Benign Prostatic Hyperplasia

A 68-year-old man presents to the urology clinic with a 2-year history of progressive lower urinary tract symptoms (LUTS). He reports nocturia 4–5 times per night, weak urinary stream, hesitancy, and incomplete emptying. Digital rectal examination reveals a smooth, firm, symmetrically enlarged prostate without nodules. Post-void residual (PVR) is 120 mL. Serum PSA is 2.8 ng/mL. Uroflowmetry shows peak flow of 8 mL/s (normal >15 mL/s). He has tried lifestyle modifications without improvement. What is the most appropriate next step in management?

A 72-year-old man with a 5-year history of BPH presents with acute urinary retention. He was started on finasteride 6 months ago for a large prostate (50 g on ultrasound) and initially improved. However, over the past 3 weeks, he has had progressive hesitancy and weak stream. Tonight, he cannot void and has suprapubic pain. Catheterization yields 800 mL of clear urine. Post-catheterization, his serum creatinine is 1.8 mg/dL (baseline 1.0 mg/dL). What is the most likely reason for his acute decompensation?

A 68-year-old man presents with lower urinary tract symptoms (LUTS) including nocturia (×4 per night), weak urinary stream, and hesitancy for 8 months. Digital rectal examination reveals a smooth, firm, symmetrically enlarged prostate. Post-void residual urine is 45 mL. Uroflowmetry shows a peak flow of 8 mL/s. He has no history of acute urinary retention or recurrent UTIs. What is the drug of choice for initial medical management?

A 72-year-old man with BPH presents with acute urinary retention following a course of oral decongestants. After catheter drainage and resolution of retention, he is evaluated for long-term management. His prostate volume is estimated at 45 mL on DRE, and he wishes to avoid surgery. Which investigation is most appropriate to guide pharmacological therapy selection?

A 72-year-old Indian man with BPH is counselled about medical management options. Which finding best distinguishes between alpha-1 adrenergic antagonists and 5-alpha reductase inhibitors in terms of their mechanism and clinical effect?