Contemporary Surgical Managemenet of BPH w/ Dr. Claus Roerhborn | BackTable Urology Podcast Ep. 6

In Part II, Dr. Aditya Bagrodia talks with Dr. Claus Roehrborn of UT Southwestern Medical Center about the surgical management of benign prostatic hyperplasia (BPH).
---
EARN CME
Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: earnc.me/oiF3pD
---
SHOW NOTES
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 surgical and post-operative management of benign prostate hyperplasia (BPH).
First, Dr. Roehrborn summarizes the different BPH surgical options based on invasiveness, use of ablation, implantation, energy source, and anatomical approaches. UroLift and the Rezum procedures are the most common minimally invasive options, while the monopolar/bipolar TURP, prostatectomies, the Greenlight (KTP) laser, and different enucleation techniques are the most common surgical options.
Next, Dr. Roehrborn discusses how patient characteristics and prostate size can help guide surgical options. He cites frailty and old age as push factors for minimally invasive techniques and greenlight lasers. To study prostate size, he recommends the point-of-care ultrasound (POCUS) because it is inexpensive and gives all the needed measurements before surgery. For large prostates (over 80 g), he proposes enucleation, simple prostatectomy, and minimally invasive treatments. For small or average-sized prostates (30-80 g), he considers all surgical options to be viable, but favors TURP or enucleation if the median lobe is substantially enlarged. He also assesses the risk of anejaculation for each approach: Urolift has no risk, Rezum and aquablation have minimal risks, other techniques depend on individual skill of the surgeon.
Dr. Roehrborn suggests a follow up visit at 1 month to evaluate urination and to stop all medication. However, he notes that some patients resume anticholinergics or beta-3-adrenergics because their storage symptoms persist. He also notes that 5-alpha-reductase inhibitors prevent prostate re-growth in genetically predisposed patients. In general, he encourages urologists to have a specific plan of action for every post-operative drug they prescribe to patients.
---
RESOURCES
Society of Benign Prostate Diseases: societyofbenign.godaddysites....
AUA Benign Surgical Hyperplasia Guidelines: www.auanet.org/guidelines/gui...
AUA MRI Prostate imaging Guidelines: www.auanet.org/guidelines/gui...
EAU Lower Urinary Tract Sympton Guidelines: uroweb.org/guideline/treatmen...
POCUS Butterfly Device: www.butterflynetwork.com/
POCUS Clarius Device: clarius.com/l/pocus-ultrasoun...
---
The BackTable Urology Podcast is a resource for practicing urologists to learn tips, techniques, and practical advice from their peers in the field. Listen on BackTable.com/Urology or on the streaming platform of your choice.
Get notified when new episodes drop! Subscribe to the BackTable Urology Podcast on your go-to podcast platform, and follow us on your social media platform of choice for regular updates.
Apple ► podcasts.apple.com/us/podcast...
Spotify ► open.spotify.com/show/32LoLeG...
KZbin ► / @_backtableuro
LinkedIn ► / backtable-urology
Twitter ► / _backtableuro
Instagram ► / _backtableuro
Newsletter ► www.backtable.com/shows/urolo...

[@universaldonor3100]

Up to what size prostate are you comfortable doing an Aquablation on?