BPH

Question 1

What are the absolute requirements for BPH workup?

Answer 1

Medical history, physical exam, U/A, and IPSS
For uroflow, we are looking for flow rates below 10cc/s, and must have voice at least 150cc
strongly consider PVR
Optional - uroflow, UDS

Question 2

What are treatment options for BPH?

Answer 2

Behavioral and lifestyle: limit fluid before bedtime or travel, avoid bladder irritants such as coffee and alcohol, times voiding, double voiding, manage constipstion, exercise, PFPT

Medical

Surgical

Question 3

What should re-evaluation contain after initiating a treatment?

Answer 3

IPSS, can consider PVR and uroflow
Must ask about adverse events

Question 4

What are common side effects of alpha blockers?

Answer 4

Anejaculation, orthostatic hypotension, headache, dizziness, dry mouth, fatigue, nasal congestion

Floppy iris sybdrome

Question 5

What are SE of 5ARI?

Answer 5

Sexual dysfunction, low libido, depression, breast changes

Controversial is PFS

Associated with high grade prostate CA

Question 6

What are side effects of PDE5i?

Answer 6

Peripheral vasodilation, facial flushing, headache, nasal congestion, dyspepsia, myalgias

Can have visual side effects - switch to tadalafil

Question 7

Are alpha blockers equal in efficacy?

Answer 7

Yes, only change for side effects

Terazosin and doxazosin most significant for BP hypotension changes (esp if prescribing with PDE5). Tamsulosin low changes. Sildosin lowest.

Question 8

When is 5ARI used?

Answer 8

Prostate > 30g on imaging OR
PSA > 1.5 OR
Palpable enlarged prostate on DRE

Will shrink about 15/25% at six months.

Question 9

When is surgery indicated?

Answer 9

Gross hematuria, recurrent UTI, renal insuffiency, refractory urinary retention, bladder stones, worsening LUTS