Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Lower Urinary Tract Symptoms-Suspicion of BPH Discussion of Procedures by Variant Variant 1: Lower urinary tract symptoms. Suspicion of benign prostatic hyperplasia. Initial imaging. Radiography Abdomen Radiographs do not directly image the prostate and are of low diagnostic yield in patients with LUTS [8]. A distended bladder may be visible on radiographs as a pelvic mass; however, the timing of last void is usually unavailable, making this appearance a finding of uncertain significance. Bladder stones can be identified on radiographs. Radiography Intravenous Urography Intravenous urography is now rarely performed as it has been replaced by CT urography at most centers [9]. Positive yield of intravenous urography for BOO is <15% [10,11]. In patients with stones, hematuria, or atypical history, CT urography may be considered for further evaluation [12]. Fluoroscopy Retrograde Urethrography Retrograde urethrography does not directly image the prostate or provide adequate evaluation of prostate size. It may be useful if urethral stricture is considered as a cause of urinary obstruction. Fluoroscopy Voiding Cystourethrography Voiding cystourethrography does not directly image the prostate or provide adequate evaluation of prostate size. It may be useful if urethral stricture is considered as a cause of urinary obstruction. TRUS Prostate Grayscale transrectal ultrasound (TRUS) is the most commonly used modality to image the prostate. Although more invasive, TRUS measurement of prostate volume is more accurate than digital rectal examination or pelvic US [13,14], though correlation between TRUS and pelvic US is consistent when bladder volumes are <400 mL [15].
Lower Urinary Tract Symptoms Suspicion of Benign Prostatic Hyperplasia. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Lower Urinary Tract Symptoms-Suspicion of BPH Discussion of Procedures by Variant Variant 1: Lower urinary tract symptoms. Suspicion of benign prostatic hyperplasia. Initial imaging. Radiography Abdomen Radiographs do not directly image the prostate and are of low diagnostic yield in patients with LUTS [8]. A distended bladder may be visible on radiographs as a pelvic mass; however, the timing of last void is usually unavailable, making this appearance a finding of uncertain significance. Bladder stones can be identified on radiographs. Radiography Intravenous Urography Intravenous urography is now rarely performed as it has been replaced by CT urography at most centers [9]. Positive yield of intravenous urography for BOO is <15% [10,11]. In patients with stones, hematuria, or atypical history, CT urography may be considered for further evaluation [12]. Fluoroscopy Retrograde Urethrography Retrograde urethrography does not directly image the prostate or provide adequate evaluation of prostate size. It may be useful if urethral stricture is considered as a cause of urinary obstruction. Fluoroscopy Voiding Cystourethrography Voiding cystourethrography does not directly image the prostate or provide adequate evaluation of prostate size. It may be useful if urethral stricture is considered as a cause of urinary obstruction. TRUS Prostate Grayscale transrectal ultrasound (TRUS) is the most commonly used modality to image the prostate. Although more invasive, TRUS measurement of prostate volume is more accurate than digital rectal examination or pelvic US [13,14], though correlation between TRUS and pelvic US is consistent when bladder volumes are <400 mL [15].