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17th European Urology Residents Education Programme > Male voiding LUTS > Flashcards

Male voiding LUTS Flashcards

(62 cards)

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1
Q

What is the percentage of men above 65 years with LUTS?

A

30%

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2
Q

How many men with LUTS will undergo prostate surgery?

A

around 20%

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3
Q

Basic clinical evaluation for LUTS:

A 
History
Assesment of symptoms (ex IPSS)
Frequency Volume Charts (ex tidsmiktion)
Digital Rectal Examination
Urinalysis
Blood Tests
-creatinine/eGFR
-PSA
Flow rate
Post void residue
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4
Q

When it comes to the size of the prostate, how sensitive is Digital Rectal examination?

A

It can discriminate between prostate volume > or < 50mL

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5
Q

What is a Mildly symptomatic IPSS-score?

A

1-7

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6
Q

What is a Moderately symptomatic IPSS-score?

A

8-19

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7
Q

What is a Severly symptomatic IPSS-score?

A

20-35

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8
Q

Predict prostate size with a PSA of >1,5 ng/mL:

A

> 30 ng/mL

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9
Q

When should you measure PSA in a patient with LUTS?

A

If a diagnosis of prostate cancer will change the management

If it assists in the treatment and/or decision making process

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10
Q

Does DRE underestimate or overestimate prostate volume?

A

underestimates

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11
Q

Why should PVR (post-void residual) be assesed at first clinical visit for a patient with LUTS?

A

High baseline PVR is predictive for future symptom progression

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12
Q

What information should be included in a bladder diarie?

A 
Voiding frequency
Voiding volume
Fluid intake
Use of pads
Activities
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13
Q

What additional tests can be considered when evaluating LUTS?

A 
Pressure flow studies
Endoscopy
Upper urinary tract US scan
Transrectal ultrasound
Bladder wall thickness
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14
Q

Lifestyle advice for LUTS:

A

reduction of fluid intake (not below 1500ml)
moderation of caffeine and alcohol intake
urethral milking to avoid post micturition dribbling
Distraction techniques- breathing exercises, mental tricks
Bladder re-training (to around 400 mls)

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15
Q

How quickly does Alpha 1 adrenoreceptors give effect?

A

1-2 weeks

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16
Q

What is the effect of Alpha 1 adrenoreceptors on LUTS?

A

improves symptoms /flow

you can expect an improvement in Qmax by 15-30%

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17
Q

What are the most common side-effects of Alpha 1 adrenoreceptors?

A

Asthenia
Dizziness (orthostatic)
Hypotention

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18
Q

What Alpha 1 adrenoreceptor is more likely to cause floppy iris syndrome?

A

Tamsulosin

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19
Q

What are the effects of 5 Alpha reductase inhibitors?

A

Improves symptoms/flow
Reduce prostate volume
Reduce longer-term risk of AUR and surgery

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20
Q

How quickly does 5 Alpha reductase inhibitors give effect?

A

6-12 months

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21
Q

How much does 5 Alpha reductase reduce the volume of the prostate?

A

by 15-25%

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22
Q

How much does 5 Alpha reductase reduce PSA?

A

50% by 6 months

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23
Q

How big is the risk reduction for surgery because of BPH with 5 Alpha reductase?

A

55%

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24
Q

How big is the risk reduction for surgery because of AUR with 5 Alpha reductase?

