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FRCSC 2020 Guidelines > CUA GL 2018 BPH > Flashcards

CUA GL 2018 BPH Flashcards

1
Q

What diagnostic tests are mandatory for someone presenting with BPH/LUTS?

A

History, physical( including DRE), Urinalysis

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2
Q

What are recommended investigations?

A

IPSS
AUA-SI
PSA( if life expectancy >10 or knowing PSA would change management, help estimate prostate Size)

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3
Q

What is optional?

A

serum creatinine, uroflowmetry, PVR, sexual function questionnaire, voiding diary(including frequency volume charts for those suspected of having nocturnal polyuria), urine cytology,

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4
Q

What tests are not recommended?

A

cytology, cystoscopy, UDS, radiological evaluation of upper tract, prostate US, prostate biopsy

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5
Q

What are indications for BPH/MLUTS surgery?

A

Recurrent UTIs, Recurrent or refractory urinary retention, bladder stones, renal dysfunction secondary to BPH, recurrent hematuria, symptom deterioration despite medical therapy, patient preference

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6
Q

what procedures/investigations should be done before intervention

A

Cystoscopy( to determine prostate size and presence of significant median lobe)

Recommended: US(abdominal or TRUS) to help determine modality of surgery.

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7
Q

Which patient should be advised to do lifestyle modifications/ watchful waiting?

A

mild symptoms, IPSS<7, if they have severe bother can also offer them treatment.

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8
Q

What are lifestyle changes that can be offered to patients with non-bothersome symptoms?

A

1- Fluid restriction, particularly before bedtime
2- Avoidance of caffeinated beverages, alcohol and spicy foods
3- avoidance/monitoring of some drugs(diuretics, decongestants, antihistamines, antidepressants)
4- Pelvic floor exercises
5-avoidance or treatment of constipation
6- Timed or organized voiding(bladder retraining)

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9
Q

What are first line medical therapies for men with symptomatic bother? name 5. which one requires dose titration

A

alpha blockers: Alfuzosin, doxazosin, terazosin, silodosin(most potent alpha 1-a blocker) , tamsulosin(IFIS)
doxazosin and terazosin need dose titration

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10
Q

Name 3 benefits of ARIs for BPH?

A

1- 25-30% volume reduction of prostate
2- decrease risk of urinary retention
3- decrease the need for surgical intervention
seems to work best in patients with PSA>1.5 and Prostate volume>30cc
alpha blockers dont do this

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11
Q

name 3 factors suggesting risk of BPH progression?

A

PSA>1.4, Prostate V>30, age>50

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12
Q

what are benefits of combination therapy? can you dc alpha blockers after a while if there is a good response

A

Improve flow rates, improved symptom score, decreased risk of urinary retention, decreased risk of prostate surgery

yes, after 6-9 months

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13
Q

What PVR would be concerning if prescribing someone antimuscarinics or beta 3 agonists.

A

250-300, older age be cautious they say in the guideline

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14
Q

What can you offer someone with combination storage and voiding symptoms

A

alpha blocker and beta 3 agonist or antimuscarinics

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15
Q

What is recommended for men with ED and MLUTS/BPH?

A

long acting PDE5i(tadalafil 5mg), studies have shown improvement in IPSS, storage and voiding symptoms and quality of life

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16
Q

What is recommended in men with nocturnal polyuria?

A

desmopressin( an arginine vasopressin (AVP), ADH analogue) , check Sodium 7 days post and 30 days.

17
Q

are there any phythotherapies recommended for MLUTS, BPH?

A

No

18
Q

What are complications of TURP?

A

Bleeding, infection, capsular perforation, TUR syndrome, bladder neck contracture, incontinence, retrograde ejaculation, ED, surgical retreatment(2% per year)

19
Q

Who should have M-TURP? What about B-TURP?

A

moderate to severe symptoms V: 30-80 cc

Same as M-TURP but has lower morbidity

20
Q

who should have bipolar plasma kinetic vaporization of prostate(BPKVP)?

A

Prostate <60ml, shorter OR time, cath time, hospital stay,. comparable peak flow rates, PSA reduction, IPSS to M-TURP

21
Q

who do they recommend open simple for?

A

Prostate>80ml, concurrent open bladder procedure(stones, diverticulum), inability to place patient in dorsal lithotomy position due to severe hip disease

22
Q

who is PVP recommended for?

A

alternative in men with moderate to severe LUTS

men on anticoagulation or high cardiovascular risk

23
Q

Who should have HoLEP?

A

anyone, if surgeon can do it

24
Q

Who sould have diode laser vaporization

A

alternate surgical approach for men on anticoagulation

25
Q

What about thulium Yag?

A

alternative treatment. can do it for small or large glands

26
Q

What is the role of TUIP?

A

Prostate<30ml without a middle lobe

27
Q

Who should have TUMT?

A

carefully selected well informed men, outpatient procedure, retreatment rate at 5 years 42-59%

28
Q

What is the role of Transurethral needle ablation (TUNA):

A

No role, they suggest we don’t offer it, high retreatment rates

29
Q

What are complications of prostatic stents? what’s their role?

A

migration, encrustation, exacerbation of LUTS, misplacement, For unfit patients for surgery as an alternative to catheterization if they got a functional detrusor

30
Q

What is the role of UroLift?

A

Prostate<80ml, no middle lobe and interested in preserving ant ejaculation. durable but less effective than TURP

31
Q

Who can have Rezum(convective water vapor energy ablation)?

A

Prostate<80ml, can have middle lobe, interested in preserving anti ejaculation… NOTE: this is different from waterjet ablation. waterjet ablation can be given to guys with prostate<80ml with or without middle lobe and is better than TURP for ejaculation

32
Q

What is the role of temporary implantable nitinol device?

A

no role right now, dont offer it, in research

33
Q

What are complications of prostatic artery embolization?

A

non targeted embolization can lead to : transient ischemic proctitis, bladder ischemia, urehtral and ureteral stricture and seminal vesicle ischemia

34
Q

Should you offer prostate artery embolization to patients?

A

No

35
Q

can you offer 5-ARI to patients with symptomatic prostate enlargement in the absence of significant bother

A

yes, to prevent progression of disease

36
Q

We suggest that men with AUR secondary to BPH
may be offered…….
therapy during the period of
catheterization

A

alpha-blocker

37
Q

We suggest that a trial with a ……is appropriate in men

with BPH-related hematuria

A

a 5ARI

FRCSC 2020 Guidelines (49 decks)

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