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Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia. BPH. Benign increase in size of prostate Hyperplasia of stromal and epithelial cells Nodules. Patient W.M. 76 yo Recurrent UTIs Acute pyelonephritis Urinary frequency, urgency, incontinence, and nocturia. Past Medical History. Hypothyroidism COPD Obesity

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Benign Prostatic Hyperplasia

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  1. Benign Prostatic Hyperplasia

  2. BPH • Benign increase in size of prostate • Hyperplasia of stromal and epithelial cells • Nodules

  3. Patient W.M. • 76 yo • Recurrent UTIs • Acute pyelonephritis • Urinary frequency, urgency, incontinence, and nocturia

  4. Past Medical History • Hypothyroidism • COPD • Obesity • 1 ppd smoker • Father – alcoholic • Mother – DM type 2

  5. Review of Symptoms • Strain to initiate urination • Urinary flow stops and then starts • Post-void dribbling

  6. Medications • Ipratropium bromide • Ibuprofen • Levothyroxine • Ferrous sulfate

  7. Case Question 1:For what condition is the patient probably taking ipratroprium bromide?

  8. Ipratropium bromide is used to relieve bronchial spasms • Anticholinergic

  9. Answer:COPD

  10. Case Question 2:For what condition is the patient probably taking levothyroxine?

  11. Synthetic thyroid hormone

  12. Answer:Hypothyroidsim

  13. IPSS • International Prostate Symptom Score • 8 question survey • Standardize patients

  14. Case Question 3:Based on the patient’s IPSS, is his condition of prostatic enlargement considered mild, moderate or severe?

  15. Case Question 4:Based on the patient’s BMI, is the patient technically overweight or obese?

  16. BMI • Measure of body fat • Underweight < 18.5 • Normal weight = 18.5-24.9 • Overweight = 25-29.9 • Obesity > 30

  17. Vital Signs • Patient’s BMI = 33.8%

  18. Physical Exam • All normal • Urinary Function Tests • Uroflowmetry • Transabdominal ultrasound • Pressure flow study

  19. Case Question 5:Which urinary function test(s) is/are consistent with an enlarged prostate?

  20. Uroflowmetry • Normal: 10 – 21 mL/sec • Patient: 7 mL/sec • Residual Urine Volume • > 50 mL significant • Patient: 110 mL • Bladder Voiding Pressure • Weak < 100 cm H2O • Patient: 74 cm H2O

  21. Case Question 6:Identify all abnormal results of this patient’s urinalysis

  22. Blood Test Results *PSA 13 months ago was 5.0 ng/mL

  23. Case Question 7:Is the patient experiencing an electrolyte imbalance?

  24. *PSA 13 months ago was 5.0 ng/mL

  25. 8. Renal Function? *PSA 13 months ago was 5.0 ng/mL

  26. 9. Hepatic Function? *PSA 13 months ago was 5.0 ng/mL

  27. 10. Hb, Hct, MCV, MCH, MCHC? *PSA 13 months ago was 5.0 ng/mL

  28. 11. T4 and TSH? *PSA 13 months ago was 5.0 ng/mL

  29. 12. Single most significant result? *PSA 13 months ago was 5.0 ng/mL

  30. Case Question 13:Provide three strong lines of evidence that this patient does not have prostate cancer

  31. Low PSA • Physical exam findings • Low WBC count

  32. Case Question 14:Pharmacotherapy or surgery?

  33. Case Question 15:When a patient with mild-to-moderate BPH does not respond to pharmacotherapy with 5α-reductase inhibitors or α1-blockers, what can be inferred?

  34. the end

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