NR 576 Week 7 Assignment; Clinical Practice Guidelines Presentation; Benign Prostatic Hyperplasia.

Disease and Background Benign Prostatic Hyperplasia • Management of Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms (2021) • Benign prostatic hyperplasia (BPH) is characterized by proliferation of glandular epithelial tissue in the prostatic transition zone • Lower Urinary Tract Symptoms (LUTS) • Hyperplasia – increase in the number of cells (Lerner et al., 2021) Benign Prostatic Hyperplasia 2 Pathophysiology • 2 mains sections • inner section • outer section • Hyperplasia • 5-alpha reductase • Dihydrotestosterone(Lerner et al., 2021) Benign Prostatic Hyperplasia 4 Clinical Presentation Objective Distended Bladder Gross Hematuria Perform Digital Rectal Exam • Prostate size does not have to correlate with the symptoms. • Men with enlarged Benign Prostatic Hyperplasia 6 prostates can be without symptoms • Men with small prostates can have obstructive and irritating symptoms Applicability in Primary Care Symptoms discovered when collecting medical history and physical exam. Differential diagnosis: • UTI, Prostatitis, Malignancy, bladder dysfunction, and obstruction. Comprehensive physical exam focusing on genitourinary system • urethral meatus, prepuce, penis, groin nodes, prior surgical scars. A digital rectal exam should be completed, examining the prostate Labs: Urine sample, PSA testing Initial treatment and referral to Urologist Benign Prostatic Hyperplasia Guideline Statement • Patients should be evaluated by providers 4- 12 weeks after initiating treatment. • For alpha blockers, beta-3 agonists, PDE5’s Follow-up and anticholinergics follow-up should be at 4 weeks. Evaluation • Assess patient satisfaction with the improvement of symptoms Benign Prostatic Hyperplasia 10 Guideline Statement 5-Alpha Reductase Inhibitor (5-ARI) • 5-Alpha Reductase Inhibitor monotherapy should be used for symptom improvement • Example is Finasteride • With LUTS/BPH with Prostatic enlargement • prostate volume of >30 cc on imaging • PSA >1.5 ng/dl • palpable prostate enlargement on DRE. • Benefits: growth reduction and shrinking. • Side effects: decrease in sexual function, gynecomastia, risk for prostate cancer Benign Prostatic Hyperplasia 12 Application to Clinical • 75 year old male seen at office for follow up of hypertension. He also voiced complaints of Nocturia (5/night), urgency, frequency and then only voiding small amounts. • Urine was tested and was unremarkable. Physical exam was unremarkable. He had been diagnosed with BPH in the past but never required medication, “it wasn’t bad enough.” Now the symptoms are bothersome. Benign Prostatic Hyperplasia References Lerner, L., McVary, K., & Barry, M. (2021). Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: Aua guideline part i, initial work-up and medical management. Journal of Urology, 206(5), 1339–1339. Retrieved June 15, 2023, from https://doi.org/ 10.1097/ju.0000000000002231 Thank you Benign Prostatic Hyperplasia 16