Geriatrics and BPH Chapter 28 Paauw
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- What causes benign prostatic hyperplasia?
- BPH is a nonmalignant enlargement of the prostate. It is due to excessive cellular growth of both glandular and stromal elements of the prostate. BPH may be related to dihydrotestosterone (DHT) and aging.
- What are the symptoms of BPH?
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The symptoms reflect bladder irritation:
1. urinary frequency
2. urinary urgency
3. dribbling
4. retention - What are important conditions to rule out when a man has symptoms of BPH?
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1. prostatitis
2. urethral stricture
3. infection
4. prostate cancer
5. bladder cancer - How can I gauge the severity of my patient's BPH?
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1. Use the AUA (American Urologial Association) symptom index.
2. Peak urine flow (normal should be greater than 15 ml/sec) and postvoid residual (normal less than 100mL) are useful to gauge disease severity.
3. Remember, prostate size does not correlate well with symptom severity or degree of obstruction - Besides symptoms, are there any other serious problems associated with BPH?
- Longstanding BPH can lead to urinary retention, renal insufficiency, UTI, gross hematuria and bladder stones. If these occur, surgery is generally indicated.
- How do I decide when to treat BPH?
- The patient's perception of symptom severity (AUA Symptom Score) is a major determinant in making treatment decision.
- How do you treat BPH?
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If the AUA score is mild: watchful waiting.
If the AUA score is moderate to severe, you review the risks/benefits of options and proceed per patient preference.
1. watchful waiting
2. medications (alpha-blocker or finasteride)
3. surgery TURP - What medications are used to manage BPH?
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2 classes of medication and one herbal remedy improves BPH symptoms
- alpha adrenergic blockers (doxazosin, terazosin, tamsulosin)
- finasteride
- saw palmetto - How do alpha-adrenergic blockers work to combat BPH?
- They block alpha1-adrenergic receptors in the bladder neck and prostate that constrict outflow
- What are side effects of alpha-adrenergic blockers?
- 5-10% of patients get orthostatic hypotension and weakness
- How does finateride work to combat BPH?
- It decreases prostatic DHT and shrinks prostate size by about 20%. Over 6-12 months, finasteride reduces urinary retention symptoms and need for surgery.
- What are the side effects of finasteride?
- Decreased libido and impotence in 3-4%, but it has fewer side effects tha alpha blockers
- How well does saw palmetto work?
- It is at least as effective as finasteride in relieving symptoms of prostate obstruction with minimal side effects.
- When should invasive or surgical interventions be considered?
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When medical therapy fails
But risks include impotence, incontinence, blood loss requiring transfusion, and infection. - What does TURP stand for?
- transurethral resection of the prostate