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PATIENT CARE PROCESS

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Patient Care Process for the Management of Benign Prostatic Hyperplasia (BPH)

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Collect

  • Patient characteristics (e.g., age, race)

  • Patient history (past medical history, family history, social—tobacco, recreational drug, or alcohol use)

  • Presence of obstructive and/or irritative bladder symptoms and their impact on patient lifestyle and health-related quality of life (see Clinical Presentation box)

  • Patient's perception of bothersomeness of voiding symptoms using AUA Symptom Score (see Diagnostic Evaluation section)

  • Current and past medications, including prescription and nonprescription medications; nonpharmacologic interventions for BPH; and medications perceived to cause or worsen BPH (see Medication-Related Symptoms section)

  • Objective data (see Diagnosis section and Clinical Presentation box)

    • Blood pressure, heart rate, height, weight, and BMI

    • Digital rectal examination

    • Labs (e.g., urinalysis, blood urea nitrogen and serum creatinine, prostate-specific antigen)

    • Urinary flow rates and postvoid residual

Assess

  • Disease severity (see Table 84-1); patient views on watchful waiting (in mild cases), medical treatment (in moderate to severe cases), and surgery (in severe cases)

  • Need for further evaluation based on laboratory and examination findings

  • Size of prostate by digital rectal exam or transrectal ultrasound of the prostate

  • Presence of BPH or other causes of lower urinary tract symptoms (prostate cancer, prostatitis)

  • Presence of erectile dysfunction

Plan*

  • Dietary and lifestyle modifications to avoid problematic symptoms and situations (see Medication-Related Symptoms section and Clinical Presentation section)

  • Interventions to encourage heart-healthy lifestyle, smoking cessation (if needed), weight loss (if needed), and management of other chronic diseases

  • Drug therapy regimen including specific agent(s), dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Figure 84-2 and Tables 84-2, 84-3, and 84-4, and the Personalized Pharmacotherapy section of the text), advantage or disadvantage of single drug versus combination therapy

  • Monitoring parameters including efficacy (symptom relief) and safety (medication-specific adverse effects) (see Table 84-5)

  • Patient education (e.g., purpose of treatment, dietary and lifestyle modification, drug therapy)

  • Comparison of before and during treatment response by repeating AUA Symptom Score or using a voiding diary (see Diagnostic Evaluation section)

  • Referrals to other providers when appropriate (e.g., physician, urologist)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up at 6–12 months for watchful waiting and at shorter intervals in those under treatment or being considered for surgical intervention

Follow-up: Monitor and Evaluate

  • Assess patient satisfaction with relief of symptoms

  • Presence of adverse effects

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals

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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

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For the chapter in the Wells Handbook, please go to Chapter 79. Benign Prostatic Hyperplasia.

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KEY CONCEPTS

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KEY CONCEPTS

  • Image not available. Although symptomatic benign prostatic hyperplasia (BPH) is rare in men younger than 50 years, it is common in men 60 years and older. Prostate growth is androgen-dependent. Symptoms commonly result from both static ...

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