BPH

Question 1

How common is the problem

Answer 1

80% of men > 70 yo showing histological evidence of hyperplasia

Question 2

LUTS - lower urinary tract symptoms, common ones?

Answer 2

• Increased frequency
• Nocturia
• Hesitancy
• Urgency
• Weak urine stream

Question 3

T of F: LUTS progress over years to develop

Answer 3

T

Question 4

How to decide treating or not?

Answer 4

• Severity of symptoms + risk of upper tract injuryversus potential side effects of therapy

Question 5

What are the risk of upper tract injury with BPH?

Answer 5

• hydronephrosis or renal insufficiency
• urinary retention (post-void residual > 25%)
• recurrent infection
• bladder decompensation (lower pressure detrusor contraction)
• International Prostate Symptom Score (IPSS)

Question 6

Treatment options for BPH?

Answer 6

• Rx

- surgical

Question 7

How does Tamsulosin/Flomax work?

Answer 7

• Alpha-1 antagonist
• relax smooth muscle in the bladder neck, prostate capsule and prostatic urethra
• usually started qhs to avoid hypotension side effect
• common se: hoTN, weakness

Question 8

How does Finasteride work?

Answer 8

• 5-alpha reductase inhibitor
• Reducing the size of the prostate gland
• 6- 12 month course
• SE: decreased libido and ejaculatory/erectile dysfunction
• PSA value decreases by the drug

Question 9

Saw Palmetto

Answer 9

Prostate supplement

Question 10

What are the surgical option?

Answer 10

• Transurethral resection TURP with cautery

- Laser

Question 11

Dx of BPH

Answer 11

Clinical:

• Hx of LUTS
• digital rectal exam (DRE) may or may not show an enlarged prostate