BPH

Question 1

What is used to grade severity of LUTS?

Answer 1

International prostate symptom score (IPSS) which includes frequency, nocturia, urgency, weak stream and straining. It is reccomended for asking BPH.

Question 2

What type of urinary abnormalities is associated with BPH?

Answer 2

Urinary frequency and urgency
Urinary hesitancy and incomplete emptying
Weak urinary stream

Question 3

What investigations can be done for BPH?

Answer 3

International prostate symptom score for severity of LUTS
Digital rectal exam
PSA test

Question 4

What is the referral guideline for prostate cancer?

Answer 4

Suspicion of prostate malignancy on DRE

Question 5

What is given for BPH pharmacologically?

Answer 5

Tamsulosin alpha blocker which relaxes smooth muscle in the prostate and bladder neck when IPSS score is 8 or greater

Finasteride

Question 6

What is the role of tamsulosin in LUTS?

Answer 6

Alpha blocker Used for dynamic obstruction. Risk of postural hypotension

Question 7

What is the role of 5-alpha reducate inhibitors?

Answer 7

Reduce prostate size
-> ideal for men at high risk of progression

Question 8

How does multiparity cause incontinence?

Answer 8

Results in stress inconteince because of weakening of pelvic floor muscles.

Indicated by leakage with coughing

Question 9

How does excessive caffeine fuse issues with incontinence? .

Answer 9

Causes urgency and frequency incontinence

Question 10

How does obesity cause icnotneince?

Answer 10

Stress incontinence due to weakening of the abdominal wall
Previous abdominal surgery can also cause this

Question 11

How does episiotomy cause incontinence?

Answer 11

Leads to stress incontinence

Question 12

What are the reversible causes of incontinence?

Answer 12

DIAPPERS’:
D - Delirium
I - Infection
A - Atrophic vaginitis or urethritis
P - Pharmaceutical (medications)
P - Psychiatric disorders
E - Endocrine disorders (e.g. diabetes)
R - Restricted mobility
S - Stool impaction

Question 13

What are importantly investigations for incontinence?

Answer 13

Physical examination of pelvic muscle function

Bladder diary

Urinalysis

Cystometryntonmeasure bladder pressure

Question 14

What investigation is performed for suspected fistula?

Answer 14

Contrast into bladder

Question 15

What is the conservative management of incontience?

Answer 15

Avoiding caffeine and fizzy sugary drinks

Pelvic floor exercises

Question 16

What is the drug management of stress incotneince?

Answer 16

Duloxetine if conservative management fails

Question 17

What is the surgical management for incotnience?

Answer 17

Mid urethral slings are gold standard to compress urethra and is minally invasive

Alternatives include pedsarie device ideal for prolapse

Bulking agents

Question 18

What is the medical management of urge incontience?

Answer 18

Anticholinergic medication like oxybutynin, tolderodine and fesoterodine.

Question 19

Which medication can be used for urge incontience in older people?

Answer 19

Mirabegron a b3 agonist

Question 20

What procedures can be performed for urge incontinence?

Answer 20

Injection of Botox
Sacral neuromoduoation

Question 21

What is functional incotnience associated with?

Answer 21

Alcohol
Sedation
Dementia

Question 22

What is the cause of overflow incotnience?

Answer 22

Under activity if detrusor muscle or urinary outlet pressure is hig like constipation or orostatism

Question 24

What is a surgical treatment for BPH?

Answer 24

Trans-urethral resection of prostate to reduce size

Question 25

What is the most definitive test to determine aetiology of voiding dysfunction and lower urinary tract symptoms?

Answer 25

Urodynamic studies, which include a filling and storage phase and voiding phase.

Question 26

What does the International Prostate Symptom Score (IPSS) classify?

Answer 26

The severity of lower urinary tract symptoms (LUTS) and their impact on quality of life ## Footnote The IPSS is a widely used tool in urology.

Question 27

What score range indicates severely symptomatic LUTS?

Answer 27

Score 20-35 ## Footnote This indicates a significant impact on quality of life.

Question 28

What score range indicates moderately symptomatic LUTS?

Answer 28

Score 8-19 ## Footnote This suggests a moderate impact on quality of life.

Question 29

What score range indicates mildly symptomatic LUTS?

Answer 29

Score 0-7 ## Footnote This reflects a minimal impact on quality of life.

Question 30

What is the first line drug for BPH?

Answer 30

Tamsulosin

Question 31

What is the second line drug for BPH?

Answer 31

Finasteride, 5 alpha reductase inhibitor

Question 32

What is the managmeent if BPH with IPSS score less than 7?

Answer 32

Conservative measure like reducing caffeine and alcohol intake, despite an enlarged smooth prostate

Question 33

What should be done if BPH does not respond to medication?

Answer 33

Transurethral resection of the prostate

Question 34

What causes issues with Hesitancy, Poor or intermittent stream, Straining, Incomplete emptying and erminal dribbling

Answer 34

Voiding issues

Question 35

What causes sensation of incomplete emptying and dribbling?

Answer 35

Post-micrutitiion dribbling

Question 36

What causes Urgency Frequency Nocturia Urinary incontinence

Answer 36

Storage pathology

Question 37

How to manage overactive bladder with persisting symptoms?

Answer 37

Anti muscarinic drugs like oxybutynin, tolteroodine and darifenacin

Question 38

What are the immediate release anti-muscarinic?

Answer 38

Oxybutynin Toterodine

Question 39

How to manage overactive bladder with persisting symptoms?

Answer 39

Anti muscarinic drugs like oxybutynin, tolteroodine and darifenacin

Question 40

Which drug should be considered if first like antimscarinics fail to ,anagement overactive bladder?

Answer 40

Mirabegro

Question 41

What is the INITIAL management of BPH?

Answer 41

Two-way Foley catheter and trial of doxazosin

Question 42

Which anticholinergic are given for BPH?

Answer 42

Tolterodine