Benign Prostatic Hyperplasia Initial Assessment

Last updated: 14 January 2026
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Clinical Presentation

The symptoms of benign prostatic hyperplasia include:

  • Dribbling at the end of urination
  • Nocturia
  • Pain after ejaculation or urination
  • Weak or interrupted urine stream
  • Straining or trouble starting a urine stream
  • Urinary frequency
  • Urinary urgency
  • Urinary retention
  • Urinary incontinence
  • Urine with unusual smell or color

History

History taking in benign prostatic hyperplasia should include the beginning and frequency of symptoms, history of recurrent urinary tract infections (UTI), hematuria, erectile dysfunction, hypotension, and fainting. Also important is how much liquid the patient typically drinks each day, frequency of caffeine and alcohol use, and general medical history, which includes past illnesses or surgeries and intake of medications such as decongestants, antihistamines, antidepressants and diuretics.



Benign Prostatic Hyperplasia_Intial AssesmentBenign Prostatic Hyperplasia_Intial Assesment

Physical Examination

In the physical examination, one should check for:

  • Any signs of distended bladder when examining the abdomen
  • Back and flank pain from urinary retention
  • Discharges from the urethra
  • Swelling or tenderness of the scrotum

A digital rectal exam (DRE) is performed for the examination of the prostate. It is the simplest method to assess the volume of the prostate but there is poor correlation to actual prostate volume. Through DRE, any palpable enlargement of the prostate is identified. Additionally, the detection of hard, firm or nodular areas in the prostate raises the suspicion of prostate cancer. A focused neurological examination is done to evaluate for neurologic diseases that might produce LUTS.

Diagnosis or Diagnostic Criteria

International Prostate Symptom Score (IPSS)  

IPSS is a scoring system used to screen and diagnose benign prostatic hyperplasia as well as to monitor and guide decisions in managing the disease. It contains 8 questions (7 regarding symptoms and 1 for the patient’s quality of life [QoL]).  

According to the scoring system, the scores are categorized as follows: 

  • Mild if the score is ≤7
  • Moderate if the score is 8 to 19
  • Severe if the score is 20 to 35

For questions on the QoL, a score of six means that the patient perceives a “terrible” QoL while a score of zero indicates that the patient is “delighted” with his QoL.