Chapter 100: Benign Prostatic Hyperplasia: Trouble with Dribbles Level II

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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

• Recognize the clinical manifestations of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) secondary to BPH.

• Differentiate between obstructive and irritative symptoms in patients with BPH.

• Recommend appropriate pharmacotherapeutic treatment for BPH.

• Identify and manage a drug interaction associated with BPH pharmacotherapy.

• Recognize when surgical therapies should be considered for patients with BPH.

• Understand how some drugs can exacerbate BPH symptoms.

PATIENT PRESENTATION

Chief Complaint

“I’m up four to five times a night feeling that I have to urinate, and then when I get to the bathroom all I do is dribble. I have a girlfriend now, but I am finding it difficult to be intimate with her.”

HPI

A 65-year-old man is being evaluated in an outpatient clinic for complaints of worsening urinary hesitancy, nocturia, and dribbling. He also has a new complaint of ED. He would like information on prescription medications to treat his urinary symptoms but is also asking about use of natural products.

PMH

• HTN

• BPH

• Type 2 DM

• ED

• Obesity

• Cat allergy (new onset)

FH

Educated through the 12th grade. Father died of massive MI at age 78; mother died of natural causes at age 91.

SH

Worked for 35 years in a grocery store; retired 7 years ago. Married once. Wife deceased 6 months ago (stroke); one daughter, two granddaughters. Lives alone but is starting to become more socially active. He recently joined a senior dating website and has started dating a 60-year-old woman. He also just adopted a 3-year-old cat from the humane society. Although he reports being allergic to cat dander, he feels that she has added happiness back into his life and uses medications to keep his allergies under control because he doesn’t want to give up the cat. Used smokeless tobacco × 35 years (quit 10 years ago); heavy ETOH in the past, occasional glass of wine now.

ROS

In conversation, he is alert, friendly, and courteous. He has no c/o dyspepsia, dysphagia, abdominal pain, hematemesis, urinary incontinence, or visible blood in the stool.

Meds

• Metformin 1000 mg PO BID

• Rosuvastatin 20 mg PO once daily

• Lisinopril 20 mg PO once daily

• Claritin-D 24-hour one tablet PO daily (allergy to cats)

All

NKDA; allergic to cat dander

Physical Examination

Gen