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Benign prostatic hyperplasia — ABIM Board MCQ

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EasyWomen's Health/Men's HealthBenign prostatic hyperplasiaABIM Board

A 68-year-old man has 6 months of bothersome urinary hesitancy, weak stream, nocturia, and a sensation of incomplete bladder emptying. His International Prostate Symptom Score is 16. Digital rectal examination shows a smoothly enlarged, nontender prostate. Urinalysis is normal, serum creatinine is normal, and prostate-specific antigen is 2.1 ng/mL. Postvoid residual volume is 85 mL. He has no history of urinary retention, recurrent urinary tract infection, gross hematuria, or bladder stones. His blood pressure is 132/76 mm Hg without orthostatic symptoms. Which of the following is the most appropriate initial pharmacologic treatment?

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Correct answer: A — Tamsulosin

The correct answer is A, tamsulosin. This patient has bothersome, moderate lower urinary tract symptoms attributable to uncomplicated benign prostatic hyperplasia. An alpha-1 adrenergic blocker relaxes smooth muscle in the prostate and bladder neck and provides relatively rapid improvement in urinary flow and symptoms. Blood pressure and orthostatic symptoms should be monitored. Ciprofloxacin is inappropriate because there is no evidence of bacterial prostatitis or urinary infection. Desmopressin may be considered for selected patients with documented nocturnal polyuria, not predominantly obstructive symptoms, and can cause hyponatremia in older adults. Bedtime furosemide would worsen nocturia. Radical prostatectomy treats localized prostate cancer, not uncomplicated BPH; BPH procedures are reserved for refractory symptoms or complications such as recurrent retention, infection, stones, bleeding, or renal dysfunction.

Reference: Wei JT, Dauw CA, Brodsky CN. Lower Urinary Tract Symptoms in Men: A Review. JAMA. 2025;334(9):809-821. https://pubmed.ncbi.nlm.nih.gov/42095477/