A

57%

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25
What is the patophysiology behind Antimuscarin drugs?
Main neurotransmitter in the bladder (acetylcholine) stimulates muscarinic receptors of detrusor smooth muscle cells
26
What type of Muscarin receptor subtype is present in the bladder?
M2 (80%) and M3 (20%) in the detrusor
27
What is the effect of antimuscarin drugs?
Reduction in: - voiding frequency - nocturia - urge incontinence - IPSS
28
What size prostate does antimuscarine drugs have the greatest effect on?
small prostates
29
What are the most common side effects of antimuscarine drugs?
Dry mouth (<16%) Constipation (<4%) Dizziness (<5%)
30
What LUTS symptom can become worse from antimuscarine treatment?
BOO (PVR can increase, no increase rate of AUR)
31
What should be included in the follow-up of patients on antimuscarine treatment?
PVR | IPSS
32
What type of drug i Mirabegron?
An antimuscarine, selective Beta3 receptor agonist
33
What is the mechanism of Mirabegron?
Mirabegron mediates relaxation of the detrusor muscle during the storage phase of the micturition cycle, thus incereasing bladder storage capacity
34
What is the drug containing Mirabegron called?
Betmiga
35
What are the contraindications for Mirabegron?
Not well controlled hypertention has higher incidence of CV events
36
What is the mechanism of PDE-5 inhibitors?
NO stimulates synthesis of cyclic GMP which reduces smooth muscle tone of detrusor, prostate and urethra PDE-5 inhibitors prevent hydrolysis of cyclic GMP
37
What is the effect on LUTS by PDE-5 inhibitors?
Less storage and voiding symptoms | Significant QoL improvement
38
What is the improvement on IPSS by PDE-5 inhibitors?
17-37%
39
What are the contraindications for PDE-5 inhibitors?
Nitrates guanylatcyklas-stimulators kraftigt nedsatt leverfunktion, hypotension (blodtryck < 90/50 mmHg), nyligen genomgången stroke eller hjärtinfarkt samt känd hereditär degenerativ näthinnesjukdom
40
What kind of drug is Desmopressin? | And how does it work?
A vasopressin analogue It binds to V2-receptors in the renal collecting duct Increases the water re-absorbtion
41
What are the practical considerations when prescribing Desmopressin?
1x1 before sleep dose titration 0,1 mg -->0,4 mg regular check of sodium concentration
42
When should you use a combination of α-blocker and | a 5α-reductase inhibitor?
Men with moderate-to-severe LUTS | and risk of disease progression (prostate volume >40mL)
43
When should you use a combination of α-blocker and a muscarinic receptor antagonist?
Men with moderate-to-severe LUTS if relief of storage symptoms has been insufficient with monotherapy with either drug
44
What is a reason to be careful when prescribing a combination of α-blocker and a muscarinic receptor antagonist?
Post-void residual volume > 150 mL
45
What are the indications for BPO surgery?
Bothersome LUTS refractory to medical treatment (relative indication) Recurrent/refractory urinary retention Overflow incontinence Recurrent UTI's Bladder stones of diverticula Treatment resisten macroscopic haematuria due to BPH/BPE Dilatation of upper urinary tract due to BPO
46
If considering surgery for LUTS what should be completed before?
Use a bladder diary for at least 3 days Use a validated symptom score questionnaire (IPSS) Physical examination including digital rectal examination Uroflowmetry Prostate imaging
47
How effective is an open prostatectomy?
63-86% reduction of LUTS | 60-87% improvement of IPSS
48
What is the blood transfusion rate after an open prostatectomy?
7-10%
49
What are the complications after an open prostatectomy?
Bleeding (need for transfusion 7-10%) Urinary incontinence ≤ 10% Bladder neck stenosis/ urethral stricture ≈5%
50
What is the re-operation rate for TurP?
2,6-7,4%
51
In men with moderate-to-severe LUTS, when is the prostate size an indication for open surgery?
> 80 mL
52
What is TUR-syndrome?
Absorbtion of fluids used to irrigate the bladder causing a disturbed electrolyte balance mostly hyponatraemia. Symptoms and electrolyte imbalance depends on what fluid is used.
53
What are the benefits of monopolar TurP vs bipolar TurP?
Similar surgical result Lower TUR-syndrome and clot-retention Shorter irrigation and catheter time
54
In men with moderate-to-severe LUTS, when is the prostate size an indication for TurP?
30-80 mL prostate
55
In men with moderate-to-severe LUTS, when is the prostate size an indication for transurethral incision?
< 30 mL prostate without middle lobe
56
What technique can be used instead of TurP for transurethral resection of the prostate?
HoLEP(holmium laser) and 532nm (greenlight) laser vaporisation Thulium Laser vaporisation (ThuVaRP) Diodelaser (DiLRP) (not enough science yet but seems good at least short-term)
57
Which patients should ideally be considered for 532nm laser treatment for LUTS?
Patients with anticoagulant treatment or high cardiovascular risk
58
When is Thulium laser vaporisation (ThuVaRP) an alternative to TurP and HoLEP?
Men with moderate-to-severe LUTS and small- or medium-sized prostates
59
What is the weakness with HoLEP (holmium laser) and 532 nm (greenlight) laser vaporisation
Increased risk of need for retreatment 19-25%
60
When is greenlight (532nm laser) a safe and effective treatment?
In small-medium prostates
61
Techniques for less invasive treatment options for LUTS?
Mechanical Device: PUL -prostatic urethral lift TIND -temporary implantable nitinol device Rezum (water vapor thermal therapy) Aquaablation
62
What are the benefits of Less invasive treatment options for LUTS?
Outpatient procedure Local anaesthesia Minimal adverse events Better ejaculatory function

17th European Urology Residents Education Programme (17 decks)

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