Assessment

Question 1

NICE indications for flexi - 5

Answer 1

haematuria
recurrent infection
sterile pyuria
pain
profound symptoms

Question 2

NICE indications for upper tract imaging - 6

Answer 2

haematuria
pain
profound symptoms
recurrent infection
sterile pyuria
chronic retention

Question 3

EAU UDS -6

Answer 3

• considering invasive treatment who cannot void > 150 mL
• considering surgery in men with bothersome predominantly voiding LUTS and Qmax > 10 mL/s.
• considering invasive therapy in men with bothersome, predominantly voiding LUTS with a post void residual > 300 mL.
• considering invasive treatment in men with bothersome, predominantly voiding LUTS aged > 80 years
• considering invasive treatment in men with bothersome, predominantly voiding LUTS aged < 50 years
• Previous unsuccessful invasive treatment for LUTS

Question 4

association of BPH with MS

Answer 4

Metabolic syndrome - at least 3 of the 5 following problems: 
central obesity
high blood pressure
high blood sugar
high serum triglycerides 
low high-density lipoprotein (HDL)

Question 5

BPH and OSA

Answer 5

negative intra thoracic pressure
release of ANP due to cardiac distension caused by negative pressure
increase sodium and water excretion
inhibition also of vasopressin and RAAA complex
Treatment of sleep apnoea and airway compromise has been shown to reverse nocturnal polyuria and thereby reduce or eliminate nocturia and enuresis

Question 6

NICE refer specialist assessment for LUTS 4

Answer 6

retention
cancer
recurrent or persistant UTI
renal impairment

Question 6

NICE refer specialist assessment for LUTS 4

Answer 6

retention
cancer
recurrent or persistant UTI
renal impairment

Question 7

change in IPSS paper

Answer 7

Barry 1005

3 point change represents subjective perception change symptoms

Question 8

other validated symptoms scores

Answer 8

DAN-PSS Danish prostate symptom score

Bristol Male LUTS

Question 9

PROSCAR
arm
type
men
inclusion
main result

Answer 9

placebo arm of PLESS
RCT
164 men
mod to severe LUTS
PSA is a stronger predictor for growth than age and volume
PSA predictor of AUR, clinical progression and surgery

Question 10

Abrams Qmax data

Answer 10

> 20 almost never obstructed
<10 = 90%
10-15 = 60%
15-20 = 30% obstructed

Question 11

examination 4

Answer 11

general signs renal failure fluid overload
neurology gait tremors
abdominal palpable bladder, ballotable kidneys, scars
DRE size, consistency, tenderness

Question 12

PSA testing PHE guidelines

Answer 12

Before a PSA test men should not have:
an active urinary infection or within previous 6 weeks
ejaculated in previous 48 hours
exercised vigorously, for example cycling in previous 48 hours
had a urological intervention such as prostate biopsy in previous 6 weeks

Question 13

PSA testing PHE guidelines

Answer 13

Before a PSA test men should not have:
an active urinary infection or within previous 6 weeks
ejaculated in previous 48 hours
exercised vigorously, for example cycling in previous 48 hours
had a urological intervention such as prostate biopsy in previous 6 weeks

Question 14

PSA test to lab

Answer 14

When taking blood for PSA testing:
ensure the specimen will reach laboratory in time for the serum to be separated within 16 hours
send samples to an ISO accredited laboratory
repeat the test if not taken in ideal circumstances

Question 15

PHE guidance PSA sensitivity

Answer 15

Most men will have a PSA level less than 3ng/ml. About 3 in 4 men with a raised PSA level (≥3ng/ml) will not have cancer. Around 15% of men with a normal PSA do have cancer

Question 16

NICE PSA testing in LUTS 3

Answer 16

At initial assessment, offer men with LUTS information, advice and time to decide if they wish to have prostate specific antigen (PSA) testing if:
•
their LUTS are suggestive of bladder outlet obstruction secondary to BPE or
•
their prostate feels abnormal on DRE or

they are concerned about prostate cancer.