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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the symptoms and signs of benign prostatic hyperplasia (BPH) in individual patients

  • List the desired treatment outcomes for a patient with BPH

  • Identify the factors that guide selection of a particular α-adrenergic antagonist for an individual patient

  • Compare and contrast the α-adrenergic antagonists versus 5-α-reductase inhibitors in terms of mechanism of action, treatment outcomes, adverse effects, and interactions when used for management of BPH

  • Describe the indications, advantages and disadvantages of single versus combination drug treatment of BPH

  • Describe the indications for surgical treatment of BPH

  • Formulate a monitoring plan for a patient on a given drug treatment regimen based on patient-specific information and formulate appropriate counseling information for patients receiving drug treatment for BPH

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PATIENT PRESENTATION

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Chief Complaint

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"I'm taking 2 drugs for my big prostate, but my urine flow is still too slow. I have urinary frequency day and night. I feel like I can't empty my bladder. Sometimes I can't get to the bathroom on time and I leak on myself."

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History of Present Illness

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George Gold is a 73-year-old male with long-standing lower urinary tract symptoms (LUTS) who is referred to the urology service after failing maximal medication therapy for BPH. He has been taking terazosin 20 mg orally daily and finasteride 5 mg orally daily for 9 months. His current complaints include urgency with urge incontinence, nocturia 2–3 times a night, a weak urinary stream, and small-volume voids. He denies hematuria, dysuria, suprapubic or flank pain. He has no fever, chills, nausea, or vomiting. His American Urological Association (AUA) symptom score is 30.

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Past Medical History

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Essential HTN × 10 years

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Hyperlipidemia × 10 years

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Obesity, BMI 35 kg/m2

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OA with chronic lower back pain × 5 years

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History of a bleeding ulcer secondary to aspirin overuse

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S/p transurethral incision of the prostate (TUIP) in 2005

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Family History

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Father died of a stroke. Mother died of breast cancer. Sister, alive, has breast cancer.

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Social History

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Married for 45 years; has 2 children: a son and a daughter, both alive and healthy.

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Tobacco/Alcohol/Substance Use

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Negative for all

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Allergies/Intolerances/Adverse Drug Events

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Sulfonamides; develops hives and shortness of breath when exposed. Cannot use Bactrim or Septra (trimethoprim/sulfamethoxazole)

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Medications (Current)

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Docusate 100 mg PO daily

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Finasteride 5 mg PO daily

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Furosemide 40 mg PO daily

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Lisinopril 40 mg PO daily

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Metoprolol 50 mg PO twice a day

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Nifedipine 60 mg extended release 2 tablets PO daily

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