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AUA BPH Flashcards

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1
Q
A
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2
Q

What hormones are necessary for BPH to develop?

A

Testosterone and DHT (dihydrotestosterone). BPH does not develop if these hormones are absent before puberty.

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3
Q

At what age does BPH typically begin and what are the prevalence rates at age 60 and 80?

A

Starts at age 40–45; 60% prevalence at age 60 and 80% at age 80.

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4
Q

What does BPE stand for and what is its median growth rate per year?

A

Benign Prostatic Enlargement; median growth rate is 1.9%–2.5% per year.

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5
Q

What is BPO and what are its components?

A

Benign Prostatic Obstruction; has mechanical (static) and dynamic (muscle tone) components.

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6
Q

What is BOO and what are some causes?

A

Bladder Outlet Obstruction; causes include BPO, urethral stricture, and bladder mass.

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7
Q

What does LUTS stand for and how does its frequency change with age?

A

Lower Urinary Tract Symptoms; increases in frequency and severity with age, affecting 50% by age 80.

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8
Q

What are the key components of BPH evaluation?

A

History, AUA Symptom Index/IPSS, physical exam (including prostate), urinalysis.

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9
Q

What are the IPSS score ranges for symptom severity?

A

0–7: Mild, 8–19: Moderate, 20–35: Severe.

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10
Q

What PVR value should prompt consultation for non-neurogenic chronic urinary retention?

A

PVR > 300 mL.

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11
Q

What uroflowmetry value suggests BOO?

A

Qmax < 10 mL/s (specificity 70%, sensitivity 47%).

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12
Q

What formula is used for the BOO Index (BOOI)?

A

BOOI = Pdet@Qmax – 2 × Qmax; >40 = obstructed, <20 = no obstruction.

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13
Q

What is the Bladder Contractility Index (BCI) formula?

A

BCI = Pdet@Qmax + 5 × Qmax; >150 = strong, 100–150 = normal, <100 = weak.

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14
Q

Define POD in terms of urine output.

A

> 200 mL/h for 2 consecutive hours or >3,000 mL/day.

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15
Q

What are risk factors for POD?

A

High serum creatinine, high serum bicarbonate, residual urine >1150 mL, signs of fluid overload.

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16
Q

What is the fluid replacement recommendation for POD?

A

Replace 0.5 mL for every 1 mL of urine output.

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17
Q

Name the main classes of medications for BPH.

A

Alpha-blockers, 5-alpha-reductase inhibitors (5ARI), PDE5 inhibitors, combination therapy, antimuscarinics, beta-3 agonists.

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18
Q

What is a key side effect to ask about before starting alpha-blockers?

A

Intraoperative Floppy Iris Syndrome (especially with tamsulosin).

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19
Q

For which prostate size and PSA level are 5ARIs recommended?

A

Volume >30 cc, PSA >1.5 ng/mL.

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20
Q

What adjustment is needed for PSA when on 5ARIs?

A

Double the measured PSA value.

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21
Q

What are the main side effects of 5ARIs?

A

Decreased libido (6.4%), erectile dysfunction (8.1%), ejaculatory disorder (0.8%), gynecomastia (0.5%).

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22
Q

What dose of tadalafil is used for LUTS?

A

5 mg per day.

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23
Q

What is the typical improvement in IPSS with PDE5 inhibitors?

A

Change in IPSS vs placebo: 2.35–4.21.

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24
Q

When is combination therapy (alpha-blocker + 5ARI) indicated?

A

Moderate-severe symptoms, prostate >30 mL, PSA >1.5 ng/mL.

