Contemporary Medical Management of BPH

In this episode of BackTable Urology, Dr. Claus Roehrborn, chairman and professor of UT Southwestern Urology department, joins our host Dr. Aditya Bagrodia to discuss the clinical evaluation and medical management of benign prostate hyperplasia (BPH).

Dr. Roehrborn begins by categorizing lower urinary tract symptoms (LUTS), which are suggestive of BPH, into 2 groups: storage vs. voiding symptoms. He emphasizes the importance of evaluating the patients via the International Prostate Symptom Score (IPSS), asking about the patients’ quality of life, and considering absolute indications for intervention (retention, gross hematuria, recurrent UTI) before formulating a treatment plan for BPH.

Additionally, Dr. Roehrborn highlights two important pre-treatment tests: the flow rate test, which judges the stream intensity, and the post-void residual (PVR) urine test, which measures residual volume. Dr. Roehrborn encourages urologists to use the voided volume and residual volume to calculate the voiding efficiency, a powerful tool to drive treatment options. Finally, he advocates for the Prostate Screening Assessment (PSA) as an effective indirect measure of prostate size, since urologists should know the size and shape of the prostate before embarking on treatment.

In the last part of the episode, Dr. Roehrborn discusses the 5 classes of BPH medication (alpha adrenergic receptor blocker, 5-alpha-reductase inhibitor, anticholinergics, beta-3-adrenergic agonists, and phosphodiesterase 5 inhibitors), their side effects, and their efficacies based on each BPH patient category. He notes that positive results are possible when combining 2 classes of medication and that urologists should always guide patients through increasing dosage and tapering medications during follow-up visits.