Question

A 70-year-old gentleman comes with lower urinary symptoms. You suspect benign enlarged prostate.
How will you manage BPH?

Hint:

Alpha-blockers and 5-alpha reductase inhibitors are the first-line pharmacological treatments for BPH. Surgical options should be considered if symptoms are severe or complications arise.

Answer 1

Step 1: Lifestyle Modifications.
- Fluid Management: Encourage patients to reduce fluid intake before bedtime to decrease nocturia.
- Diet and Exercise: Recommend a healthy diet and regular exercise to maintain healthy prostate function and prevent obesity, which can worsen symptoms.

Step 2: Pharmacological Treatment.
- Alpha-Blockers: Medications like tamsulosin and alfuzosin help relax the smooth muscles in the prostate and bladder neck, improving urinary flow and reducing symptoms.
- 5-Alpha Reductase Inhibitors: Drugs like finasteride or dutasteride reduce prostate size by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), which is responsible for prostate enlargement.
- Combination Therapy: In some cases, a combination of alpha-blockers and 5-alpha reductase inhibitors is used for better symptom control.
- Phosphodiesterase-5 Inhibitors: Medications like tadalafil may be used in patients with concurrent erectile dysfunction.

Step 3: Surgical Treatment.
- Transurethral Resection of the Prostate (TURP): The gold standard surgical treatment for moderate to severe BPH. It involves removing part of the prostate to relieve the obstruction.
- Laser Therapy: Laser procedures can vaporize prostate tissue and relieve obstruction with less bleeding compared to TURP.
- Prostatectomy: In severe cases or when other treatments fail, a prostatectomy may be performed, especially if there is a large prostate.
- Minimally Invasive Procedures: Techniques such as prostatic stenting or balloon dilation may be considered for patients who are not candidates for surgery.

Step 4: Follow-Up.
- Regular follow-up to monitor symptom progression and evaluate for complications such as urinary retention, infection, or kidney dysfunction.

Step 5: Conclusion.
BPH can be managed effectively with medications, lifestyle changes, or surgery, depending on the severity of symptoms and complications.