Dr. Song on risk stratification in patients with BPH

In this video, Dr. Joseph Song discusses the risk areas to consider when deciding which BPH treatment to offer patients. Song is a urologist at Georgia Urology.

Transcription:

What are the biggest challenges in risk stratifying patients with BPH for treatment selection? How can we better tailor treatment approaches to individual patient needs and risk factors?

There are many different areas of risk. There’s the surgical risk, the risk of side effects after surgery, and the risk of sexual dysfunction. In that order, the surgical risks are obviously the anesthesia risk, the risk of putting the patient through a procedure, but I always check to see if patients have other factors that might put them at risk of infection, whether they’re self-catheterizing, whether they have elevated residue in their urine, whether they’ve recently had an indwelling catheter put in. These are patients who may need a longer course of preoperative antibiotics. Make absolutely sure they have negative urine cultures before you operate on them because the last thing you want is someone who gets sepsis afterward. I also try to keep in mind that just because someone has lower urinary tract symptoms doesn’t mean it’s just coming from the prostate. People with Parkinson’s comorbidities, previous spinal cord injuries, frail patients, and sometimes patients with mild BPH, but their symptoms are disproportionate to the size of their prostate. I often advise these patients, “You may have pelvic floor dysfunction. We’ll fix the problem we’re seeing here, but there may be underlying overactivity or you may have pelvic floor dysfunction or there may be another contributing factor.” I always build that expectation because the last thing you want to do is tell the patient, “I’m going to cure you 100%. That’s the only thing you need.” I always tell patients, “Urination is a complex process. It’s not just the tubing that matters, it’s your pump.” That’s an analogy I always use. You can open the tubing as much as you can, but if your pump isn’t working, you’re not going to get good flow. You’re going to continue to have problems. And I think sometimes we’re a little reductionist in the way we talk to patients about what’s going on and reduce it to this one problem. Patients then expect that everything will be perfect when that’s done. And that may not always be the case.

This transcription has been edited for clarity.