Mnemonic based approach to grading and planning treatment for BPH

MNEMONIC: FUNWISE

During the last 1 month, how often/many times you had to –

1. Frequency: Urinate again <2 hours after you finished urinating ?

2. Urgency: Difficulty in postponing the urine ?

3. Nocturia: Get up to urinate from bedtime to wakeup ?

4. Weak stream: Weak urinary stream ?

5. Intermittency: Stopped and started again several times when urinated ?

6. Straining: Push or strain to begin urination ?

7. Emptying incomplete: Sensation of incomplete emptying of bladder after finishing urination ?

Irritative symptoms – FUN (Frequency, Urgency, Nocturia)

Obstructive symptoms – WISE (Weak stream, Intermittency, Straining, Emptying incomplete)

Each of the 7 questions are graded out of 5 (0-5) for a total score of 35.

• 0 – Not at all
• 1 – <1/5 time
• 2 – <1/2 time
• 3- 1/2 time
• 4 – >1/2 time
• 5 – Almost always

Grading:

0-7: Mild

• Candidates for watchful waiting – reducing fluid intake after evening meal and avoiding decongestants

8-19: Moderate and 20-35: Severe

• Indications for surgery: Urinary retention, Recurrent UTI, Gross hematuria, Bladder stones, Renal insufficiency, Severe prostatism, Maximum flow rate (PFR) <10 ml/s and Increased postvoidal residual urine (PVRU)
  • Indications for open prostatectomy: Prostate size >100 cc, Requiring bladder surgery (stone removal, tumor, diverticulectomy), Failed medical management
    • Transvesical (Freyer’s) approach – Bladder opened
    • Retropubic (Millin’s) approach – Bladder pushed to one side
  • Other modalities: TURP (Transurethral resection of prostate), TUIP (Transurethral Incision of Prostate), Minimally invasive (Prostatic stents, Thermotherapy, Transurethral Needle Ablation or TUNA, High Focused Ultrasonography or HIFU, Laser treatment)
• Medical therapy if no indications of surgery:
  • If prostate size <40 cc – Alpha blockers (decrease tone of smooth muscle in prostate and bladder neck) e.g. Tamsulosin (usually prescribed as 0.4 mg PO HS for few months), Doxazosin, Prazosin, Terazosin (1 mg HS)
  • If prostate size >40 cc – 5 alpha reductase inhibitor (decreases Dihydrotestosterone) eg. Finasteride (usually prescribed as 5 mg/day as a single oral dose for few weeks to months), Dutasteride (0.5 mg/day as a single oral dose)

The International Prostate Symptom Score (IPSS) uses the same 7 questions as the AUA Symptom Index, but adds a “Disease Specific Quality of Life Question” (sometimes referred to as the “bother score”) and scored on a scale from 0 to 6 points (“delighted” to “terrible”).

• If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?
  • Delighted – 0
  • Pleased- 1
  • Mostly satisfied – 2
  • Mixed – 3
  • Mostly disappointed – 4
  • Unhappy – 5
  • Terrible – 6

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Disclaimer:  *Data source: INTAGE SRI, ADULT DIAPERS SALES, APR’10- JAN’16. The views about the product described here are solely in experience of the writer and does not represent view of the Lifree company or this website.

Written by Mr Shrestha