Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

230 Benign Prostatic Hyperplasia

➣Prior surgery of the lower urinary tract

➣Screen for concomitant medications (see above)

management

What to Do First

■Rule out common indications for surgery

➣Gross hematuria (may be treated first with a trial of a 5-alpha

reductase inhibitor such as finasteride or dutasteride)

➣Bladder stones (may not require treatment of prostate by surgery

after successful removal; often medical therapy is sufficient for

LUTS)

➣Refractory urinary tract infection

➣Refractory retention after one attempt at catheter removal

➣Upper urinary tract compromise (elevated creatinine, hydro by

ultrasound)

General Measures

■Rule out all differential diagnoses, specifically prostate cancer by

serum PSA and DRE.

specific therapy

Indications

■Indications for surgical intervention (see above)

■If no absolute indications exist, decision for or against treatment

depends on the patient’s degree of bother.

Treatment Options

■Watchful Waiting

■Yearly follow-up with standard evaluation

Medical Therapies: Alpha Blocker

■First-line medical therapy: tamsulosin (Flomax); doxazosin (Car-

dura); terazosin (Hytrin), alfuzosin (Uroxatral)

■Improve all symptoms by about 30%, improve flow rate and emptying

■Adverse events: dizziness, asthenia (more common w/ doxazosin

and terazosin), fatigue, ejaculatory abnormalities (particularly tam-

sulosin)

■Medical Therapies: 5-alpha reductase inhibitor

■Finasteride (Proscar), dutasteride (Avodart)

■Reduces prostate volume by 20%, serum PSA by average of 50% by

blocking key enzyme in testosterone metabolism