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Johns Hopkins Health Alert

Do You Have BPH?

Approximately 50% of all men experience symptoms of enlarged prostate, BPH, by age 75. If you're one of them, you'll want to take this easy, self-scoring questionnaire to calculate the severity of your symptoms.

The International Prostate Symptom Score questionnaire, also called the American Urological Association Symptom Index, was developed by the American Urological Association to help men evaluate the severity of their symptoms from benign prostatic hyperplasia (BPH) -- enlarged prostate. This self-administered BPH test can help determine which type of prostate treatment is needed, if any.

However, the BPH questionnaire alone cannot be used for diagnosis for two main reasons. First, other diseases can cause lower urinary tract symptoms similar to those of BPH. Second, as men age, the bladder naturally becomes less efficient at storing urine, and symptoms of urinary frequency and urgency become more common.

Therefore, a careful medical history, physical examination, and laboratory tests are required to exclude conditions such as urethral stricture (narrowing of the urethra) and bladder disease. In fact, some reports indicate that as many as 30% of men who undergo surgery for BPH are found not to have urethral obstruction (meaning their symptoms were caused by something other than BPH).

Prostate Symptoms Questionnaire:

Use this key to answer each question, then tabulate your score to assess your BPH severity: mild BPH (1 to 7), moderate BPH (8 to 19), or severe BPH (20 to 35).

Generally, no treatment is needed if BPH symptoms are mild; moderate BPH symptoms usually call for some form of BPH treatment; and severe symptoms indicate that surgery for BPH is most likely to be effective.

Not at all = 0
Less than 1 time in 5 = 1
Less than half the time = 2
About half the time = 3
More than half the time = 4
Almost always = 5

1. Over the past month, how often have you had the sensation of not emptying your bladder completely after you finished urinating?

2. Over the past month, how often have you had to urinate again less than two hours after you finished urinating?

3. Over the past month, how often have you found you stopped and started again several times when you urinated?

4. Over the past month, how often have you found it difficult to postpone urination?

5. Over the past month, how often have you had a weak urinary stream?

6. Over the past month, how often have you had to push or strain to begin urination?

7. Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?

Posted in Enlarged Prostate on October 14, 2008
Reviewed March 2010

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Health Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the Johns Hopkins editors cannot be answered in this space.

The views expressed here do not constitute medical advice, and do not represent the position of Johns Hopkins Medicine or MediZine LLC, which has no responsibility for any comments posted on this site.


Subsequent to radiation treatment (IMRT and HDR) for prostate cancer 4 years ago, I developed chronic prostatitis. Initially severe with daily hematuria and dysuria, the symptoms abated slowly over time and were largely refractive to standard medical treatment.

About 4 weeks ago I drank a small container of Red Bull, an "energy drink". I didn't realize it at the time, but this concoction has a level of caffeine several orders of magnitude greater than coffee. About 40 minutes later, I had a severe bout of hematuria which was hemorhagic in nature. Subsequent to that, my prostatis flared to a level I've never experienced. That was followed by all the classic signs of severe BPH. I am now wearing a urinary catheter awaiting cystoscopy and ultrasound studies to determine the next course of treatment. My question is, has this sequence of events ever been seen before? Would such a high dose of caffeine stimulate severe prostatitis and BPH in a compromised gland? There were no warnings on the label indicating the level of caffeine in the drink.

Posted by: AllanK | October 18, 2008

Subsequent to radiation treatment (IMRT and HDR) for prostate cancer 4 years ago, I developed chronic prostatitis. Initially severe with daily hematuria and dysuria, the symptoms abated slowly over time and were largely refractive to standard medical treatment.

About 4 weeks ago I drank a small container of Red Bull, an "energy drink". I didn't realize it at the time, but this concoction has a level of caffeine several orders of magnitude greater than coffee. About 40 minutes later, I had a severe bout of hematuria which was hemorhagic in nature. Subsequent to that, my prostatis flared to a level I've never experienced. That was followed by all the classic signs of severe BPH. I am now wearing a urinary catheter awaiting cystoscopy and ultrasound studies to determine the next course of treatment. My question is, has this sequence of events ever been seen before? Would such a high dose of caffeine stimulate severe prostatitis and BPH in a compromised gland? There were no warnings on the label indicating the level of caffeine in the drink.

