Diagnosis of Benign Prostate Hyperplasia
Diagnostic Test list for Benign Prostate Hyperplasia:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Benign Prostate Hyperplasia
includes:
Benign Prostate Hyperplasia Diagnosis: Book Excerpts
Tests and diagnosis discussion for Benign Prostate Hyperplasia:
A doctor usually can detect an
enlarged prostate by rectal exam. The doctor also may examine the
urethra, prostate, and bladder using a cytoscope, an instrument that
is inserted through the penis. (Source: excerpt from Prostate Problems - Age Page - Health Information: NIA)
Diagnosis of Benign Prostate Hyperplasia: medical news summaries:
The following medical news items
are relevant to diagnosis and misdiagnosis issues for Benign Prostate Hyperplasia:
Diagnostic Tests for Benign Prostate Hyperplasia: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about diagnostis of Benign Prostate Hyperplasia.
PROSTATIC MASS OR ENLARGEMENT:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The main consideration in diagnosing a prostatic mass is to rule out carcinoma. It is therefore wise to draw blood for PSA before proceeding in anyone that is suspected of prostate cancer. If the mass is located in the posterior lobes, there is further support for the diagnosis. Ultrasonography can be done for further localization before proceeding with a biopsy. Obviously, if the PSA is positive, referral to a urologist is mandatory, although false-positives can occur in this test. A large, boggy prostate suggests a prostatic abscess or prostatitis. If there is no urethral discharge, one can elicit a discharge by prostatic massage. However, this should not be done if the patient has fever and significant tenderness of the prostate. It is better to proceed with antibiotic therapy and reexamine the patient after the fever has subsided. A smear and culture of the discharge is made. If upon examining the discharge under high-power microscopy, four or more WBCs per high-power field are found, the diagnosis of prostatitis can be made. If benign prostatic hypertrophy is suspected, cystoscopy and retrograde pyelography can be done.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Prostatic cancer:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
A digital rectal examination that reveals a small, hard nodule may help diagnose prostatic cancer. The American Cancer Society advises a yearly digital examination for men older than age 40, a yearly blood test to detect prostate-specific antigen (PSA) in men older than age 50, and ultrasound if abnormal results are found.
CONFIRMING DIAGNOSIS A biopsy confirms the diagnosis of prostatic cancer. PSA levels will be elevated in all men with metastatic prostatic cancer. Serum acid phosphatase levels will be elevated in two-thirds of men with metastatic prostatic cancer.
Therapy aims to return the serum acid phosphatase level to normal; a subsequent rise points to recurrence. Magnetic resonance imaging, computed tomography scan, and excretory urography may also aid diagnosis.
Elevated alkaline phosphatase levels and a positive bone scan point to bone metastasis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Prostatitis:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Characteristic rectal examination findings suggest prostatitis. In many cases, a urine culture can identify the causative infectious organism.
CONFIRMING DIAGNOSIS A firm diagnosis depends on a comparison of urine cultures of specimens obtained by the Meares and Stamey technique. This test requires four specimens: one collected when the patient starts voiding (voided bladder one); another midstream; another after the patient stops voiding and the physician massages the prostate to produce secretions (expressed prostate secretions; and a final voided specimen. A significant increase in colony count in the prostatic specimens confirms prostatitis.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Benign prostatic hyperplasia:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Clinical features and a rectal examination are usually sufficient for diagnosis. Other findings help to confirm it:
❑ Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.
❑ Elevated blood urea nitrogen and serum creatinine levels suggest renal dysfunction.
❑ Urinalysis and urine culture show hematuria, pyuria and, when the bacterial count exceeds 100,000/µl, urinary tract infection (UTI).
When symptoms are severe, a cystourethroscopy is definitive, but this test is performed only immediately before surgery to help determine the best procedure. It can show prostate enlargement, bladder wall changes, and a raised bladder.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Prostate Abnormality:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Benign prostatic hypertrophy
❑ Acute bacterial prostatitis
❑ Chronic prostatitis
❑ Adenocarcinoma
❑ Prostatic calculus
❑ Prostatic abscess
Diagnostic Approach
History helps in risk stratification: Men with a first degree relative with prostate cancer have a 2 to 3 fold increased incidence of prostate cancer. With 2 first degree relatives, this increases 5 to 8 fold.
