The patient will be asked to fill out three medical questionnaires beforehand:

1. A questionnaire (such as the IPSS) is used to detect benign prostatic hyperplasia (BPH) and assess the severity of symptoms.
2. A questionnaire on sexual function (the IIEF-5 or PEDQ) is used for diagnosing erectile dysfunction and premature ejaculation.
3. A questionnaire (such as the qADAM) is used for identifying low testosterone.

Low testosterone is a common issue among men 45 and older. This condition can have a significant impact on a man’s sex life and on his physical and mental health. By learning more about testosterone deficiency, men with this condition can better cope with its consequences in their day to day life.

The following tests can also be performed, if necessary during the appointment:

• Urine flowmeter
• Ultrasound scan of the bladder
• Post-void residual urine test
• Various laboratory tests

The IPSS questionnaire determines a patient’s International Prostate Symptom Score. This helps the urologist to assess the severity of BPH symptoms.

The screening test asks patients the following seven questions:

1. Do you have the feeling of not completely emptying your bladder after you’ve finished urinating?
2. Do you frequently have to urinate again less than 2 hours after you finished urinating?
3. Do you ever have to stop and start again several times when urinating?
4. Do you find it hard to hold your urine when you notice the urge to urinate?
5. Has your urine stream become weaker or thinner over time?
6. Do you ever have to push or strain to begin urinating?
7. Over the past month, how many times a night, on average, have you had to get up to urinate?

The IIEF-5 questionnaire is used to screen for and identify symptoms of erectile dysfunction.

The screening test assesses sexual function over the preceding six months and includes the following questions:

1. How confident are you in your ability to get and maintain an erection?
2. When you achieve an erection as a result of sexual stimulation, how often are your erections hard enough to permit penetration?
3. During sexual intercourse, how often are you able to maintain your erection after having penetrated your partner?
4. How difficult is it to maintain an erection from the beginning of sexual intercourse until the end?
5. When you have sexual intercourse, how frequently is it satisfying for you?

The quantitative Androgen Deficiency in Aging Male (qADAM) questionnaire is used to screen for and assess symptoms of low testosterone.

The questionnaire has 10 questions:

1. Has your sex drive decreased?
2. Do you lack energy?
3. Has your strength or endurance decreased?
4. Has your height decreased?
5. Do you enjoy life less than used to?
6. Are you sad or grumpy?
7. Are your erections less firm?
8. Has your athletic performance gotten worse?
9. Do you fall asleep after dinner?
10. Has your job performance gotten worse?

The results can be interpreted as follows:

• A score equal to or greater than 3 suggests a testosterone deficiency.
• A positive answer to questions 1 or 7 suggests a testosterone deficiency.

Also known as a urine flow test, a uroflowmetry is a simple medical test. It allows the urologist to determine the precise pressure of a patient’s urine stream and the quantity of urine discharged during urination.

During the exam, the patient urinates in a funnel-shaped device resembling a toilet that wirelessly connects to a computer. The test takes a few minutes, after which the result appears on a computer. Urine output varies depending on the age and sex of the patient. If the results indicate a problem such as an obstruction, other tests may be needed to clarify the diagnosis.

After the patient has urinated, a nurse will get him to lie down on his back on an exam table. The patient will be asked to lower his pants so that only the lower abdomen area is visible. An ultrasound transducer, lubricated with gel, is placed on the stomach. This allows the medical staff to see the bladder and measure the amount of urine remaining after urination.

The following tests can be done prior to or following the screening appointment:

• Urinalysis
• Prostate specific antigen (PSA) test
• Testosterone levels test

He will interpret and compare the questionnaires. He will ask you additional questions. He will do a physical examination of the genitals, which usually includes a digital rectal examination, to examine the prostate. Dr. Marois will check for volume, texture and abnormal symptoms.

He will discuss with you the possibilities of treatment for benign prostatic hypertrophy treatment of overactive bladder, treatment of testosterone deficiency treatment of erectile dysfunction or possible treatment of prostate cancer.

If the results indicate problems, further tests may be needed to clarify the diagnosis.