#148 Benign Prostatic Hyperplasia for the Internist
Published April 29, 2019
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62 min
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    This week we narrow in on the enlarging prostate and decipher the common issue of benign prostatic hyperplasia with Adam C. Reese MD, Associate Professor of Urology at the Lewis Katz School of Medicine at Temple University and Chief of Urologic Oncology at Temple University Hospital. Learn how to interpret the symptom profile for patients presenting with common urinary issues, what to feel for in the digital rectal exam, how to treat BPH, and when to refer.

    ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

    See you at SGIM 2019!

    Find us in our red Curbsider’s t-shirts handing out Curbsiders and Kashlak stickers/patches at SGIM 2019 in Washington DC! We’ll be recording full length shows and daily recaps!

    Credits

    Written and produced by: Paul Williams MD

    Hosts: Paul Williams MD, Matthew Watto MD

    Images and infographics: Elena Gibson, Beth Garbitelli

    Show Notes: Elena Gibson, Beth Garbitelli

    Edited by: Matthew Watto MD, Chris Chiu MD

    Guest: Adam Reese MD

    Time Stamps

    00:00 SGIM announcement

    00:30 Disclaimer, intro and guest bio

    03:20 Guest one liner, book recommendation, favorite failure and surgical M&M

    10:56 Case of benign prostatic hyperplasia, defining terms and obstructive/voiding versus storage/irritative symptoms

    16:11 IPSS score and evaluating symptoms

    22:10 Digital rectal exam. Will this give any useful information?

    26:55 Taking a history about BPH and some lifestyle modifications

    29:20 Lab studies for urinary tract symptoms and interpreting PSA and free PSA

    36:20 Initial therapy for BPH and managing patient expectations, alpha blocker side effects

    39:25 Choice of agent and monitoring symptoms on therapy

    42:25 Nonpharmacologic management of bladder complaints

    45:10 Who and when to refer to urology

    47:33 Counseling about use of 5 alpha reductase inhibitors, their side effects and is there a risk for high grade cancer?

    52:35 Phosphodiesterase inhibitors for BPH symptoms

    53:50 Urethral milking. NOT prostate milking

    54:55 Desmopressin for nocturia

    56:20 Take home points

    59:03 Prostate volume and PSA

    61:10 Outro

    Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

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