Patients with benign prostatic hyperplasia experience symptoms of prostatism which are considered either irritative or obstructive in nature (Table 1). The symptomatology of benign prostatic hyperplasia (BPH) often varies, and significant intra- and interindividual variation in symptoms exists. Nocturia, urinary urgency and frequency and pain or burning on urination are typical irritative symptoms, while obstructive symptoms manifest with urinary hesitancy, straining or dribbling during micturition, and a weak or interrupted stream of urine. Initially, the bladder can expel urine past the prostatic blockage. Eventually the bladder is no longer able to compensate, which results in incomplete emptying and stasis of urine within the bladder. Patients may present with severe symptoms that are hallmarks of advanced disease, such as urinary retention, urinary tract infections, nephrolithiasis, hydronephrosis, gross hematuria and compromised renal function.
| Table 1 Urinary Symptoms of Benign Prostatic Hyperplasia |
| Irritative Symptoms |
Obstructive Symptoms |
| Dysuria |
Hesitancy |
| Nocturia |
Straining |
| Urgency |
Dribbling |
| Frequency |
Weak stream |
| Burning |
Incomplete emptying |
The Multidisciplinary Measurements Committee of the American Urological Association (AUA) published its Urinary Symptom Index for Prostatism (Table 2) which is an accepted and validated patient questionnaire. In order to eliminate any bias from interviewer technique, the patient administers a seven-question test to himself. The AUA symptom score is an indicator of symptom severity from mild to severe prostatism. However, the AUA symptom index may not be BPH-specific, and significant interindividual variation is often seen. A recent study compared the scores obtained from the AUA index in an unselected group of men and a parallel group of women between 55 and 79 years of age. The prevalence and severity of symptoms of prostatism as defined by the AUA symptom index was identical between groups. These findings suggest that the development of urinary symptoms termed “prostatism” is probably a multifactorial process and not exclusively related to benign prostatic hyperplasia (BPH).
| Table 2. |
| International Prostate Symptom Score (I-PSS) |
|
Not at all |
Less than 1 time in 5 |
Less than half the time |
About half the time |
More than half the time |
Almost always |
| 1. Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating? |
0 |
1 |
2 |
3 |
4 |
5 |
| 2. Over the past month, how often have you had to urinate again less than two hours after you finished urinating? |
0 |
1 |
2 |
3 |
4 |
5 |
| 3. Over the past month, how often have you found you stopped and started again several times when you urinated? |
0 |
1 |
2 |
3 |
4 |
5 |
| 4. Over the past month, how often have you found it difficult to postpone urination? |
0 |
1 |
2 |
3 |
4 |
5 |
| 5. Over the past month, how often have you had a weak urinary stream? |
0 |
1 |
2 |
3 |
4 |
5 |
| 6. Over the past month, how often have you had to push or strain to begin urination? |
0 |
1 |
2 |
3 |
4 |
5 |
|
None |
1 time |
2 times |
3 times |
4 times |
5 or more times |
| 7. Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning? |
0 |
1 |
2 |
3 |
4 |
5 |
|
Total I-PSS Score: |
| Quality of Life Due to Urinary Symptoms |
|
Delighted |
Pleased |
Mostly satisfied |
Mixed (about equally satisfied and dissatisfied) |
Mostly dissatisfied |
Unhappy
|
Terrible |
| If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
|
Quality of Life Assessment Index: |
| Courtesy of the American Urological Association |
|
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