-up of LUTS/BPH: From Standard to New Perspectives

Diagnostic work-up of lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia aims to detect/quantify the three disease components (LUTS, benign prostatic enlargement, and benign prostatic obstruction (BPO)), estimate disease progression, and identify alternative diseases since LUTS is multifactorial. Standard tests include: (1) medical history, (2) symptom questionnaires, e.g., International Prostate Symptom Score, (3) physical examination (including digital-rectal examination), (4) urinalysis, (5) blood analysis with prostate-specific antigen if a diagnosis of prostate cancer will change management or if it assists in the treatment and/or decision making process, (6) post-void residual (PVR) measurement, and (7) uroflowmetry prior to any active treatment. In selected men, the following tests are recommended: voiding diary (for those with nocturia and/or storage symptoms), imaging of the kidneys (in cases with high PVR, hematuria, or urolithiasis history) or prostate (to choose appropriate drugs), urethro-cystoscopy (in men with suspected bladder/urethral pathology and before minimally invasive surgery), and pressure-flow studies. Novel approaches have been developed to quickly, noninvasively, and safely detect BPO; promising tests are ultrasound measurements of intravesical prostatic protrusion or detrusor wall thickness.