Campbell BPH/LUTS Medical Management 2021

Question 1

Frequency volume charts should be used during basic evaluation of ___ or ___.

Answer 1

Prevalent storage LUTS or nocturia

** FVCs = mainstay for assessment of nocturia

Question 2

Nocturia definition

Answer 2

The complaint that an individual has to wake at night one or more times to void.

Question 3

FVC duration: ___

Answer 3

3 days

Question 4

Urine dipstick test and/or urine microscopy is suggested in ___.

Urine cytology should always be requested in men with ___, especially if they have ___.

Answer 4

All patients complaining of LUTS.

Severe storage symptoms and dysuria
A smoking history

Question 5

The value of PSA testing i patients with LUTS (3):

Answer 5

Assess the risk and eventually rule out the presence of PCa

Estimate PV

Predict BPH-related outcomes

Question 6

When to measure PSA: ___

Exception: ___

Answer 6

Measure PSA if diagnosis of PCa will change management.

Exception: life expectancy < 10 years

Question 7

PSA level where PV would be > 40 mL in these ages:

50s: ___
60s: ___
70s: ___

Answer 7

PSA level at PV > 40 mL, at age ranges:

50s: 1.6 ng/mL
60s: 2.0 ng/mL
70s: 2.3 ng/mL

** Also cited in EAU guidelines

Question 8

According to Guess et al., (1993), serum PSA level is reduced by 40-50% after ___ months of 5ARIs.

Answer 8

12 months

p. 3345

Question 9

TRUE or FALSE:

GFR should be assessed routinely in patients with LUTS.

Answer 9

FALSE.

Serum creatinine may be assessed if renal impairment is suspected based on medical history or if surgical treatment is considered.

MTOPS: <1% of men with LUTS experienced kidney failure over a period of 4 years.

Question 10

PVR volume regarded as important: > ___ mL

< ___ mL is considered nonsignificant

Answer 10

> 50 mL = important

< 30 mL = nonsignificant

• • Ultrasound should be used to assess PVR volume
• • Abnormal PVR NOT highly correlated with BOO (can also be DUA)

Question 11

PVR volume should be assessed during ___.

Answer 11

During basic workup and follow-up of patients with LUTS

** Monitor PVR closely if patient chooses nonsurgical therapy.

Question 12

Uroflowmetry main parameters

Answer 12

Qmax (peak urinary flow rate/PFR)

Voided volume

Flow pattern

Question 13

PFR cutoff ___ could be used to define BOO, but does NOT differentiate between obstruction and bladder decompensation.

Answer 13

15 mL/s

** Uroflowmetry is optional in LUTS, but recommended before any active treatment.

Question 14

The gold standard for assessment of LUTS pathophysiology.

Characterized by 2 evaluations: ___ and ___

Answer 14

Invasive urodynamic test

Filling cystometry and PFS

** It is used to identify DO, DUA, low bladder compliance, and BOO

Question 15

Cystometry assesses the ___ phase, detects ___.

Answer 15

Storage phase
Involuntary detrusor contractions, which may identify DO.

** DO = may benefit from anticholinergic drugs alone or in combination

Question 16

PFS assesses the ___ phase.

Differentiate: BOO and DUA based on flow rate and detrusor pressure

Answer 16

Voiding phase
Detrusor pressure and flow rate

BOO = impaired flow rate with increased detrusor pressure
DUA = impaired BOTH flow rate and detrusor pressure

Question 17

Urodynamics NOT recommended routinely for LUTS, except in these specific scenarios: (5)

Answer 17

• Previously unsuccessful invasive treatments for LUTS
• Cannot void more than 150 mL
• PVR volume greater than 300 mL
• > 80 years of age with predominantly voiding
  LUTS
• <50 years of age with predominantly
  voiding LUTS

ALSO: PFS for patients with Qmax >10mL/s before surgical treatment is considered

Question 18

TRUE or FALSE

Routine upper tract ultrasonography is recommended in patients with LUTS.

Answer 18

FALSE.

** Imaging assessment of the upper tract is currently suggested for patients with LUTS combined with an elevated serum creatinine level or large PVR volumes.
ALSO: History of hematuria, UTI, urolithiasis, or prior urinary tract surgery

Question 19

Prostate volume should be assessed by TRUS/suprapubic before: ___ or ___

Answer 19

5ARI treatment
OR
BPH surgery (to choose most appropriate technique)

Question 20

Cystourethrogram is suggested for: ___

Answer 20

Additional diagnostic test when urethral strictures or bladder anomalies are suspected.

Question 21

TRUE or FALSE

Cystourethroscopy is useful for the diagnosis of BOO and to determine the need for treatment.

Answer 21

FALSE.

A poor correlation between BOO and cystourethroscopy findings has been widely reported.

USE FOR: gross hematuria, bladder CA, recurrent UTIs or urethral injury, previous urethral or prostate surgery

Question 22

Watchful waiting rationale

Answer 22

A number of patients with LUTS suggestive of BPH are affected by an indolent, nonprogressive disease that does not require active treatment.

Question 23

WW patients should be followed up every ___ to detect progression/complications.

Answer 23

Every year/yearly

Question 24

WW Fluid management (4)

Answer 24

Daily fluid intake 1500-2000 m
Avoid inadequate/excessive fluid intake based on FVC
Fluid restriction when symptoms are inconvenient
Fluid restriction in the evening for nocturia (2 hours before sleep)

Question 25

WW Caffeine and alcohol self-management (3)

Answer 25

Avoid caffeine
Avoid alcohol in the evening if nocturia is bothersome
Small-volume alcoholic drinks (wines and spirits, vs. beer)

Question 26

WW Toileting and Bladder Retraining

Answer 26

Advise double-voiding (extra time on toilet to empty bladder completely)
Urethral milking for dribbling
Bladder retraining (increase minimum time between voids to 3 hours, min voided volume 200-400 mL)
Avoid constipation

Question 27

Treatment for:
Male LUTS (no indications for surgery)
No bothersome symptoms

Answer 27

WW

Question 28

Treatment for:
Male LUTS (no indications for surgery)
Bothersome symptoms
Predominant

Answer 28

Education
Lifestyle advice
+/- vasopressin analogue

Question 29

Treatment for:
Male LUTS (no indications for surgery)
Bothersome symptoms
Storage symptoms predominant

Answer 29

Education + lifestyle advice with or without muscarinic receptor antagonist/beta –3 agonist

Question 30

Treatment for:
Male LUTS (no indications for surgery)
Bothersome symptoms
Storage symptoms, polyuria and nocturia NOT predominant
Prostate > 40 mL, long term

Answer 30

Education + lifestyle advice with or without

5α-reductase inhibitor ± α1- blocker/PDE5l

Question 31

Treatment for:
Male LUTS (no indications for surgery)
Bothersome symptoms
Storage symptoms, polyuria and nocturia NOT predominant
Prostate < 40 mL

Answer 31

Education + lifestyle advice with or without α1-blocker/PDE5l

Question 32

Treatment for:
Male LUTS (no indications for surgery)
Bothersome symptoms
Storage symptoms, polyuria and nocturia NOT predominant
Prostate < 40 mL
With residual storage symptoms

Answer 32

Education + lifestyle advice with or without α1-blocker/PDE5l

Add muscarinic receptor antagonist/beta –3 agonist

Question 33

Patients with successful TWOC: ___% will fail within ___ months

Answer 33

80% will fail to void within 6 months