Diagnosing Male Urinary Dysfunction

At NYU Langone, our urologists can determine whether your urinary symptoms are caused by problems with the bladder muscles, the prostate gland, the urethral sphincter—which are the muscles that control the exit of urine from the bladder—or the nervous system, such as in Parkinson’s disease. 

Lower urinary tract symptoms can range from mild to serious and may include urinating frequently; getting up at night to urinate; having a sudden, unstoppable urge to urinate; straining to urinate; dribbling after urination; pain with urination; and weak urine flow.

After taking a medical history and performing a physical exam, your doctor may order one or more tests. 

Prostate Exam

Your doctor may perform a rectal examination with his or her fingers, which can determine whether your prostate gland is enlarged and whether there are any nodules, or bumps, that may need to be tested for prostate cancer. If so, an MRI scan may be recommended.

Prostate Symptom Scale

Your urologist may ask you to fill out a questionnaire called the American Urological Association symptom index, which gathers information about your urinary health, including the frequency, urgency, and strength of your urination. 

Urodynamic Testing  

If your doctor needs to better understand how your bladder works in order to diagnose your condition, he or she may recommend urodynamic testing. Using a local anesthetic, your doctor inserts a thin device called a catheter into the bladder through the urethra, the tube that carries urine out of the body. Fluid is then slowly infused into the bladder through the catheter. A second thin catheter is then gently placed into the rectum. 

These catheters monitor the pressure in the bladder and the rectum. The doctor asks you to cough in order to check for any involuntary loss of fluid and to urinate to check for blockages and ensure that your bladder muscle works. 

Cystoscopy

Cystoscopy is a test used to diagnose many conditions that affect the lining of the bladder or the prostate. During the procedure, your doctor guides a narrow, flexible scope through the urethra into the bladder. It can help your doctor identify whether an enlarged prostate is blocking urine flow. It enables the urologist to check the urethra for any narrowing, called urethral stricture, or conditions that can irritate the bladder, such as a bladder stone or cancer. It can also help your urologist determine whether the prostate is enlarged and blocking the urethra. 

This procedure is performed in the doctor’s office with a local anesthetic. 

Postvoid Residual Testing

Postvoid residual testing is used to screen men for different types of male urinary dysfunction in which the bladder doesn’t empty completely, such as benign prostatic hyperplasia or neurogenic voiding dysfunction. Prior to a postvoid residual test, you are asked to urinate to empty your bladder. Immediately afterward, an ultrasound, which uses sound waves to create images on a computer monitor, scans the bladder to measure any remaining urine, which can signify a blockage. This may be caused by an enlarged prostate or a problem with the bladder muscle.

PSA Test

Your urologist may order a test to measure the amount of prostate-specific antigen (PSA) in the blood. A high level of this protein, which is produced by the prostate gland, can indicate inflammation of the prostate, benign prostatic hyperplasia, or prostate cancer. American Urological Association guidelines recommend that men ages 55 to 69 talk to their doctors about whether regular PSA screening is right for them.

For men who are at higher risk for prostate cancer—including African American men and men with a family history of prostate cancer—PSA testing may be appropriate earlier. 

An MRI scan may be recommended for men with elevated PSA levels. 

Ultrasound

An ultrasound imaging test may be used to look at the kidneys and bladder to determine whether there are any blockages, bladder stones, or tumors. 

Urinalysis

Your doctor takes a urine sample so that it can be analyzed for signs of a bladder or urinary tract infection, which can lead to increased frequency of urination or urgency incontinence. The urine is also inspected for red blood cells, which can be an early sign of cancer, and glucose, which can signify diabetes.

Uroflow

A uroflow is a funnel-shaped collection device that measures the force of your urine stream. Urinary flow tends to be reduced in men with benign prostatic hyperplasia because of the pressure exerted on the urethra by the enlarged prostate gland. 

Uroflow helps doctors determine whether there is a blockage in the urethra that is limiting the urine flow. Men with neurogenic voiding dysfunction may also have a low urine flow rate, a result of weakened bladder muscles.