Symptoms related to bladder emptying include:
- Urinary hesitancy or straining, i.e. difficulty starting a urine stream
- Weak flow
- Dribbling after urination
- A sensation that the bladder is not completely empty
- Frequency, or a sensation of needing to urinate again soon after urination
- Dysuria, i.e. pain during urination
Symptoms related to bladder storage include:
- Nocturia, or waking up at night
- Frequent urination
- A sudden, uncontrolled urge to urinate
The degree of enlargement of the prostate may not always be correlated with the severity of urinary symptoms. In addition, other conditions such as overactive bladder, diabetes, urinary tract infections, neurologic disease, and heart disease may cause similar symptoms.
When the bladder does not empty completely, the risk of developing a urinary tract infection increases. Other serious problems can occur, including the development of bladder stones, blood in the urine, and overactive bladder. In rare cases, urinary retention, i.e. the inability to urinate, or kidney damage can occur.
Evaluation of an enlarged prostate can take several forms. First, a medical history and physical exam that focuses on the urinary tract are important. A neurological exam should be performed to determine whether your symptoms are related to a problem with the nerves controlling the bladder. A urinalysis should be performed. Often, other tests are performed, including a digital rectal exam to check the size and firmness of the prostate, a urine culture to evaluate for the presence of infection, and a PSA to check for prostate cancer. If your symptoms are more severe, a postvoid residual test may be performed to evaluate the amount of urine left in the bladder after urination. A blood creatinine test assesses how well your kidneys are working. Urodynamics, or pressure-flow studies, may be used to distinguish whether your urinary symptoms are due to blockage from an enlarged prostate or to a problem with the bladder or its nerves. A transrectal ultrasound can measure the size of the prostate. Cystoscopy may also allow one to find out how much an enlarged prostate is blocking the urethra.
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