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25
What is the main indication for anticholinergics in BPH?
LUTS with overactive bladder symptoms, provided PVR <200 mL.
26
What effect does mirabegron have on voiding frequency?
Statistically significant decrease in urgency and voiding frequency.
27
What should be prescribed before a voiding trial in AUR?
Oral alpha-blocker, at least 3 days before trial.
28
Name three indications for surgical intervention in BPH.
Renal insufficiency secondary to BPH, refractory urinary retention, recurrent UTI, recurrent bladder stones or hematuria, LUTS refractory to meds.
29
What is the retreatment rate after TURP?
2%.
30
What is the risk of retrograde ejaculation after TURP?
48%.
31
What is post-TURP syndrome and its main cause?
Hyponatremia from fluid absorption during monopolar TURP.
32
What is the maximum recommended correction of serum sodium in hyponatremia?
≤12 mEq/L in the first 12 hours.
33
What is the formula for BOOI?
Pdet@Qmax – 2 × Qmax; >40 = obstructed, <20 = none.
34
What is the formula for BCI?
Pdet@Qmax + 5 × Qmax; >150 = strong, <100 = weak.
35
What is the PVR threshold for consultation?
>300 mL (consultation), >1150 mL (POD risk).
36
What is the POD urine output definition?
>200 mL/h x2h or >3,000 mL/day.
37
What is the PSA adjustment for 5ARIs?
Double measured PSA.
38
What is the TURP retreatment rate?
2%.
39
What is the TURP retrograde ejaculation rate?
48%.
40
What are the main features of Prostatic Urethral Lift (Urolift)?
For 30–80 gm, no median lobe, no ED/ejaculatory dysfunction, 13.6% retreatment at 5 years.
41
What are the main features of Water Vapor Thermal Therapy (Rezum)?
30–80 gm, treats median lobe, 4.4% retreatment at 4 years, no sexual dysfunction.
42
What are the main features of Laser Enucleation (HoLEP/ThuLEP)?
Size-independent, low transfusion risk, suitable for anticoagulated patients.
43
What are the main features of Aquablation?
30–80 gm, less retrograde ejaculation than TURP.
44
What is the best outlet procedure for patients who cannot stop anticoagulation?
Laser prostatectomy (HoLEP, PVP, ThuLEP).
45
How should post-TURP syndrome be managed?
Monitor sodium/osmolality, use 3% saline for symptomatic hyponatremia, avoid rapid correction (>12 mEq/L in 12h).
46
What are the main risk factors for bladder stones in BPH?
Urinary retention, neurogenic bladder, foreign bodies, high pH.
47
Should bladder stones be removed at the time of TURP?
Yes, as combined treatment improves outcomes.
48
What is PVP?
Photoselective Vaporization of the Prostate (PVP) is a minimally invasive surgical procedure for treating benign prostatic hyperplasia (BPH) using a high-powered laser to vaporize excess prostate tissue.
49
What laser technology is used in PVP?
PVP uses a 532 nm wavelength laser (commonly 120 or 180 W side-fire laser), which is preferentially absorbed by hemoglobin, allowing for effective tissue ablation and vaporization.
50
What are the main features of PVP?
Suitable for prostates with apposed lateral lobes; higher conversion to TURP if prostate >60 gm. Uses lower energy for apposed lateral lobes. Avoid fluid warmers due to higher temperatures from the laser.
51
How does the efficacy of PVP compare to TURP?
PVP provides similar improvements in IPSS (symptom score), reoperation rates, and incontinence rates compared to TURP.
52
What is the transfusion risk with PVP?
PVP has a lower transfusion rate compared to monopolar TURP (<1% vs 4%), and is similar to bipolar TURP.
53
What is the retreatment rate after PVP?
The retreatment rate for PVP (using 120 W and 180 W lasers) is similar to that of TURP.
54
What are the indications for PVP?
Men with moderate to severe LUTS due to BPH. Especially considered for patients at higher risk of bleeding or those on anticoagulation.
55
What are the advantages of PVP?
Minimally invasive, lower risk of bleeding, shorter catheterization and hospital stay, comparable efficacy to TURP.
56
What are potential complications of PVP?
Dysuria (painful urination), urethral stricture, urinary tract infection, rarely, need for reoperation or conversion to TURP.
57
What is UroLift?
UroLift is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses small permanent implants to lift and hold enlarged prostate tissue away from the urethra, improving urine flow without cutting, heating, or removing tissue.
58
How does the UroLift system relieve BPH symptoms?
The UroLift Delivery Device is inserted through the urethra, and tiny implants are placed to retract the obstructing prostate lobes, creating an open channel for urine flow.
59
Who is eligible for UroLift treatment?
Men with moderate to severe lower urinary tract symptoms (LUTS) due to BPH, typically with prostate sizes up to 80 grams, and who wish to preserve sexual function.
60
What are the advantages of UroLift compared to other BPH treatments?
No cutting, heating, or removal of prostate tissue Minimal downtime; often no catheter required Preserves sexual function (no new erectile or ejaculatory dysfunction) Performed as a same-day outpatient procedure Rapid symptom relief, often within 2 weeks Suitable for patients who want to avoid long-term medications or more invasive surgery.
61
What should patients expect after the UroLift procedure?
Most go home the same day, usually without a catheter Common temporary side effects: blood in urine, mild pelvic discomfort, burning with urination, increased urgency (usually resolve within 2–4 weeks) Return to normal activities within a few days.
62
What are potential side effects or risks of UroLift?
Temporary urinary symptoms (dysuria, hematuria, urgency) Rare need for retreatment or additional procedures Sexual side effects are very rare compared to other procedures.
63
How long do the benefits of UroLift last?
Implants are intended to be permanent Durable symptom relief shown for at least 4–5 years in clinical studies Does not preclude future BPH treatments if needed.
64
What materials are used in UroLift implants?
Nitinol (nickel-titanium alloy) capsular tab Stainless steel urethral tab Polyethylene suture connecting the tabs.
65
How many UroLift implants are placed during the procedure?
Usually 2–4 implants, but can vary depending on prostate size and anatomy.
66
Who should not receive UroLift?
Men with prostate volume >100 cc Active urinary tract infection Urethral conditions preventing device insertion Prominent median lobe (relative contraindication).
67
What is the Rezum procedure?
Rezum is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses water vapor (steam) to ablate excess prostate tissue, relieving urinary obstruction.
68
How does Rezum relieve BPH symptoms?
The Rezum system delivers controlled bursts of steam directly into the prostate tissue via a transurethral device. The thermal energy causes cell death, shrinking the prostate and opening the urethra.
69
Who is eligible for Rezum therapy?
Men with prostates sized 30–80 grams, including those with median lobe enlargement, who have moderate to severe lower urinary tract symptoms (LUTS) due to BPH.
70
What are the main features and benefits of Rezum?
Treats both lateral and median lobes; minimally invasive; outpatient procedure; preserves sexual function (no new erectile or ejaculatory dysfunction); rapid symptom relief, typically within 3 months; lower retreatment rate compared to some other minimally invasive therapies.
71
What should patients expect after Rezum?
Most go home the same day, usually with a temporary catheter for a few days. Common side effects: blood in urine, dysuria, increased urinary frequency/urgency (usually resolve within weeks). Return to normal activities within a few days.
72
What are potential side effects or risks?
Temporary urinary symptoms (dysuria, hematuria, urgency); urinary retention (may require catheter); low risk of sexual side effects; retreatment rate: 4.4% at 4 years.

Prostate (benign) (13 decks)

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