medical management of BPH

Question 1

__ period is considered a reasonable compromise to increase the accuracy of frequency-volume charts without decreasing patient adherence.

Answer 1

. A 3-day period

Question 2

___ be considered in patients presenting with storage symptoms and a history of smoking to rule out urothelial neoplasms.

Answer 2

URINE CYTOLOGY

Question 3

The diagnosis of bladder outlet obstruction relies on __.

Answer 3

8. a. Invasive urodynamic tests.

Question 4

t/f Among adrenergic receptors, the β-1 subfamily is poorly represented in the lower urinary tract and is not targeted by any of the currently available treatments for LUTSs.

Answer 4

true

Question 5

Uroselective agents have high affinity for the __ and __ receptors; as such, they have greater selectivity for prostatic and urethral tissue.

Answer 5

a-1, a-1d

Question 6

. As a consequence of the vascular side effects associated with the inhibition of α-1b receptors,__is frequently reported after treatment with terazosin and doxazosin. 1

Answer 6

dizziness

Question 7

Randomized trials assessing treatment with dutasteride and finasteride have shown a prostate volume reduction ranging from __ after __ months of treatment.
Ss

Answer 7

15% to 30%

6-24 months

Question 8

Patients should be warned regarding a higher risk of __ associated with 5-ARI treatment.

Answer 8

depressive symptoms

Question 9

___ monotherapy has been shown to significantly decrease the IPSS score as compared with placebo. Several randomized trials demonstrated significant relief Conversely, there is no evidence of improved __ parameters with PDE5is alone.

Answer 9

pDE5i

no improvement of urinary flow

Question 10

__ TRIAL demonstrated that combination therapy of an α-blocker and a 5-ARI can significantly reduce the risk of disease progression at long-term follow-up. This effect was greater than with both placebo and monotherapy

Answer 10

The MTOPS trial

Question 11

The CombAT study showed a ___ in the risk of surgical treatment for patients treated with dutasteride as compared with tamsulosin.

Answer 11

greater reduction

Question 12

The PSA test should be considered for patients with a life expectancy longer than __

Answer 12

10 years.

Question 13

should be considered if bladder motility alterations (e.g., detrusor overactivity, detrusor underactivity) are suspected

Answer 13

4. Invasive urodynamic tests

Question 14

__ are effective in relieving LUTSs, either alone or in combination with α1-blockers.

Answer 14

PDE5is

Question 15

phytotherapy in LUTS

Answer 15

s, repens

Question 16

The use of __ is recommended to increase the odds of a successful TWOC.

Answer 16

a1-blockers

Question 17

. Dutasteride and finasteride have been shown to significantly decrease the risk of __ ` in patients with moderate to severe LUT

Answer 17

AUR

Question 18

In the course of performing a monopolar TURP under spinal block, the nurse anesthetist reports the patient is suddenly markedly confused, brachycardic, and hypertensive. Patient is likely experiencing TUR syndrome; thus rapid termination is needed. The height of the irrigating fluid above the patient should be carefully chosen. Investigators have demonstrated that the ideal height of the fluid was ___ above the patient. This appears to be the minimal height to maintain good vision but also not lead to excessive systemic fluid absorption. Increasing the height ___ above this leads to increased pressure in the prostatic fossa and a greater than twofold increase in systemic fluid absorption. Diagnosis of this condition is made by assessment of neurologic status and comparison to laboratory values. Serum sodium should be obtained in long, large resections postoperatively (or intraoperatively if concern exists). A serum sodium of ___ indicates a significant dilution and may lead to coma or seizures. Transient visual disturbances or blindness indicate central nervous system (CNS) toxicity and are obviously very distressing to all the parties involved. If profound central nervous symptoms are noted, judicious administration of ___ should be instituted and formulas exist to help guide this resuscitation as overly rapid correction of hyponatremia may lead to a___

Answer 18

60 cm

10 cm

less than 120 mEq/L

Hypertonic saline

demyelinating lesion of the brain (central pontine myelinolysis).

Question 19

risk factors for TUR syndrome: Failure to use ___, ___ irrigating solution and the bipolar electroresection system

steps to prevent TUR syndrome:

the use of isotonic, iso-osmolar irrigating solution and the bipolar electroresection system this risk has theoretically been eliminated.

While most authors agree that TUR syndrome is caused by dilutional hyponatremia, there have been alternate etiologies proposed. Excessive glycine absorption can lead to liberation of __ from metabolic pathways leading to immediate or delayed encephalopathic symptoms. Several steps can be taken to prevent this complication. Use of a __ resection method should certainly be considered. The __of the irrigating fluid above the patient should be carefully chosen. Use the ___ to maintain good vision but also not lead to excessive systemic fluid absorption.

Answer 19

risk: Failure to use isotonic, iso-osmolar irrigating solution and the bipolar electroresection system.

ammonia

bipolar

height

minimal height

Question 20

ETIOLOGY OF TUR SYNDROME: Absorption of non–___-containing irrigating fluid, leading to an acute __. Absorption of non– sodium-containing irrigating fluid into the __ that is exposed during resection is the etiology of the disease. This risk appears to be unique to __; other BPH techniques (such as bipolar TURP, HoLEP, and laser vaporization) use isotonic/iso-osmolar irrigating fluid such as normal saline. The ideal height of irrigating fluid was determined to be __ cm above the patient, as this balanced the benefits of visualization with systemic absorption. Heights above this level will lead to an increased systemic absorption. In general, symptoms of TUR syndrome begin with a serum sodium of ___

Answer 20

non- sodium

dilutional hyponatremia

prostatic venous system

Monopolar turp

60 cm above the patient

less than 120 mEq/L.

Question 21

TRUE regarding transurethral incision of the prostate (TUIP)

It may have a ___ of ejaculatory dysfunction in patients when done unilaterally. The procedure is relatively short and does not cause __. The procedure is only appropriate for small prostate glands (generally __), and no prostate adenoma is removed. ___ occurs in up to 37% of patients. Although this is controversial, most authors believe that the risk of retrograde ejaculation is lower if done __ as opposed to bilaterally

Answer 21

lower rate

TUR SYNDROME

less than 30 ml

RETROGRADE EJACULATION

unilaterally