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LEARNING OBJECTIVES

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

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  • 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 drug interactions associated with BPH pharmacotherapy.

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

  • Understand how some drugs can exacerbate BPH symptoms.

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PATIENT PRESENTATION

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Chief Complaint

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“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’m very lightheaded when I stand up, and sometimes I don’t make it to the bathroom in time. I have a girlfriend now, but I am finding it difficult to be intimate with her. Also, going to the bathroom all night is really impacting my love life.”

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HPI

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Jimmy McCracken is a 65-year-old man with a long-standing history of UTIs. He has a history of urosepsis requiring hospitalization. He is being evaluated because of complaints of worsening urinary hesitancy, nocturia, and dribbling. He also has a new complaint of ED.

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PMH

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  • HTN

  • Laminectomy 10 years ago

  • BPH with urge incontinence

  • Chronic UTIs

  • Type 2 DM

  • Allergy to cat dander

  • ED

  • Obesity

  • Osteoarthritis

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FH

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

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SH

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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 socially active. Recently started dating a 60-year-old woman he met online through a senior dating website. Patient would like information on current prescription medications used to treat BPH symptoms but is not opposed to treating current symptoms with natural products if possible. Used smokeless tobacco × 35 years; heavy ETOH in the past, occasional glass of wine now.

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ROS

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

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Meds

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  • Metformin 1000 mg PO BID

  • Terazosin 10 mg PO once daily

  • Amitriptyline 25 mg PO at bedtime (insomnia)

  • Metoprolol succinate 50 mg PO once daily

  • Ibuprofen 800 mg PO BID

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

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All

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NKDA; allergic to cat dander

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Physical Examination

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Gen
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White male in NAD; well-kept appearance; A & O × 3

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VS
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BP 110/60 ...

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