The normal prostate is heart-shaped with a median raphe and a mass of 20 to 25 g. Carefully examine the posterior surfaces of the lateral lobes because this is where most prostate cancer originates. In screening for prostate cancer, digital rectal examination (DRE) looking for nodules, induration, or asymmetry may help to calibrate PSA values in the “gray zone” of 4 to 10. For example, a large gland may offer an explanation for a mildly elevated PSA, but a small gland or one with induration or asymmetry should heighten suspicion of prostate cancer. The positive predictive value for prostate cancer of an abnormal finding on DRE is 15% to 30%, increasing odds 1.5- to 2-fold. Because of low sensitivity, the value of a negative DRE to rule out prostate cancer is low. Men with an abnormality on DRE and a PSA ,4 still have a probability of prostate cancer of 12%, so biopsy is usually recommended. Examination followed by biopsy of any prostate nodule is the appropriate tactic because the clinical examination alone is not accurate enough in distinguishing benign causes from adenocarcinoma.
New suspicious findings on DRE in a patient with an initial negative baseline helps to select for aggressive tumors. Cancer found based on the first DRE has a 5 year prostate cancer mortality of 3% and 10 year mortality of 14%. Cancer found on a subsequent DRE has mortalities of 19% and 43% respectively.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Prostatic cancer:
Diagnosis
(Handbook of Diseases)
A digital rectal examination that reveals a small, hard nodule may help diagnose prostatic cancer. The American Cancer Society advises a yearly digital examination for men older than age 40, a yearly blood test to detect prostate-specific antigen (PSA) in men older than age 50, and ultrasonography if abnormal results are found.
Biopsy confirms the diagnosis. PSA is produced by the normal neoplastic ductal epithelium of the prostate and secreted into the lumen; its concentration in the blood is proportional to the total prostate mass. PSA levels will be elevated in all patients with prostatic cancer, and serum acid phosphatase levels will be elevated in two-thirds of men with metastatic prostatic cancer. Therapy aims to return the serum acid phosphatase level to normal; a subsequent rise points to recurrence. Magnetic resonance imaging, computed tomography scan, and excretory urography may also aid the diagnosis.
CLINICAL TIP: Elevated alkaline phosphatase levels and a positive bone scan point to bone metastasis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Prostatitis:
Diagnosis
(Handbook of Diseases)
Although a urine culture can usually help identify the causative infectious organism and rectal examination findings may suggest prostatitis, firm diagnosis depends on a comparison of urine cultures of specimens obtained by triple-void urine specimens. This test requires three specimens:
❑ one collected when the patient starts voiding (voided bladder one [VB1])
❑ another specimen collected midstream (VB2)
❑ another specimen collected after the patient stops voiding and the physician massages the prostate to express prostate secretions.
A significant increase in colony count in the prostatic specimens confirms prostatitis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Benign prostatic hyperplasia:
Diagnosis
(Handbook of Diseases)
Signs and symptoms and a rectal examination are usually sufficient for a diagnosis. Other test findings help to confirm it.
❑ Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.
❑ Elevated blood urea nitrogen and serum creatinine levels suggest impaired renal function.
❑ Urinalysis and urine culture show hematuria, pyuria and, when the bacterial count exceeds 100,000/µl, urinary tract infection.
With severe symptoms, a cystourethroscopy is definitive, but this test is performed only immediately before surgery to help determine the best procedure. It can show prostate enlargement, bladder wall changes, and a raised bladder.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Scrotal Enlargement:
Clinical Features and Diagnosis
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Painful Scrotal Enlargement
Testicular
Torsion of Testis
Twistingof spermatic cord causes diminished blood flow to testis and acutescrotal pain. Lower abdominal pain and vomiting also may occur.Tender, swollen testis is located higher in scrotum, and cremastericreflex is usually absent.History of intermittent bouts of scrotalpain may indicate previous intermittent torsion.In many cases, diagnosis can be madeclinically and should be confirmed by prompt surgical exploration.If diagnosis is uncertain, procedure of choice to determine testicularperfusion is U/S with color flow Doppler. Orchitis
May existas isolated viral infection (mumps virus is most common) or as extension ofepididymitis.Unusual before puberty.1 or both testes are swollen and painful.With mumps infection, orchitis usuallyoccurs a few days after onset of parotitis. Trauma
Trauma toscrotum may produce a spectrum of disease, including mild swelling,hematoma formation, or rupture of testis with blood in scrotum.U/S is procedure of choiceto assess structural integrity of scrotum. Nontesticular
Torsion of Appendages of Testis and Epididymis
Attachedto the testis and epididymis are vestiges of embryologic remnantsthat can twist around their base, producing infarction. This iscalled torsion of appendix testis or appendix epididymis.Usual age of occurrence is school agebefore adolescence. Pain is usually not as severe as with torsionof testis and develops over a few days. Tender bluish nodule signifyingtorsion of appendix testis is often seen at superior lateral aspectof testis. Torsion of appendix epididymis occurs at head of epididymis.This is often clinical diagnosis; however,scrotal U/S should be performed if diagnosis is uncertain. Epididymitis
Most commonin adolescents who are sexually active, whereas younger boys tendto have associated urinary tract infection.Scrotal pain and swelling as well asepididymal tenderness are usual findings. Early in illness, it maybe possible to distinguish epididymis from testis, but this maybe impossible with progression of inflammation and swelling.If diagnosis is uncertain, scrotalU/S with color flow Doppler can be performed. UA and urineculture also should be performed.After course of appropriate treatmentin older age group, if dysfunctional voiding exists, urinary urodynamictesting should be performed. In younger age group after course ofappropriate treatment, renal U/S and contrast voiding cystourethrographyshould be performed, because urinary tract anomalies (e.g., posteriorurethral valves or ectopic ureter emptying into seminal vesicle)may occur. Incarcerated Inguinal Hernia
Painful,tender mass is palpable in inguinal area with extension at timesinto scrotum.If hernia cannot be reduced, compromiseof bowel may occur, and surgery should be performed immediately.If hernia can be reduced, surgery is usually performed in a fewdays, after swelling has decreased. Nonpainful Scrotal Enlargement
Testicular
In Utero Torsion
Poor fixationof spermatic cord during fetal life predisposes to in utero torsionof testis during testicular descent.Firm testicular mass is discolored,and salvage of infarcted testis is unlikely.Although some controversy exists aboutmanagement, exploration and contralateral orchiopexy are performedelectively in our hospital once infant is stable. Tumor
Testiculartumors are rare in children and usually present as painless, firmto hard, testicular masses. Most common ones include yolk sac tumor,teratoma, and testis infiltration with leukemia or non-Hodgkin lymphoma.Scrotal U/S can confirm presenceof testicular tumor. Histologic diagnosis is definitive. Nontesticular
Inguinal Hernia
May extend into scrotum and produce enlargedscrotum. Increased intraabdominal pressure with crying or strainingmay produce recurrent episodes of painless inguinal and scrotalswelling. Although reduction is usually easy, hernia should be repairedto prevent incarceration. Hydrocele
Fluid withintunica vaginalis surrounding testis is called a hydrocele. Becausepatent processus vaginalis permits communication with abdominalcavity, hydrocele may change in size because of changing amountof fluid in scrotum.Communicating hydrocele tends to persistand may lead to development of inguinal hernia if diameter of processusbecomes larger. Closed processus results in formation of noncommunicatinghydrocele. Its size does not fluctuate, and fluid often disappearsby 1 yr of age.Hydrocele of spermatic cord may presentas fluid-filled inguinal canal mass.Occasionally, hydrocele may occur inolder children secondary to trauma, inflammation, or testiculartumor.U/S is helpful if diagnosisis uncertain. Spermatocele
