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

Benign Prostatic Hyperplasia Disease & Backgroun d 1. Identifies the disease condition. 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. 2. Gives a brief statement of incidence and prevalence in the US. Prostate begins to enlarge at 40-45 years old. By the age of 60 the prostate has increased in size by 60% 80% at age 80 3. The student briefly summarizes the disease pathophysiology. Prostate consists of 2 main sections. Inner section produces secretions to keep the urethra moist. Outer section – contributes to seminal fluids. Hyperplasia is driven by 5 alpha reductase activity which increases with age, which leads to increased dihydrotestosterone production causing the cells to live longer and multiply faster. 4. Identifies the typical clinical presentation seen in a patient with the disease Subjective decreased force of stream hesitancy post-void dribbling sensation of incomplete bladder emptying overflow or urge incontinence inability to voluntarily stop the stream of urine urinary retention straining nocturia frequency urgency dysuria Objective Distended Bladder Gross Hematuria Perform DRE, but size of prostate does not have to correlate with the symptoms. Men with enlarged prostates can have no symptoms. Men with small prostates can have obstructive and irritating symptoms. Follow-up Evaluation (Guideline Statement 3 ) Patients should be evaluated by providers 4-12 weeks after initiating treatment. For alpha blockers, beta-3 agonists, PDE5’s and anticholinergics follow-up should be at 4 weeks. Assess patient satisfaction with the improvement of symptoms. Alpha Blockers (Guideline Statement 10 ) When symptoms are bothersome, the clinician should offer an alpha blocker such as: Alfuzosin, doxazosin, silodosin, tamsulosin, or terazosin. Decision should be based on patients age, comorbidities, and adverse Effects Terazosin and Doxazosin are approved for hypertension and BPH. Tamsulosin, Alfuzosin, and Silodosin have lower potential for orthostatic hypotension and syncope. 5-Alpha Reductase Inhibitor (5-ARI)(Guideline Statement 13 ) 5-Alpha Reductase Inhibitor monotherapy should be used for symptom improvement Example is Finasteride With LUTS/BPH with Prostatic enlargement having a prostate volume of >30 cc on imaging, a prostate specific antigen (PSA) >1.5 ng/dl, or palpable prostate enlargement on digital rectal exam. Benefits include growth reduction and shrinking. Side effects: decrease in sexual function, gynecomastia, risk for prostate cancer. Phosphodiesterase-5 Inhibitor (PDE5) (Guideline Statement 17 ) For patients with LUTS/BPH, Tadalafil 5 mg daily should be discussed as a treatment option for men with erectile dysfunction Application in Clinica l 1. Using an example of a patient from their clinical rotation with the