Campbell Evaluation and Nonsurgical Management of BPH Flashcards
The main goal of the baseline interview
of any patient is ____.
to identify potential causes of LUTS so as to
further address the diagnostic and therapeutic decision-making process with a more patient-tailored approach
The DRE has a double aim: (2)
Obtain baseline estimation of prostate volume.
Exclude palpable nodules or any increased consistency, that may signal the presence of PCA.
** The sensitivity of DRE in detecting PCa is low, with historical
series showing PCa detection rates on biopsy as low as 40% to
50% in the era before prostate-specific antigen (PSA) testing among
patients with positive DRE findings
International clinical guidelines advise that _____ should be used during the basic evaluation of
patients with prevalent storage LUTS or nocturia
FVCs (or their derived forms)
*** Frequency-volume charts (FVCs), recording the voided volume
and the time of each micturition during day and night hours for
24 hours
VS.
*** Bladder diaries, recording the time of micturition, voided volume,
and additional information such as fluid intake, incontinence
episodes, degree of incontinence, pad usage, and degree of urgency
The use of a _____ is suggested in all patients complaining of LUTS
as a part of the baseline evaluation
dipstick test and/or the microscopic evaluation of urine samples
_____ should always be requested in men with severe
storage symptoms and dysuria, especially if they have a smoking
history.
Urine cytology
The value of PSA testing among patients presenting for LUTS is
multiple: _____ (3)
assess the risk and eventually rule out the presence of
PCa;
estimate PV;
and predict BPH-related outcomes.
Current international clinical guidelines suggest measurement of PSA if
_____, excluding, for instance, those ______.
a diagnosis of PCa will change LUTS management,
men with a life expectancy of less than 10 years
PSA level at which there is a 65-70% chance of detection of prostate volume > 40 mL at a specific age.
PSA level at which there is a 65-70% chance of detection of prostate volume > 40 mL at a specific age.
- 6 ng/mL = 50s
- 0 ng/mL = 60s
- 3 ng/mL = 70s
Caution should be paid in patients treated with 5α-reductase inhibitors (5ARIs), given that serum PSA level is reduced by ____
40% to 50% after 12 months of treatment
TRUE or FALSE
The assessment of renal function based on serum creatinine level
or estimated glomerular filtration rate is not routinely suggested in patients with LUTS.
TRUE
The assessment of renal function based on serum creatinine level
or estimated glomerular filtration rate is NOT routinely suggested
in patients with LUTS.
As a whole, AUA guidelines no longer recommend a routine renal function assessment but EAU guidelines suggest assessment of serum creatinine level if renal impairment is suspected on the basis of medical history or when surgical treatment is considered.
PVR volume is defined as _____ . Currently, there is no standardized
definition for a normal PVR volume.
In clinical practice, a PVR volume of ____ is usually considered nonsignificant, whereas PVR volume ____ could be regarded as important.
the volume (mL) of urine left in the bladder at the end of micturition
less than 30 mL (nonsignificant)
persistently greater than 50 mL (important)
ICS Urodynamics Committee for correct assessment of PVR Volume:
• The interval between voiding and PVR volume measurement
should be of short duration.
• Although transurethral catheterization is considered the gold
standard to assess PVR volume, it could be associated with patient
discomfort and the risk for UTIs and urinary tract trauma.
• The ultrasound bladder volume measurement should be used
to assess PVR volume and can be performed with either a
real-time transabdominal ultrasound scanner or a portable
bladder scanner.
The presence of an abnormal PVR volume is [HIGHLY or NOT HIGHLY] correlated with BOO.
not highly
Indeed, an abnormal PVR volume could be the consequence of either BOO or DUA. In this context, the diagnostic accuracy of PVR volume measurement has a positive predictive value of 63% and a negative predictive value of 52% to detect BOO
PVR volume assessment is suggested both during _____.
Men with significant PVR volume should be _____.
basic workup and during the follow-up of patients with LUTS.
monitored closely if they elect to have nonsurgical therapy
Uroflow measurement: _____
The main parameters provided by uroflowmetry: (3)
Electronic recording of the free urinary flow rate throughout the course of micturition.
Qmax (or peak urinary flow rate [PFR]): inaccurate if the voided volume is less than 125 to 150 mL
Voided volume
Flow pattern
*** Average flow rate is considered less accurate than Qmax to detect
BOO
*** There is substantial within-subject variation in terms of uroflowmetry
results among measurements taken either on the same
day or on consecutive days
According to expert opinion, a PFR cutoff of _____ could be used to define outlet obstruction in clinical practice.
15 mL/s
*** a PFR of less than 15 mL/s does not differentiate between obstruction and bladder decompensation.
International clinical guidelines consider uroflowmetry as an _____ test in the assessment of patients with LUTS, although its use is recommended _____.
OPTIONAL
before any active treatment
The invasive urodynamic test is the gold standard for the assessment of LUTS pathophysiology and it is used to identify _______.
Two distinct evaluations investigating the storage
and voiding phase of micturition: _____ and ______.
DO, DUA, low bladder compliance, and BOO.
the filling cystometry and the pressure-flow study (PFS).
videourodynamics refers to the use of ______.
This test allows one to obtain ______.
synchronous radiographic imaging and filling the bladder with contrast medium while cystometry and a PFS are performed.
additional anatomic information by showing the presence of eventual alteration of the bladder profile (diverticula, trabeculation), of vesicoureteral reflux, or of alterations of the pelvic floor activity.
** No clear recommendation is currently provided regarding the use
of videourodynamics
Cystometry allows the assessment of the _____.
It is characterized by _____
storage phase.
a continuous fluid filling of the bladder through a transurethral catheter, with a concomitant measurement of intravesical and abdominal pressure and the display of the detrusor pressure
Cystometry: In patients with LUTS suggestive of BOO, the main goal of this test ____.
is the detection of involuntary detrusor contractions, which may identify DO.
*** The diagnosis of DO could be useful to identify patients who
may benefit from the use of anticholinergic drugs either alone or
in combination with other treatments.
PFS allows assessment of the ____.
It is defined as the measurement of the ______ while
uroflowmetry is performed with a transurethral catheter in place
The joint evaluation of detrusor pressure and flow
rate allows the diagnosis of either _____ or _____.
BOO (characterized by impaired flow rate along with an increased detrusor pressure)
or
DUA
(characterized by the impairment of both flow rate and detrusor
pressure).
As invasive diagnostic modalities, both the European and the American guideline panels do NOT routinely suggest the use of urodynamic tests to assess men with LUTS.
However, PFS is suggested before invasive treatments in some specific scenarios:
• Patients with previously unsuccessful invasive treatments for
LUTS
• Patients who cannot void more than 150 mL
• Patients with PVR volume greater than 300 mL
• Patients older than 80 years of age with predominantly voiding
LUTS
• Patients younger than 50 years of age with predominantly
voiding LUTS
ALSO, AUA: PFS may be performed in patients with a Qmax greater than 10 mL/s before
surgical treatment is considered
TRUE or FALSE
The routine assessment of the upper tract with ultrasonography is NOT recommended in patients with LUTS.
TRUE
** In a population of 6102 patients evaluated in 25 studies by intravenous urography
before prostate surgery, only 7.6% were found to have hydronephrosis.
*** imaging assessment of the upper tract is currently suggested for patients with LUTS
combined with an elevated serum creatinine level or large PVR volumes.
patients with a history of hematuria, UTI, urolithiasis, or prior urinary tract surgery should also be assessed with abdominal ultrasonography