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Home / BPH diagnosis – Information collected to determine suitable treatments

Benign Prostatic Hyperplasia (BPH) diagnosis – Information collected to determine suitable treatments

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Overview by Mr Amr Emara

Consultant Urologist

Hampshire Hospitals NHS Foundation Trust

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Prostate volume ultrasound images
Determining enlarged prostate treatment options
In order to determine which treatment may be suitable for you a number of factors need to be taken into consideration.
The first step is to assess the severity of the symptoms.
This is determined using the International Prostate Symptom Score.
International Prostate Symptom Score (IPSS)
The IPSS is an eight question, (7 symptom and 1 quality of life) questionnaire used to derive a score (0-35) and determine the management of Benign Prostatic Hyperplasia (BPH). You can determine your IPSS online using the link
or download the IPSS questionnaire and determine your score manually.
Typically a score of 0-7 indicates mild symptoms, 8-19 moderate symptoms and 20-35 severe symptoms. Scores less than seven are considered mild and generally do not warrant treatment. Regardless of your score, if your symptoms are bothersome, you should consult with your doctor.

Prostate Volume

The size, measured as volume, of the prostate gland needs to be determined. A good estimate of prostate volume is critical in determining which treatments can be offered.

Multiparametric MRI (see under Prostate Cancer Diagnosis) is the gold standard for accurately determining prostate volume.
Transrectal Ultrasound (TRUS) is the most commonly used method. There are a new generation of scanners which are very easy and quick to use – such as the Clarius.
TRUS involves using ultrasound images to examine and estimate the size of the prostate.
The video shows how the procedure is performed.
Digital (finger) rectal examination (DRE) is sometimes used, though  DRE tends to give a rather poor estimate of volume and should be avoided.

Other factors that need to be taken into consideration in determining enlarged prostate treatments options

Other factors that need to be taken into consideration in determining which treatments are suitable include:
  • Risk of incontinence
  • Preservation of sexual function both in terms of erection and ejaculation
  • Age of the patient and durability of the procedure
  • Patient  health including ischemic heart disease
  • Hospital stay and recovery
  • Other complications such as Diverticulum (small bulges or pockets that can develop in the lining of the intestine as you get older) or bladder stones
IPSS questionairre
More on DRE
MRI for determining volume
The Clarius Scanner
Comparative research on measuring volume
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