BPH

Question 1

Prostate is derivation of ____derm

Answer 1

endoderm

Question 2

____ zone is site of BPH

Answer 2

Transitional (encircles urethra)

Question 3

____ zone is site of prostate ca.

Answer 3

Peripheral (75% of gland)

Question 4

BPH is cellular proliferation of ____ and ____ parts

Answer 4

stromal & epithelial

Question 5

alpha-1 blockers inhibit prostate _____ and decrease prostatic urethral resistance

Answer 5

smooth muscle contraction

Question 6

LUTS work-up

History
Exam
_____ symptom score
Lab test: ____

Answer 6

AUA-SS

UA

Question 7

Prior to BPH surgery….

Size evaluation with ___, ____, or ___
Voiding studies - ____ & ____

Answer 7

U/S, cystoscopy, or cross-sectional imaging

PVR & Uroflow

Question 8

1st Line BPH therapies

Answer 8

• Fluid restriction prior to sleeping
• Limiting alcohol and caffeine
• Voiding diary with frequency-volume chart
• Timed voiding
• Double voiding
• Bladder training
• Avoiding constipation

Question 9

Alpha-blocker side effects

Answer 9

Adverse effects
• Dizziness (orthostasis)
• Retrograde ejaculation (6%)
• Rhinitis (12%)
• Intraoperative floppy iris syndrome (IFIS)
• higher rates of iris trauma and posterior capsule rupture during cataract surgery with ANY use of Tamsulosin

Question 10

____ has the least risk of ejaculatory dysfunction of all alpha-blockers

Answer 10

Alfuzosin (Uroxatral)

Question 11

5-ARIs have maximal prostate size reduction after ___ with an average size reduction of ___ %

Answer 11

6 months… 15-30%

Question 12

Finasteride also suppresses _____ which makes it useful in men with refractory hematuria 2/2 prostatic bleeding

Answer 12

VEGF

Question 13

Risk reduction of retention or prostate surgery with Finasteride use is ___%

Answer 13

70%

Question 14

____ medications work by relaxing detrusor muscle to increase bladder storage volumes and decrease sensation for micturition

Answer 14

Beta-3 agonists (Mirabegron)

Question 15

Side effects of Mirabegron

Answer 15

HTN(7.3%), Nasopharyngitis (3.4%)

Question 16

PDE-5i with FDA approval for daily use in men with BPH/LUTS

Answer 16

Tadalafil 5 mg (Cialis)

Question 17

Side effcts of PDE-5i

Answer 17

Headache (15%)
Facial flushing (4-10%)
Dyspepsia (3-11%)

Question 18

Mechanism of PDE-5i

Answer 18

block breakdown of cGMP to GMP by phosphodiesterase leading to vasodilation

Question 19

MTOPS study

Compared ___, ____, ___, ____
Results: ____ AUR, BPH surgery, BPH progression

Answer 19

placebo vs doxazosin vs finasteride vs combo

REDUCED aur, bph sx, bph progression

Question 20

COMBAT trial

Compared ____ vs ____ vs ____
Results: ___ Qmax, PSA, & prostate volume

Answer 20

Tamsulosin vs Dutasteride (Avodart) vs combo

Question 21

TIMES Trial

Compared ____ vs _____
Results: ____ nocturia, frequency/urgency, ____ in Qmax, PVR

Answer 21

Tolteroderine (Detrol) vs Detrol + Flomax

Improved symptoms
No change in Qmax or PVR

Question 22

PLUS trial

Compared ____ vs ____
Results: ____ mean volume voided per micturition, & urgency and frequency, ____ in Qmax or PVR, ____
retention rates in the tamsulosin plus mirabegron group

Answer 22

Flomax vs Flomax + Mirabegron

Improved volume & urgency & frequency
No change in Qmax or PVR
Higher retention rates in combo group

Question 23

Indications for BPH Surgery

Answer 23

Refractory to and/or unwilling to use other therapies  Renal insufficiency secondary to BPH
Urinary retention secondary to BPH
Recurrent UTI
Recurrent bladder stones
Gross hematuria secondary to BPH

Question 24

Urolift contraindications

Size >___ cc
Prominent ____ lobe

Answer 24

> 80 cc

Prominent middle lobe

Question 25

Water Vapor Therapy (Rezum) Mechanism

Answer 25

Water vapor energy leads to disruption of cell membranes and tissue necrosis

Question 26

AUA Guideline: PAE is ___ recommended for the treatment of LUTS/BPH outside the context of a clinical trial

Answer 26

NOT

Question 27

AUA Guideline: PAE is ___ recommended for the treatment of LUTS/BPH outside the context of a clinical trial

Answer 27

NOT