genitourinary disorders
Benign Prostatic Hyperplasia (BPH)
Treatment of BPH
Avoidance of anticholinergics, sympathomimetics, and opioids , especially if there is concomitant Erectile Dysfunction None Transurethral resection of the prostate or an alternative bladder outlet procedure Significant urinary retention requires immediate decompression. Passage of a standard urinary catheter is first attempted; if a standard catheter cannot be passed, a Bladder Catheterization with a coudé tip may be effective. If this catheter cannot be passed, flexible cystoscopy or insertion of filiforms and followers (guides and dilators that progressively open the urinary passage) may be necessary. (This procedure should usually be done by a urologist.) Suprapubic percutaneous decompression of the bladder may be used if transurethral approaches are unsuccessful. For partial obstruction with troublesome symptoms, all anticholinergics and sympathomimetics (many available in over-the-counter [OTC] preparations), and opioids should be stopped, and any infection should be treated with antibiotics. 30 mL) glands. A combination of both classes of drugs is superior to monotherapy. For men with concomitant Erectile Dysfunction , daily Surgery is done when patients do not respond to drug therapy or develop complications such as recurrent Introduction to Urinary Tract Infections (UTIs) , About 10% of men undergoing TURP need the procedure repeated within 10 years because the prostate continues to grow. Various laser ablation techniques are being used as alternatives to TURP. Larger prostates (usually>75 grams) traditionally require open surgery via a suprapubic or retropubic approach (currently, most surgeons prefer laparoscopy or robotic laparoscopic assistance to open surgery), although some newer techniques such as the holmium laser enucleation of the prostate (HoLEP) can be done transurethrally. All surgical methods require postoperative catheter drainage for 1 to 7 days. Alternatives to TURP include microwave thermotherapy, electrovaporization, various laser techniques, high-intensity focused ultrasonography, transurethral needle ablation, radiofrequency vaporization, pressurized heated water injection therapy, urethral lift, steam injection therapy, and intraurethral stents. Prostatic artery embolization (PAE) is being evaluated for men with an enlarged prostate gland, particularly those with hematuria who are poor candidates for surgery ( Treatment references ). The circumstances under which these procedures should be used have not been firmly established, but those done in the physician’s office (eg, steam injection) are being more commonly used and do not require use of general or regional anesthesia. Their long-term ability to alter the natural history of BPH is under study. 1.Lerner LB, McVary KT, Barry MJ, et al: Management of benign prostatic hyperplasia/lower urinary tract symptoms: AUS Guideline part I, initial work-up and medical management.J Urol206:806, 2021. 2.Lerner LB, McVary KT, Barry MJ, et al: Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA Guideline part II — Surgical evaluation and treatment.J Urol206(4):818-826, 2021. doi: 10.1097/JU.0000000000002184 3.Dias US, Liberato de Moura MR, Viana PCC, et al: Prostatic artery embolization: Indications, preparation, techniques, imaging evaluation, reporting, and complications.RadioGraphicsPublished online: August 20, 2021. https://doi.org/10.1148/rg.2021200144 