skip to main content

Benign prostatic enlargement treated with tamsulosin before cataract surgery — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

HardUrologyBenign prostatic enlargement treated with tamsulosin before cataract surgeryMSRA

A 73-year-old man with bothersome lower urinary tract symptoms due to benign prostatic enlargement has taken tamsulosin 400 micrograms daily for 18 months, with sustained improvement in hesitancy and weak stream. He is also taking finasteride. He has no postural symptoms and no history of urinary retention. He is scheduled for cataract surgery in 5 days. During pre-operative assessment, he asks his GP whether he should stop tamsulosin because he has read that it can cause operative complications. What is the most appropriate management plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Notify the ophthalmic team of current and previous tamsulosin exposure and obtain their peri-operative plan

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

Tamsulosin exposure is associated with intraoperative floppy iris syndrome (IFIS), which can increase complications during cataract surgery. Crucially, IFIS has been reported both in people currently taking tamsulosin and in those who stopped it previously, including after a longer interval. Although withholding tamsulosin for 1 to 2 weeks has been anecdotally considered helpful, its benefit has not been established. The decisive action is therefore to ensure that the cataract surgeon and ophthalmic team know about current or prior exposure so that they can plan appropriate operative measures. A and D wrongly assume that a short interruption reliably removes the operative risk. B is inappropriate because changing to another alpha-blocker immediately does not address the need to alert ophthalmology; a class effect has also been considered with alpha-1 blockers. E is unjustified because cataract surgery alone is not an indication for permanent withdrawal of effective LUTS treatment. Finasteride reduces progression risk in suitable men but does not make abrupt cessation of an effective alpha-blocker routinely necessary.

Reference: Tamsulosin hydrochloride Zentiva 400 microgram prolonged-release hard capsules - Summary of Product Characteristics (Revised 9 August 2024) — https://www.medicines.org.uk/emc/product/9245/smpc Alfuzosin HCl 2.5 mg film-coated tablets - Summary of Product Characteristics (2026) — https://www.medicines.org.uk/emc/product/5205/smpc Lower urinary tract symptoms in men: management - NICE guideline CG97, drug treatment (Last reviewed December 2024) — https://www.nice.org.uk/guidance/CG97/chapter/recommendations