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BPH

Presents in 80% of men over aged 80 y/o
Diagnosis based on the following sensation of incomplete voiding, increased urinary frequency, strained to void, intermittent or weak urine stream, nocturia (at least 2-4 times a night)

Palpable prostate size may not correlate with degree of obstruction or symptom severity
Obtain chem 7, PSA, UA

Medical Intervention:


1. Nonselective a-blockers : doxazosin, prazosin, terazosin
    MOA: decrease prostate smooth muscle tone --> immediate improvement in urine flow
    SE: dizziness, postural hypotension, fatigue, asthenia

2. Tamsulosin

3. 5a reductase inhibitors: finasteride, dutasteride
    MOA: slowly reduces dihydrotestosterone levels --> 20% decrease in prostate volume over 3-6 months

Surgical Intervention:


Indication for surgery : failure of medical therapy, refractory urinary retention, inability to express urine without a catheter, recurrent infection, persistent hematuria, bladder stones , or renal insufficiency

1. TURP -- Transurethral resection of the prostate --> symptomatic improvement in 88% of cases

2. Open prostatectomy --> symptomatic improvement in 98% of cases

Remember, men , those of you who are middle aged (45-60), make sure to get prostate exam as well as colon exams to scan for any problems involving the prostate and colon. Prevention is always better than treating !


Best,
Dr. Lorenzo