BPH guidelines and CUR white paper

Question 1

Initial BPH/LUTS workup (4)

Answer 1

Medical history
Physical exam
IPSS
UA

Question 2

Initial BPH counseling

Answer 2

behavioral, medical, procedural

Question 3

Follow up interval and steps after initial BPH treatment

Answer 3

4-12 weeks
IPSS
(PVR, uroflow optional)

Question 4

Testing before BPH intervention

Answer 4

-Consider prostate size/shape assessment via US, cysto, CT, or MRI
-PVR
-Uroflow
-Consider pressure flow studies

Question 5

What alpha blockers can be used?

Answer 5

Alfuzosin, doxazosin, silodosin, tamsulosin, terazosin (choose based upon age, comorbidities, adverse events)
-ASK ABOUT CATARACT surgery plans

Question 6

5-ARI indications and use

Answer 6

-Monotherapy can be used if >30g, PSA >1.5, or palpable BPH
-Can be used for bleeding
-Ok for combo therapy
-Discuss sexual side effects

Question 7

Indications for surgical therapy for BPH

Answer 7

renal insufficiency due to BPH
Urinary retention
rUTIs
Recurrent bladder stones or BPH
LUTS and unwilling/unable to use other treatments
NOT asymptomatic bladder diverticulum

Question 8

When can TUIP be used

Answer 8

Prostate <30g and LUTS

Question 9

When can urolift be used

Answer 9

30-80g, no middle lobe, desires ejaculation

Question 10

When can rezum be used?

Answer 10

30-80g, men who desire ejaculation

Question 11

When can aquablation be used?

Answer 11

30-80g with LUTS

Question 12

Temporary prostatic urethral stent indications

Answer 12

25-75g prostate, no median lobe, LUTS

Question 13

Best options for patients at high risk of bleeding?

Answer 13

HoLEP, ThuLEP, PVP

Question 14

What qmax suggests obstruction

Answer 14

<10mL/s

Question 15

IPSS cutoff

Answer 15

<8 mild
<20 moderate
20+ severe

Question 16

Which alpha blocker causes less anejaculation?

Answer 16

alfuzosin

Question 17

5-ARI mechanism

Answer 17

Block conversion of T to DHT

Question 18

5-ARI side effects

Answer 18

Low libido
Ejaculatory dysfunction
breast pain
mood swings
post-finasteride syndrome (maybe)
?increased high-grade prostate cancer

Question 19

Alpha blocker side effects

Answer 19

anejaculation
Dizziness
Headache
Postural hypotension
Floppy iris syndrome

Question 20

5-ARI medications available

Answer 20

Finasteride
Dutasteride

Question 21

Definition of chronic urinary retention

Answer 21

> 300mL on 2+ checks for at least 6 months

Question 22

High risk CUR

Answer 22

Hydro
Bladder stones
CKD3
Recurrent UTIs

Question 23

Low bladder compliance

Answer 23

<15mL/cm H20

Question 24

Can asymptomatic low risk CUR patients be placed on surveillance?

Answer 24

yes