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PATIENT CARE PROCESS

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

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

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

KEY CONCEPTS

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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