BPH - Bishay

Question 1

BPH histological diagnosis:

Answer 1

Proliferation of smooth muscle and epithelial cells within the prostatic TRANSITION ZONE.

Question 2

LUTS - Storage Symptoms

Answer 2

frequency

nocturia

Question 3

LUTS - Voiding Symptoms

Answer 3

hesitancy
intermittency
weak stream
dribbling

Question 4

urgency with or without urge incontinence usually with frequency and nocturia

Answer 4

Overactive Bladder Syndrome

Question 5

urodynamic observation of an involuntary detrusor contraction

Answer 5

Detrusor Overactivity

Question 6

Define Benign Prostatic . . .
A) Hyperplasia
B) Enlargement
C) Obstruction

Answer 6

A) Hyperplasia - histological diagnosis
B) Enlargement - gland enlargement
C) Obstruction - obstruction is suspected based on flow rates/urodynamics

Question 7

Bladder Outlet Obstruction

Answer 7

any obstructive process

Question 8

Main drug classes used for treatment of LUTS

Answer 8

Alpha blockers (dynamic)
5-alpha reductase inhibitors (static)

Question 9

Long Acting Alpha Blockers

Answer 9

Terazosin, Doxazosin, Alfuzosin

require dose titration

Question 10

a1 Receptor Blockers

Answer 10

Tamsulosin (Flomax)

Sildosin (Rapiflo)

Question 11

5 alpha reductase inhibitor action

Answer 11

blocks conversion of testosterone to DHT in prostate tissue

average 50% reduction in PSA

Question 12

5 alpha reductase inhibitors are used in patients with a prostate > ______ grams or PSA > _____.

Answer 12

30 grams or PSA > 1.5

Question 13

Patient has a small prostate gland or low PSA. What type of treatment do you use?

Answer 13

alpha-blocker

Question 14

When to consult a urologist:

Answer 14

1) refractory to medical management
2) recurrent urinary retention
3) recurrent UTI
4) renal insufficiency
5) hematuria
6) bladder calculi

Question 15

Cancer in the prostate occurs in what zone

Answer 15

Peripheral Zone

Question 16

Patient presentation of BPH (LUTS)

Answer 16

Lower Urinary Tract Symptoms

1) Direct Bladder outlet obstruction (static component)
2) Increased smooth muscle tone and resistance (dynamic component)
- Frequency, nocturia (storage)
- Hesitancy, intermittency, weak stream, dribbling (Voiding)

Question 17

Index patient according to AUA for BPH

Answer 17

Male aged 45 or older with LUTS

• No history suggesting non-BPH causes
• LUTS may or may not be due to enlarged prostate, BOO, or histological BPH

Question 18

A questionnaire given to patients with LUTS. What is it called, what does it include and ow is it scored?

Answer 18

AUA Symptom Index (AUA-SI). 7 question and 1 quality of life question.
Mild: 0-7
Moderate: 8-19
Severe: 20-35

Question 19

Recommended tests for LUTS

Answer 19

1) Medical hx
2) Assesment of LUTS
3) Severity and bother (AUA-SI)
4) DRE and PE
5) UA
6) Serum PSA
7) Frequency/volume chart

Question 20

Polyuria is defined as:

Answer 20

> 3L in 24 hours

Question 21

Modifiable factors of LUTS

Answer 21

Fluid intake

Question 22

Alpha blockers:

Answer 22

Alfuzosin, doxazosin, Terazosin, Tamsulosin, Silodosin

Question 23

5ARIs

Answer 23

Avodart and Finasteride

Question 24

Patients with LUTS secondary to BPH whom an alpha blocker is offered, what syndrome do you need to worry about?

Answer 24

Intraoperative Floppy Iris Syndrome- If planned cataract surgery, hold alpha blocker until after

Question 25

A patient has LUTS secondary to BPH and without an elevated PVR and mainly irritative symptoms, what should you consider prescribing?

Answer 25

Anticholinergics- M3 receptor (Ex: Oxybutynon)

Question 26

Minimally invasive therapy for LUTS

Answer 26

Transurethral needle ablation-TUNA

Transurethral microwave thermotherapy- TUMT

Question 27

Surgery Treatments for LUTS

Answer 27

1) Transurethral: Incision of prostate (TUIP), Vaporization of Prostate (TUVP), Resection of Prostate (TURP).
2) Open simple prostatectomy
3) Robotic/Laparoscopic simple prostatectomy