madman
Super Moderator
Morgan McDowell, DNP, APRN, WHNP-BC, AGPCNP-BC, Director of APP Education, Centra Health, Lynchburg, Virginia, delivers an in-depth overview of benign prostatic hyperplasia (BPH) grounded in the AUA guidelines. She begins this 45-minute presentation with foundational anatomy and epidemiology, clarifying key diagnostic terminology, distinguishing BPH from benign prostatic enlargement, obstruction, and bladder outlet obstruction. Lower urinary tract symptoms (LUTS) and overactive bladder are also addressed.
Evaluation begins with history, physical exam, urinalysis, post-void residual, and symptom scoring with the International Prostate Symptom Score. She emphasizes the value of bladder diaries and flow rate analysis.
Regarding treatment, Dr. McDowell discusses lifestyle modifications, including timed voiding, fluid management, and reducing bladder irritants like caffeine and alcohol, as first-line strategies. Pharmacologic management includes alpha-blockers and 5-alpha reductase inhibitors. Combination therapy is appropriate for larger prostates and more severe symptoms. Additional options include PDE-5 inhibitors and agents targeting overactive bladder symptoms.
Dr. McDowell transitions to surgical interventions, explaining indications such as urinary retention, renal insufficiency, recurrent infections, or patient preference. She details classic and emerging procedures, including TURP, TUIP, HoLEP, PAE, UroLift, Rezūm, laser ablation, TUVP, Aquablation, iTind, and Optilume. Each is discussed with attention to prostate size suitability, outcomes, complications, and patient selection.
She highlights the role of imaging, morphology, and patient values in choosing treatment, reinforcing the advanced practice provider’s central role in BPH evaluation, counseling, and ongoing care. This comprehensive review equips clinicians with actionable guidance to individualize management strategies.
