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To understand the need to assess for other clinical disorders in patients who present with urinary symptoms similar to BPH.
The lower urinary tract symptoms seen in patients with BPH result from bladder outlet obstruction. Typical symptoms of BPH with bladder outlet obstruction are related to impaired bladder emptying (e.g., straining, hesitancy, intermittency, weak stream, terminal dribbling, and incomplete emptying) and bladder irritation/detrussor instability (e.g., daytime frequency, nocturia, urgency, and urge incontinence). In a middle-aged or elderly man with typical symptoms and a confirmatory examination, a presumptive diagnosis of BPH can be made. However, the physician must always be aware of other causes of lower urinary tract symptoms, and an appropriate workup should be carried out. Such causes include congestive heart failure (especially when urinary changes accompany edema, orthopnea, or paroxysmal nocturnal dyspnea), diabetes mellitus, urinary tract infection, and prostatitis. Although patients with BPH may have some hematuria, other diagnoses (including upper urinary tract disease and bladder cancer) should always be ruled out before gross hematuria is attributed to BPH. In a man with dysuria of sudden onset, urinary tract infection or prostatitis is more likely than BPH.