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).
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!
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
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
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