#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! CreditsWritten and produced by: Paul Williams MDHosts: Paul Williams MD, Matthew Watto MDImages and infographics: Elena Gibson, Beth GarbitelliShow Notes: Elena Gibson, Beth GarbitelliEdited by: Matthew Watto MD, Chris Chiu MDGuest: Adam Reese MD Time Stamps00:00 SGIM announcement00:30 Disclaimer, intro and guest bio03:20 Guest one liner, book recommendation, favorite failure and surgical M&M10:56 Case of benign prostatic hyperplasia, defining terms and obstructive/voiding versus storage/irritative symptoms16:11 IPSS score and evaluating symptoms22:10 Digital rectal exam. Will this give any useful information?26:55 Taking a history about BPH and some lifestyle modifications29:20 Lab studies for urinary tract symptoms and interpreting PSA and free PSA36:20 Initial therapy for BPH and managing patient expectations, alpha blocker side effects39:25 Choice of agent and monitoring symptoms on therapy42:25 Nonpharmacologic management of bladder complaints45:10 Who and when to refer to urology47:33 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 symptoms53:50 Urethral milking. NOT prostate milking54:55 Desmopressin for nocturia56:20 Take home points59:03 Prostate volume and PSA61:10 OutroFull show notes available at http://thecurbsiders.com/episode-list.