What are the benefits of ultrasonography in the workup of benign prostatic hyperplasia (BPH)?

Updated: Feb 19, 2021
  • Author: Levi A Deters, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Ultrasonography (abdominal, renal, transrectal) and intravenous urography are useful for helping determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary retention or signs of renal insufficiency. Generally, they are not indicated for the initial evaluation of uncomplicated LUTS.

A systematic review concluded that patients with suspected large post-void residual volumes should undergo a bladder scan for urine volume to assess for bladder outlet obstruction. Urine volumes measured by bladder scanning correlated highly with urine volumes measured by bladder catheterization.  Symptoms alone proved insufficient for diagnosis, although an International Prostate Symptom Score of 20 or greater increased the likelihood of bladder outlet obstruction. [8]

Transrectal ultrasonography (TRUS) of the prostate is recommended in selected patients, to determine the dimensions and volume of the prostate gland. The success of certain minimally invasive treatments may depend on the anatomical characteristics of the gland. In patients with elevated PSA levels, TRUS-guided biopsy may be indicated to assess for prostate cancer.

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