105

Minimally Invasive and Endoscopic

Management of Benign Prostatic

Hyperplasia

Kevin T. McVary; Charles Welliver

Questions

1.In the last 30 years of benign prostatic hyperplasia (BPH) management, which of the following has been a general trend in endoscopic surgical treatment?

a.With the widespread use of medical therapy for BPH, there has been a trend toward less use of surgical management.

b.The advent of the bipolar resection system increased the overall percentage of endoscopic procedures done as transurethral resections of the prostate (TURPs).

c.Socioeconomic factors involved in acceptance and use of laser technology have not been described.

d.Younger men are more likely to undergo treatment for BPH than older men.

e.Retreatment rates have not influenced the continued adoption of new endoscopic and minimally invasive treatments.

2.With regard to defining outcomes in BPH treatment, which of the following statements is NOT correct?

a.Intent to treat analyses are commonly reported.

b.Subjective symptoms (such as dysuria) can be influenced by observer reporting.

c.Reports of long-term treatment efficacy are highly influenced by a loss of patients to follow-up and, possibly, reporting of responder data only.

d.Comparisons across surgical techniques are often unfair because new

technologies are frequently compared with a historic, and often inferior, data set.

e.In a randomized controlled trial (RCT), comparison with TURP assumes that the surgeon performing the TURP has been sufficiently trained and can produce predictable results.

3.The minimum antibiotic coverage for treatment of BPH according to the American Urological Association (AUA) best practice statement is:

a.ceftriaxone.

b.ampicillin.

c.fluoroquinolone.

d.trimethoprim.

e.acyclovir.

4.TURP should begin with resection of the:

a.apical portion of the prostate.

b.prostate floor.

c.bladder neck.

d.median lobe, if present.

e.anterior portion of the prostate.

5.Transurethral resection (TUR) syndrome is caused by:

a.absorption of fluid during procedures such as holmium laser enucleation of the prostate (HoLEP) and bipolar TURP.

b.absorption of non–sodium-containing irrigating fluid, leading to an acute dilutional hyponatremia.

c.irrigating fluid placed at a less than ideal height above the patient.

d.a serum sodium of greater than 130 mEq/L.

e.intraoperative ureteral injury.

6.Which of the following is TRUE of bipolar compared with monopolar TURP?

a.In a meta-analysis of patients undergoing bipolar TURP, authors concluded that by treating 50 patients with bipolar TURP, one case of TUR syndrome could be prevented.

b.A relative risk of 0.53 for blood transfusion with bipolar resection was found in meta-analysis.

c.Improved visualization during bipolar TURP may also lead to a decrease in capsular perforations and operating time.

d.Late complications such as bladder neck contracture and need for retreatment of BPH do not appear to be much different from those found with conventional TURP.

e.All of the above.

7.Which of the following is TRUE about transurethral vaporization of the prostate (TUVP)?

a.There is a large startup cost associated with the procedure due to the required purchase of new generators and equipment.

b.Frequently leads to lower hemostasis related complications (transfusion, clot retention) compared to monopolar TURP

c.Is available only as a monopolar technology

d.Was first described in 2005

e.It leads entirely to tissue vaporization.

8.Transurethral microwave therapy (TUMT) has been shown to:

a.frequently cause erectile dysfunction.

b.improve AUA Symptom Score (AUASS) by approximately 60% at 1 year.

c.have comparable results in both the low energy and high energy platforms.

d.increase density of nerve endings in the prostate.

e.induce changes in prostate volume of greater than 50%.

9.Sham studies on urologic procedures for lower urinary tract symptoms (LUTS) due to BPH:

a.frequently show statistically significant decreases in AUASS.

b.are poorly tolerated by the patient.

c.have significant side effects and should not be performed as part of research.

d.have never shown a statistically significant improvement in objective measures such as peak urinary flow.

e.have never been performed.

.Which of the following is the most commonly reported complication/adverse event associated with TUMT?

a.Blood transfusion

b.Urinary tract infection

c.Erectile dysfunction

d.Urethral stricture

e.Incontinence

.Transurethral needle ablation (TUNA):

a.now universally regulates temperature based on impedance.

b.is required to be done in a hospital-based operating room with

overnight admission.

c.should only be performed on prostates less than 50 mL in size.

d.has an equivalent need for retreatment for lower urinary tract symptoms (LUTS) due to BPH compared to TURP.

e.is not recommended in patients with metallic pelvic prostheses.

. Which of the following is TRUE regarding transurethral incision of the prostate (TUIP)?

a.It commonly results in TUR syndrome.

b.It is generally only used in prostates larger than 60 mL.

c.It causes retrograde ejaculation in 80% of cases.

d.It results in removal of a large volume of prostate adenoma.

e.It may have a lower rate of ejaculatory dysfunction in patients when done unilaterally.

. With regard to laser safety, which of the following statements is correct?

a.Eye protection is required for the surgeon only.

b.All windows or wall openings from the operating room (OR) must be covered.

c.Signs denoting that a laser is in use need only be displayed on the most commonly used door for that operating room.

d.Eye protection is required only when a video camera is not used during the case.

e.All laser energy is readily absorbed by air/irrigating fluid, making it safe to use in the OR.

. Holmium laser resection of the prostate (HoLRP) differs from HoLEP in that HoLRP:

a.follows anatomic planes to remove the prostate in lobes.

b.requires the use of a morcellator.

c.preceded HoLEP chronologically and conceptually.

d.has been shown to be superior to TURP in recent meta-analyses.

e.uses a thulium laser.

. Which of the following is TRUE of HoLEP?

a.Transient urinary retention is seen in more than 50% of patients.

b.A morcellator-related bladder injury has never been reported.

c.Bladder neck contracture may be more common in smaller prostate glands.

d.Overall complication rates increase significantly with increasing prostate size.

e. When observed, urinary incontinence is generally permanent.

.Prostate vaporization:

a.ideally uses a wavelength that is readily absorbed by hemoglobin for improved hemostasis.

b.utilizes coagulation of tissue over ablation of tissue.

c.was ideally suited for the neodymium laser.

d.increases with decreasing laser wattage.

e.occurs frequently during TURP.

.Patients on anticoagulation who undergo photoselective vaporization of the prostate (PVP) have an increased risk of:

a.erectile dysfunction.

b.blood transfusion.

c.TUR syndrome.

d.ejaculatory dysfunction.

e.time in the hospital after procedure.

.The mechanism of action of prostate urethral lift is:

a.implantation of a radiation-eluting implant that causes tissue ablation with time.

b.primarily in compression of peripheral zone of the prostate.

c.primarily in compression of the transition zone of the prostate.

d.delayed tissue necrosis of the prostatic urothelium causing a decrease in local irritative symptoms.

e.implantation of a stent within the lumen of the urethra to relieve obstruction by the lateral lobes.

.When using the prostate lift for treatment of LUTS due to BPH, implants are placed where in the prostate anatomically?

a.Anterolaterally

b.Posterolaterally

c.Anteriorly

d.Posteriorly

e.In the peripheral zone

.Which statement is TRUE of prostate embolization?

a.The pelvic vasculature is generally straightforward, and the procedure is technically not challenging.

b.It is achieved by occluding the internal iliac vessels.

c.It is applicable to a wide variety of patients.

d.It incurs no radiation to the patient.