Dr. Song on risk-stratifying patients with BPH

Opinion
Video

In this video, Joseph Song, MD, discusses the areas of risk to weigh when considering what BPH procedure to offer patients. Song is a urologist with 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 multiple different areas of risk. There's the surgical risk, there's the risk of side effects after your surgery, there's the risk of sexual dysfunction. Taking it in that order, in terms of surgical risk, obviously, there's the risk of anesthesia, the risk of putting a patient through a procedure, but more so I always evaluate whether patients have other factors that might be putting them at risk for infection, whether they're on self catheterization, they have elevated postvoid residuals, whether they've had a recent indwelling catheter. Those are patients who may need a longer course of preoperative antibiotics, really confirm that they have negative urine cultures before you take them to surgery, because the last thing you want is somebody who's going septic afterwards. I also try to keep in mind that just because somebody is having lower urinary tract symptoms, doesn't mean they're having it from the prostate alone. People who have comorbid issues with Parkinson's, previous spinal cord injury, patients who are frail, and sometimes you also see patients who may have some mild BPH, but their symptoms are all out of proportion to the size of their prostate. Those are patients who I'll oftentimes counsel, "you may have some pelvic floor dysfunction. We're going to fix the issue that we're seeing here, but you may have some underlying overactivity or you have pelvic floor dysfunction, or you have some other contributing factor." I always kind of build that expectation, because the last thing you want is to tell the patient, "I'm going to fix you 100%. This is the only thing you need." I always tell patients, "urination is a complex process. It's not just the pipe that matters; it's your pump." That's an analogy I always use. You can have as wide open a pipe as possible, but if your pump isn't working, you're not going to get great flow. You're still going to have issues. And I think sometimes we can be reductive in the way that we talk to patients about what's going on and we boil down to this 1 issue and they expect that once this is done, everything will be perfect. And that may not always be the case.

This transcription was edited for clarity.

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