Benign prostatic hyperplasia with tamsulosin exposure before cataract surgery — MSRA MCQ

Correct answer: B — Inform the cataract surgeon of current tamsulosin exposure and continue treatment pending the ophthalmic team's perioperative plan

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · E = shown as D · B = shown as E

Tamsulosin is associated with intraoperative floppy iris syndrome (IFIS) during cataract surgery, which can increase operative and postoperative ophthalmic complications. The key action is to ensure that the cataract surgeon and ophthalmic team know of both current and previous tamsulosin exposure so that appropriate intraoperative measures can be planned. Stopping tamsulosin 1–2 weeks before surgery has been considered helpful anecdotally, but the SmPC states that benefit has not been established; IFIS has also occurred in people who stopped tamsulosin substantially earlier. Therefore, unilateral cessation is not the best plan, particularly in a man whose LUTS are well controlled. The decision to continue or interrupt treatment should be made with the ophthalmic team. A is unattractive because finasteride does not provide an immediate symptomatic substitute; benefit may require at least 6 months of treatment. D is excessive: planned cataract surgery does not require permanent discontinuation. E misses the essential safety communication and could prevent the surgical team from anticipating and managing IFIS.

Reference: Tamsulosin hydrochloride Zentiva 400 microgram prolonged-release hard capsules – Summary of Product Characteristics (15 August 2024) — https://www.medicines.org.uk/emc/product/9245/smpc Finasteride 5 mg Tablets – Summary of Product Characteristics (2026) — https://www.medicines.org.uk/emc/product/547/smpc NICE CG97: Lower urinary tract symptoms in men: management – Drug treatment (Last updated 3 June 2015) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations