Video: How Do You Know If You Have BPH? | Off the Cuff With Mark Moyad, MD, MPH

Off the Cuff With Mark Moyad, MD, MPH | Transcription

Dr. Moyad: Yeah, let's see if you've got BPH. So, you're going to make me fill out a questionnaire, right? 

Dr. Gange: Right. 

Dr. Moyad: Are you going to do that finger test in my rectum? 

Dr. Gange: Virtually always. 

Dr. Moyad: You are a mean, mean man. And then, but okay, so that's important to check for enlargement, right? 

Dr. Gange: Symmetry, nodularity, firmness, you know? We're not just, so when we're exploring the possibility of BPH, we're excluding the possibility of cancer. So we're going to do PSA, we're going to do the DRE, and, you know, then we do a couple of other things. We do a, usually, some urologists are pretty attached to the flow rate—the urinary flow rate—where a man essentially urinates through a calibrated toilet. 

Dr. Moyad: They call that a QMax, right? 

Dr. Gange: Mm-hmm.

Dr. Moyad: So do you do the flow rates? So set this up for me, isn't this a situation where you basically pee-pee in a container and we see how strong your pee-pee is? 

Dr. Gange: Right. 

Dr. Moyad: Do you do that? 

Dr. Gange: So we, in our practice, don't do it. We do it in our research practice because it's important in that arena. The problem with flow rates, to get an accurate flow rate requires a certain volume of urine. To get a guy to have that certain volume of urine you could be waiting out in the lobby all day. So, it's an impractical test in my office. But we do post-void residuals. So there's a non-invasive test, a little ultrasound that we use on the lower abdomen to see what's left after a guy has gone to the bathroom, and that can be useful. 

Dr. Moyad: So post-void residuals is another test they could talk to their doctors about. That's a PVR… 

Dr. Gange: Or a bladder scan.

Dr. Moyad: Or a bladder scan.

And so what are you looking for when you do this scan? You're looking for urine that's leftover in the bladder after you pee? 

Dr. Gange: Right, because really the problem with BPH isn't so much that the prostate is getting big; the problem is that the prostate sits at the base of the bladder. Urine has to travel through the urethra which is essentially encircled by the prostate, and over time, it's not even about the size of the prostate. It's about the squeeze of the prostate which hampers the flow of urine leaving more behind, and really, over time this is a muscle, not like the bicep. This is a smooth muscle like the GI tract, where it has only a certain capacity to expel, you know, to hypotrophy, to grow and become strong, and then the expulsion over time is gonna be diminished because of the strength of those contractions hit a point where there is no ability to get stronger. And so, the point here is simply that the bladder deterioration is the endpoint of untreated BPH. 

Dr. Moyad: Ah. And if you have a lot of urine left in your bladder after you go to the bathroom and you got bad BPH, don't things... As I visualize it... Don't things back up like a toilet?

Dr. Gange: Absolutely. So there is where we find bladder stones, you know little rocks in the bladder which are often much larger than kidney stones that people pass. We see urinary infections, sort of the stasis of the urine is kind of like a stagnant pond that just sort of, you know, grows the green covering. And we see pressure exerted up to the kidneys where the ureters and the kidneys themselves dilate and when there's that intrinsic pressure in the kidneys, then the kidney function begins to deteriorate. And we'll see patients who come into the office with really about 1/10 of the normal amount of kidney function related to a huge amount of leftover urine in the bladder. 

Dr. Moyad: So you've seen guys who have BPH that's bad enough that it starts damaging the kidneys. 

Dr. Gange: Absolutely. And before we had any therapy for BPH, BPH was a lethal disease, and this is why it was lethal. Kidneys would fail. Urinary infections would ensue. And there was no way around it because there weren't any therapies. 

Dr. Moyad: Anything else that, okay, you use the finger, you can use that PVR, you can fill out a form. 

Dr. Gange: We'll check the urine of course. Make sure there's no red blood cells which could indicate a number of things (stones, cancers), no white blood cells indicating infection. We don't typically measure the kidney function, the blood tests that measure the kidney function, but if someone has an enormous amount of leftover urine, I get curious and so we do that test called a creatinine. But in general, with the information that we have gathered in the things that we have discussed we can initiate some therapy.