Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ BENIGN PROSTATIC HYPERPLASIA (BPH) +++ Management ++ Men Age > 45 +++ Recommendations from ++ ►AUA 2021, EUA 2022 ++ Evaluation ++ –Evaluate patients with bothersome lower urinary tract symptoms (LUTS) with a medical history, physical examination, an International Prostate Symptom Score (IPSS), and urinalysis. (AUA) –Do not routinely measure serum creatinine in men with BPH unless renal impairment is suspected. Assess renal function if hydronephrosis is present or if surgical treatment is being considered for LUTS. –Do not recommend dietary supplements or phytotherapeutic agents for LUTS management. –In patients with LUTS and no signs of bladder outlet obstruction by flow study, treat for detrusor overactivity. Alter fluid intake. Behavioral modification. Anticholinergic medications. ++ Therapies ++ –Treatment options for moderate-to-severe LUTS from BPH (International Prostate Symptom Score ≥ 8): Watchful waiting. Medical therapies: Alpha-blockers.1 5-Alpha-reductase inhibitors.2 Anticholinergic agents. Combination therapy. Transurethral needle ablation. Transurethral microwave thermotherapy. Transurethral laser ablation or enucleation of the prostate. Transurethral incision of the prostate. Transurethral vaporization of the prostate. Transurethral resection of the prostate. Laser resection of the prostate. Photoselective vaporization of the prostate. Prostatectomy. –Reevaluate patients receiving medical therapy for symptoms within 4–12 wk with utilization of the International Prostate Symptom Score. Consider evaluating further symptoms with a post-void residual measurement and uroflowmetry. –Refer for surgery when BPH causes renal insufficiency, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), bladder stones, gross hematuria, refractory LUTS, and/or if unwilling to use other therapies. ++ Practice Pearls Combination therapy with alpha-blockers and 5-alpha-reductase inhibitors is effective for moderate-to-severe LUTS with significant prostate enlargement. Men with planned cataract surgery should be counseled of the associated risks of floppy iris syndrome with alpha-blockers and discuss with their ophthalmologists. 5-Alpha-reductase inhibitors should not be used for men with LUTS from BPH without prostate enlargement. Anticholinergic agents are appropriate for LUTS that are primarily irritative symptoms, and if patient does not have an elevated post-void residual (>250 mL). The choice of surgical method should be based on the patient’s presentation, anatomy, surgeon’s experience, and patient’s preference. +++ Sources ++ –http://www.guidelines.gov/content.aspx?id=25635&search=aua+2010+bph –https://www.auanet.org/guidelines/benign-prostatic-hyperplasia-(bph)-guideline + ++ 1Alpha-blockers: alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin. All have equal clinical effectiveness. ++ 25-Alpha-reductase inhibitors: dutasteride and finasteride. +++ BLADDER CANCER (CA) +++ Screening ++ Adults +++ Recommendations from ++ ►USPSTF 2021 ++ –Current evidence is insufficient to assess the balance of benefits and harms of screening for bladder cancer in asymptomatic adults. ++ Practice Pearls There is inadequate evidence to determine whether screening for bladder CA has an impact on mortality. Based on fair evidence, screening for bladder CA would result in unnecessary diagnostic procedures and overdiagnosis (70% of bladder ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.