BPH Flashcards
What should clinicians obtain during the initial evaluation of patients with bothersome LUTS possibly due to BPH?
Clinicians should obtain a medical history, conduct a physical examination, utilize the International Prostate Symptom Score (IPSS), and perform a urinalysis. (Clinical Principle)
What intervention options should patients be counseled on for BPH?
Patients should be counseled on behavioral/lifestyle modifications, medical therapy, and/or referral for discussion of procedural options. (Expert Opinion)
When should patients be evaluated after initiating treatment for BPH?
Patients should be evaluated 4-12 weeks after initiating treatment, unless adverse events require earlier consultation. Re-evaluation should include IPSS, and may include PVR and uroflowmetry. (Clinical Principle)
What should be done if a patient on initial medical management for BPH does not experience symptom improvement or has intolerable side effects?
The patient should undergo further evaluation and consideration of change in medical management or surgical intervention. (Expert Opinion)
What assessments should be considered before intervention for LUTS/BPH?
Clinicians should consider assessing prostate size and shape via transrectal or abdominal ultrasound, cystoscopy, MRI, or CT. (Clinical Principle)
What tests should be performed prior to intervention for LUTS/BPH?
Clinicians should perform a post-void residual (PVR) assessment and consider uroflowmetry. (Clinical Principle)
When should pressure flow studies be considered before intervention for LUTS/BPH?
Pressure flow studies should be considered when diagnostic uncertainty exists. (Expert Opinion)
What should clinicians inform patients about when considering surgical and minimally invasive treatments for LUTS/BPH?
Clinicians should inform patients about the possibility of treatment failure and the need for additional or secondary treatments. (Clinical Principle)
What alpha blockers should be offered for treating moderate to severe LUTS/BPH?
Clinicians should offer alfuzosin, doxazosin, silodosin, tamsulosin, or terazosin. (Moderate Recommendation; Grade A)
What factors should be considered when choosing an alpha blocker for LUTS/BPH?
Choice should be based on patient age, comorbidities, and different adverse event profiles (e.g., ejaculatory dysfunction, blood pressure changes). (Moderate Recommendation; Grade A)
What should be discussed with patients who plan to undergo cataract surgery before initiating alpha blocker therapy?
Patients should be informed about the risks of intraoperative floppy iris syndrome (IFIS) and advised to discuss these risks with their ophthalmologists. (Expert Opinion)
When should 5-ARI monotherapy be used for symptom improvement in LUTS/BPH?
5-ARI monotherapy should be used in patients with prostatic enlargement (>30g on imaging, PSA >1.5ng/mL, or palpable enlargement on DRE). (Moderate Recommendation; Grade B)
What are the benefits of 5-ARIs alone or in combination with alpha blockers for BPH?
They can prevent progression of LUTS/BPH, reduce urinary retention, and decrease the need for future prostate-related surgery. (Strong Recommendation; Grade A)
What risks should clinicians inform patients about before starting a 5-ARI?
Risks include sexual side effects, uncommon physical side effects, and a low risk of prostate cancer. (Moderate Recommendation; Grade C)
How can 5-ARIs help in surgical interventions for BPH?
They may reduce intraoperative bleeding and the need for blood transfusion after TURP or other surgeries. (Expert Opinion)
What phosphodiesterase-5 inhibitor (PDE5) can be considered for LUTS/BPH treatment?
Daily 5mg tadalafil should be discussed as a treatment option, regardless of erectile dysfunction status. (Moderate Recommendation; Grade B)
When should combination therapy with 5-ARI and an alpha blocker be offered?
Only to patients with LUTS associated with demonstrable prostatic enlargement (>30g on imaging, PSA >1.5ng/mL, or palpable enlargement on DRE). (Strong Recommendation; Grade A)
What medications can be offered for moderate to severe predominant storage LUTS?
Anticholinergic agents alone or in combination with an alpha blocker, and beta-3-agonists with an alpha blocker. (Conditional Recommendation; Grade C)
What combination therapies can be considered for LUTS/BPH?
Low-dose daily 5mg tadalafil with alpha blockers or finasteride. (Conditional Recommendation; Grade C)
What should be prescribed before a voiding trial in patients with acute urinary retention (AUR) due to BPH?
An oral alpha blocker should be prescribed before attempting a voiding trial. (Moderate Recommendation; Grade B)
How long should patients with AUR complete medical therapy before attempting trial without catheter (TWOC)?
At least three days of medical therapy should be completed before TWOC. (Expert Opinion)
What should patients who pass a successful TWOC for AUR be informed about?
They remain at increased risk for recurrent urinary retention. (Moderate Recommendation; Grade C)
When is surgery recommended for BPH?
Surgery is recommended for patients with renal insufficiency, refractory urinary retention, recurrent UTIs, bladder stones, gross hematuria, or refractory LUTS. (Clinical Principle)
Should surgery be performed for an asymptomatic bladder diverticulum?
No, but evaluation for bladder outlet obstruction (BOO) should be considered. (Clinical Principle)
