#148 Benign Prostatic Hyperplasia for the Internist

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.