BPH and management

Question 1

European association of urology (EAU) guidelines currently recommend TURP as the first choice in patients who:

Answer 1

1. are suitable to undergo surgery under anaesthesia 2. Prostate volume 30-80 cc
2. can stop taking anticoagulants

Question 2

peri-operative complications of TURP show they include:

Answer 2

transfusion (2%), TUR syndrome (0.8%), clot retention (4.5%), urinary tract infection (UTI) (4.1.%) and recatheterisation (4.5%) [

Question 3

Late complications of TURP include:

Answer 3

bladder neck contractures (2%), urethral strictures (4.1%) and stress urinary incontinence (0.6%)

Question 4

TURP COMPLICATIONS: ___ is also seen in the majority (65.4%) and ___ in a smaller proportion (6.5%) [7], although the latter may be more commonly seen in those that undergo watchful waiting than undergo a TURP

Answer 4

retrograde ejaculation erectile dysfunction

Question 5

EAU guidelines state that __ or ___ should be offered to surgically treat men with prostates between 30mL and 80mL volume

Answer 5

B-turp, conventional turp

Question 6

theoretical advantages of B-turp over conventional turp:

Answer 6

Less energy is required to resect prostatic tissue, with potential benefits for effective coagulation, and it permits the use of saline as an irrigant solution, thus almost eliminating the risk of TUR syndrome

Question 7

meta-analysis comparing B-TURP to conventional TURP, there was a clear benefit for B-TURP with regard to peri-operative morbidity:

Answer 7

a transfusion odds ratio of 0.49 a TUR syndrome odds ratio of 0.22 a mean reduction in length of stay of 0.79 days a clot retention odds ratio of 0.47

Question 8

The most recent major meta-analysis comparing B-TURP to conventional TURP showed: no significant/significant difference in IPSS scores, QoL score or PVR at 12 months a significant/ small mean difference in Qmax __, in favour of B-TURP, at 12 months

Answer 8

no significant difference in IPSS scores, QoL score or PVR at 12 months a small mean difference in Qmax (1.26mL/s), in favour of B-TURP, at 12 months

Question 9

TRUE/FALSE B-TURP lacks the high-quality, long-term follow-up data of conventional TURP.

Answer 9

TRUE

Question 10

(Ho:YAG) laser.

Answer 10

holmium yttrium-aluminum-garnet laser

Question 11

Transurethral incision of the prostate (TUIP) refers to a __ incision of the bladder outlet ____, with the aim of being a less invasive option than TURP.

Answer 11

longitudinal without removing tissue

Question 12

Efficacy and complications of TUIP: A meta-analysis from 2010 of 10 RCTs, of moderate to poor quality, involving 392 men undergoing TUIP, showed equivalence in___ and __ outcomes at 12 months.

Answer 12

A meta-analysis from 2010 of 10 RCTs, of moderate to poor quality, involving 392 men undergoing TUIP, showed equivalence in IPSS (or other symptom scores) and QoL outcomes at 12 months [19].

Question 13

Efficacy and complications of TUIP: There was a suggestion that TUIP produced a smaller improvement in __ at 12 months, although this was not significant

Answer 13

Qmax

Question 14

T/F A higher re-operation rate was seen with TUIP

Answer 14

A higher re-operation rate (18.4% versus 7.2%) was seen with TUIP

Question 15

TUIP vs TURP : There was a statistically significant reduction/increase in ___ in TUIP , but no difference in the risk of __.

Answer 15

anejaculation rates ED.

Question 16

There are no studies on the optimal limits of prostate size for TUIP, but most RCTs used a cut-off prostate volume of 30mL (some used 60mL), and therefore EAU guidelines recommend TUIP as the first-line option for prostates of less than __ without a ___ lobe

Answer 16

30mL less than 30mL without a middle lobe

Question 17

two approach for open prostatectomy

Answer 17

It can be performed via a transvesical (Freyer) or retropubic (Millin) approach.

Question 18

EAU and NICE guidelines recommend offering OP for the surgical treatment of prostates__ in volum

Answer 18

>80 cc

Question 19

efficacy of HOLEP At one year follow-up there was a small difference in favour of HoLEP for (3)

Answer 19

1 IPSS (mean difference 0.91), 2 Qmax (mean difference 1.6 mL/s) and 3 PVR

Question 20

Photoselective vaporisation of the prostate uses a ____ or KTP side-firing laser with a 532nm wavelength that is absorbed by __ to vaporise prostatic tissue whilst aiming to cause effective coagulation.

Answer 20

lithium tribunate (LBO)

hgb

Question 21

Bipolar transurethral vaporisation of the prostate (B-TUVP)

This utilises the plasma effect of a bipolar electrode to ___ prostate tissue whilst causing ___. This has previously been performed with monopolar systems

Answer 21

plasma effect

haemostasis

Question 22

was developed in the 1980s and is a minimally invasive procedure using a transurethral device to heat the prostate and cause necrosis of prostatic tissue

Answer 22

Transurethral microwave therapy (TUMT)

Question 23

transurethral needle ablation (TUNA)

recommended by EAU?

Answer 23

false\

TUMT and TUNA are minimally invasive procedures that can be performed under local anaesthetic, but their inferior efficacy has led to them falling out of fashion.

Question 24

Prostatic urethral lift is a technique where a permanent implant made from ___ stainless steel and suture material is inserted transurethrally to compress the ___ lobes of the enlarged prostate and produce a ___

Answer 24

nitinol,

LATERAL

larger urethral channel.

Question 25

The EAU recommends PUL as treatment for men interested in preserving ___ with prostates less than __ in volume and with no middle lobe

Answer 25

ejaculatory function

70 ml

Question 26

The WATER study

1. baseline subjects
2. comparison
3. results:

Answer 26

prostate between 30mL and 80mL

Aquablation or TURP (55% monopolar/45% bipolar)

Non-inferiority was demonstrated in terms of symptom relief and safety at six months’ follow up!

There were no significant differences in IPSS reduction (mean 16.9 with Aquablation, 15.1 with TURP), Qmax increase (mean 10.9mL/s with Aquablation, 8.9mL/s with TURP) or PVR reduction (mean 55mL with Aquablation, 64mL with TURP).

Question 27

In PAE (__) , ___ of the prostatic arteries is performed by interventional radiologists, followed by __ with microparticles. The consequent __ is thought to cause shrinking of the prostate. __ is usually performed prior to the procedure.

Answer 27

Prostatic artery embolisation (PAE)

superselective catheterisation

embolisation

reduction in blood supply

CT angiography

Question 28

UroLift was recently shown to be suitable for patients with __

Answer 28

UroLift was recently shown to be suitable for patients with median lobes.