BPH

Nota:

• Proliferation of fibrostromal tissue Obstruction of urinary outlet

1. Dx
   1. PE - DRE

      Nota:

      • enlarged prostate - anteriorly
      1. enlarged prostate
   2. Labs: PSA may be slightly elevated
2. RF

   Nota:

   • 60-65 yo men; sx may start at 45
   1. 60-65 yo men; sx may start at 45
3. Sx

   Nota:

   • Obstruction - decreased force of urinary stream, hesitancy, straining, postvoid dribbling, sensation of incomplete emptying.  Irritation - frequency, nocturia, urgency
   1. Assoc Sx

      Nota:

      • Recurrent UTI and urinary retention
      1. Recurrent UTI and urinary retention
   2. Obstruction - decreased force of urinary stream, hesitancy, straining, postvoid dribbling, sensation of incomplete emptying. Irritation - frequency, nocturia, urgency
4. Tx

   Nota:

   • 1. Mild-mod: watchful waiting. 2. Alpha-adrenergic agonists (prazosin, etc.), 5-reductase inhibitors (finasteride, dutasteride), and phosphodiesterase-5 inhibitors (tadalafil, vardenafil) may improve prostate symptom scores for LUTS due to BPH. Anticholinergic agents may be appropriate and effective treatment alternatives for management of LUTS secondary to BPH in men without an elevated postvoid residual and when LUTS are predominantly irritative. Tamsulosin plus tolterodine extended release reduces symptoms in men with LUTS and overactive bladder. Intramuscular cetrorelix (60 mg, then 30 mg at 2 weeks) improves International Prostate Symptom Score in men with symptomatic BPH.  3. Behavioral strategies include the limiting of fluids prior to bedtime. 4. Procedures that may be used to relieve obstruction include use of balloon dilation, microwave irradiation, and stent placements. 5. Surgical treatment is transurethral resection of prostate or transurethral incision of prostate.  
   1. mild-mod: watchful waiting
   2. Rx: Alpha-adrenergic agonists (prazosin, tamsulosin, etc.), 5-reductase inhibitors (finasteride, dutasteride), and phosphodiesterase-5 inhibitors (tadalafil, vardenafil)
   3. Limit fluids prior to bedtime, decrease diuretics
   4. balloon dilation, stent placement, microwave irradiation
   5. transurethral resection or incision