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  #1  
Old 12-11-2012
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Arrow A 60-year-old man with BPH

A 60-year-old man presents to the urologist complaining of difficulty urinating. He states that 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 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 that is located on the middle posterior aspect of the prostate. He has a prostate-specific antigen level of 6 ng/mL (normal: 0–4 ng/mL), a blood urea nitrogen of 20 mg/L, and a creatinine of 1.6 mg/L. The patient under-goes a transrectal prostate biopsy, and no dysplasia or atypia is present. Given the clinical scenario and pathologic findings, what is the most appropriate treatment?

(A) Brachytherapy
(B) Finasteride
(C) Radical retropubic prostatectomy
(D) Transurethral resection of the prostate
(E) Watchful waiting
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(D) Transurethral resection of the prostate

He has BPH with obstructive symptoms with raised creatinine. It will also give tissue for histology.

Finasteride is not going to help in the presence of obstructive symptoms.

The biopsy is negative so there is no need for a radical procedure/brachytherapy.
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Quote:
Originally Posted by Novobiocin View Post
(D) Transurethral resection of the prostate

He has BPH with obstructive symptoms with raised creatinine. It will also give tissue for histology.

Finasteride is not going to help in the presence of obstructive symptoms.

The biopsy is negative so there is no need for a radical procedure/brachytherapy.
I can't imaging removal of enlarged prostate thru narrow urethra which may also complicated by urethral injury
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Quote:
Originally Posted by heartbeat View Post
I can't imaging removal of enlarged prostate thru narrow urethra which may also complicated by urethral injury
They do TURP where they take out small slices (bit by bit) to remove the prostate piece by piece.
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yea TURP is appropriate.
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C. Turp,,,,
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Old 12-13-2012
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Yup TURP is correct ans
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