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?

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

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

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

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

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

21. 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

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

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

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

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

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

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

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

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

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

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

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

34. Case Question 14:Pharmacotherapy or surgery?

35. 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?

36. the end