Posted by: AllanK | October 18, 2008

In February,'09, I had the TURP(partial) procedure, by laser. Prior to the surgery, I had continuous or at least, very regular, prostate "hot spots", testicle aches, leading to bladder irritation, with aching and stiffness of the pelvis, and general low grade fever symptons, which I thought might be bladder infections. However, urinalysis failed to show any such infection. The pre-surgery treatment was a long string of various antibiotics, which gave relief, but as soon as discontinued, the problems again flared up. Since the procedure, I still have some of the same symptoms, but for the first few months at a significantly lower level, and easily tolerated without treament. However, the last few weeks, things seem to have increased a bit, and I'm worried that I might be returning to the pre-surgery condition. I have a very knowledgeable and skillful urologist, and will soon return to visit with him. Any suggestions?

Posted by: Frenchspanish | July 11, 2009

I was recently diagnosid with chronic prostatitis by my MD who has been treating me for the past ten years for an anxiety disorer. About 4 years ago I came down with a serious case of diverticulitis, which also had some of the very same symptoms of the prostatitis I recently was diagnised with. I hve been experiencing debilitating pain in the left side of my abdomen from the bottom of my rib cage down to my belt line which sometimes occurs on the right side also & a constant pain in my penis & testicles & just below my testicles above my rectum. My pain also is in my back on the left side about 6" or 8" above my belt line. As the pain in my penis & back is very bothersome, it is nothing like the pain on my left side & right side which feels like someone pulling on my intestines or colon. I have been taking about 10 mg of hydrocodone for approx. 6 weeks to relieve this pain but it has not been helping very much the past two week or so. about 5 weeks ago I was prescided Levequin & Flagyl when my MD thought I was having another flare up of Diverticulitis, which I took for 2 weeks without any improvement. He then did another CT scan & that is when he diagnosid the Recuurent Chronic Prostatitis. Does this sound like prostatitis to any of you guys or something else & what has given you the most pain relief. This is drastically changing the quality of my life, as I feel like I have no energy at all & sitting for any period of time at my desk or driving is debilitatingly painful. I called my doctor yesterday to tell him I was in excruciating pain & I needed to come in & see him & his nurse came back to me & told me to give the Levequin he prescibed to me again last Tuesday some more time to try to kill the infection, but it didn't work the 1st time he gave it to me 4 weeks ago & I am not convienced after taking it for 3 more days that it is doing anything this time either. Should I start talking to another MD? Help!!!

Posted by: kevin gill | July 30, 2009

Question seven is an important question but asks for a response that can't be answered. All the others ask, "How often?" Question seven does not and scorinh becomes difficult.

Posted by: nemtom | August 10, 2009

In the 6 years I have been dealing with BPH and prostitius no URO doc has ever suggested taking a simple anti inflammatory such as ibuprofen. By accident I found that by taking 400mg before going to bed reduced my AUA score from 25 to 10. I was considering surgery but my better judgment told me not to. I am glad I made the right decision..

Posted by: Rich55 | September 5, 2009

I had very similar symptoms and took High grade and dose of Cranberry extract and it helped a take care of it!!!!

Posted by: dpv | September 21, 2009

TWO YEARS AGO, I was diagnosed with mildly enlarged prostat, measuring 34x46x34mm, and approximate weight is 29 grams. There was no residual urine seen after voiding. I did not take any treatment. Now if Itake the BPPH TEST, THE SCORE IS LESS THAN 7. WHICH SHOWS THAT IT IS NOT A SERIOUS CONDITION EVEN TODAY BUT I EXPERIENCED A CHANGE ( DECREASE ) IN MY SEXUAL ABILITY AND HAVE SUFFERED FRONM ERECTILE DISFUNCTION WHICH IS VERY DISTURBING.

WHAT SHOULD I DO ?I DO NOT KNOW.CAN ANY ONE HELP PLEASE?

Posted by: malamgir | October 10, 2009

My psa level was at 10 upon my last urology visit two months ago and even thought my PSA level has been from 6 to 10 my test score for the Questionaire is 7. I am very reluctant in having a biospy of which my primary care doctor suggest. Are there any alternative test that can be taken to determine if there is prostate cancer? Please advise.

Posted by: thinton | November 20, 2009



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