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  #1  
Old 02-18-2012
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Question Treatment of BPH?

A 60-year-old man presents to the urologist complaining of difficulty urinating. He states he frequently gets out of bed in the middle of the night to go to the bathroom. Once he gets to the bathroom he can’t urinate easily and must “bear down” to do so. He denies any history of sexually transmitted disease, trauma to the genitourinary tract, or prior genitourinary instrumentation. On rectal examination the patient has an enlarged prostate and one 1-cm area of induration located on the middle poste-rior aspect of the prostate. He has a prostate specific antigen level of 6 ng/mL (normal: 0–4 ng/mL), BUN of 20 mg/L, and creatinine of 1.6 mg/L. The patient undergoes a transrectal prostate biopsy, and no dysplasia or atypia is present. Which of the following is the most ap-propriate treatment?
(A) Brachytherapy
(B) Finasteride
(C) Radical retropubic prostatectomy
(D) Transurethral resection of the prostate
(E) Watchful waiting

please give your reason too.
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  #2  
Old 02-18-2012
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finastride....5 alpha reductase inhibitor...
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  #3  
Old 02-18-2012
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B) Finasteride

It sounds BPH to me. I think medical therapy is the best initial treatment in this setting
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  #4  
Old 02-18-2012
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i also thought finasteride but answer is surgery.

reason
his creatinine rise in setting of BPH = indication for surgery

can anyone tell me indications for surgery in BPH...i know some
1. BPH + gross hematuria
2. BPH + diverticula
3. BPH + hydronephrosis
there are more...can't find those...anyone?
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  #5  
Old 02-18-2012
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Default treatment of BPH

Mild symptoms: watchful waiting

Moderate to severe : do additional test such as flow rate, residual urine volume, pressure

If compatible with obstruction: suggest medical or surgical
If incompatible with obstruction search other sources.

Indications of surgery
Refractory urinary retention: failure of one attempt at catheter removal
large bladder diverticula
sequalae of BPH: recurrent UTI, Reccurent gross hematuria , baldder stones and Chronic kidney disease.


source : CMDT 2011
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  #6  
Old 02-18-2012
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would other options be prazocin, doxazocin, terazocin or even flomax?
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  #7  
Old 02-18-2012
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Quote:
Originally Posted by tyagee View Post
i also thought finasteride but answer is surgery.

reason
his creatinine rise in setting of BPH = indication for surgery

can anyone tell me indications for surgery in BPH...i know some
1. BPH + gross hematuria
2. BPH + diverticula
3. BPH + hydronephrosis
there are more...can't find those...anyone?
is ur ans D..
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  #8  
Old 02-18-2012
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yup D TURP
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  #9  
Old 02-18-2012
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y is it d?
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Old 02-19-2012
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i guess D because his BUN and creat are rising. And any sequelae of BPH is an indication for surgery
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