Is a sperm-containing cyst of rete testes,ductuli efferentes, or epididymis. It is nontender, usually <1cm in diameter, and located posterior and superior to testis inpostpubertal boys. Aspiration yields milky fluid composed of spermcells. Surgery may be required if cyst is painful. Varicocele
Group ofdilated, elongated spermatic cord veins, which may be seen in boys10–15 yrs of age. Most varicoceles occur on left side.Scrotum is enlarged and sometimes painful.Mass is often described as bag of worms. Veins are palpable on standingbut collapse and disappear in supine position. Valsalva maneuveror coughing also may cause varicocele to become more apparent.Presence of testicular atrophy on affectedside is indication for surgery because of possible occurrence ofinfertility. Henoch-Schönlein Purpura
Purpuric rash in this disorder typicallyoccurs on buttocks and lower legs. Occasionally, rash may involvescrotum and cause some swelling. See Chap.28, Hematuria. Kawasaki Disease
Scrotal swelling also may occur with Kawasakidisease, which is discussed in Chap.21, Fever. Meconium Peritonitis
Intestinalperforation is cause of antenatal meconium peritonitis. Meconiumpasses along patent processus vaginalis into scrotum, and bilateralneonatal hydroceles may be palpable as firm nodular masses on 1or both sides of scrotum.Abdominal radiography that includesscrotum demonstrates calcifications in scrotum as well as underdiaphragm. U/S also may confirm diagnosis. Tumors of Epididymis, Spermatic Cord, or Scrotal Wall
Benign tumorsinclude lipoma, fibroma, leiomyoma, and lymphangioma. Paratesticularrhabdomyosarcoma is of most concern.U/S can help locate and defineextent of tumor.Histologic diagnosis is definitive. Generalized Edema
Scrotal edema may occur as part of generalizededema, which is discussed in Chap.17, Edema. Testis and spermatic cord are normal. Diagnostic Approach
Cause ofscrotal enlargement often can be determined clinically based onhistory and physical exam. Age of child, type of presentation (acuteor chronic, unilateral or bilateral), and presence of scrotal ortesticular pain or testicular enlargement are distinguishing featuresuseful in diagnosis.Torsion of testis, torsion of appendixtestis, and epididymitis often can be distinguished clinically earlyin clinical course. With progression of disease process, this maynot be possible. If diagnosis is uncertain, U/S with colorflow Doppler should be performed. Surgical exploration is indicatedwhenever there is high suspicion of torsion of testis.Transillumination can help distinguishsolid or cystic lesions, but incarcerated inguinal hernia also cantransilluminate.U/S can determine whethermass is testicular or nontesticular and can distinguish solid from cysticlesions.Nontesticular cystic lesions are usuallybenign and can be managed according to specific diagnosis. Testicularmass is assumed to be malignant tumor until proven otherwise. >
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
PROSTATIC MASS OR ENLARGEMENT:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The main consideration in diagnosing a prostatic mass is to rule out
carcinoma. It is therefore wise to draw blood for prostate-specific antigen
(PSA) before proceeding in anyone who is suspected of having prostate
cancer. If the mass is located in the posterior lobes, there is further
support for the diagnosis. Ultrasonography can be done for further
localization before proceeding with a biopsy. Obviously, if the PSA test is
positive, referral to a urologist is mandatory, although false-positives can
occur in this test. A large, boggy prostate suggests a prostatic abscess or
prostatitis. If there is no urethral discharge, one can elicit a discharge
by prostatic massage. However, this should not be done if the patient has
fever and significant tenderness of the prostate. It is better to proceed
with antibiotic therapy and reexamine the patient after the fever has
subsided. A smear and culture of the discharge is made. If upon examining
the discharge under high-power microscopy, four or more white blood cells
(WBCs) per high-power field are found, the diagnosis of prostatitis can be
made. If benign prostatic hypertrophy is suspected, cystoscopy and
retrograde pyelography can be done.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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