The prostate is palpated with attention to size, consistency, shape, presence of nodularity and tenderness. The size of the prostate in digital examination does not always correlate with the patient's symptoms. Patients with a small prostate and a large median lobe hypertrophy may experience marked obstructive symptoms, whereas, patients with marked prostate enlargement may have minimal or no urinary obstructive symptoms. Evaluation of external sphincter tone during rectal exams can reflect the status of vesicle innervation. Patients with moderate to severe symptom scoring need to have a few laboratory tests such as a urinalysis, urine culture, serum creatinine and prostate specific antigen.
Urine cytology is necessary in the evaluation of patients with hematuria.
Urodynamic studies include uroflowmetry, cystometry and pressure flow studies. These studies may provide information in the evaluation of the severity of bladder outlet obstruction and to rule out a neurological disorder of the bladder muscle. The intravenous urogram is not a necessary part of the evaluation and rarely influences the choice of treatment, but may be useful in assessing the presence or absence of hydronephrosis, renal or bladder calculi, hydro-ureter and genitourinary malignancies. Cysto-urethroscopy helps to determine the size of the prostate, the length of the prostatic urethra and status of vesicle neck and the presence or absence of urethral stricture. It is also use to evaluate the severity of bladder trabeculation and detecting other bladder conditions, including diverticula, stones and cancer.