《良性前列腺增生(英文)》由会员分享，可在线阅读，更多相关《良性前列腺增生(英文)（40页珍藏版）》请在金锄头文库上搜索。
1、Benign Prostatic Hyperplasia,Selection of the treatment of BPH,Case Presentation,Bruce Crosby, 67 y.o. retired salesman Married, nonsmoker, drinks rarely Generally healthy Takes no medications,History,Increasing urinary symptoms X 7 yrs Get up to urinate 2 to 3 times every night, weak urine stream,
2、feeling bladder not completely empties. No hematuria, no retention, no previous urinary problems AUA symptom index 10 (moderate symptoms), bothersome score 4,Examination,Discussion Point # 1,How confident are you in a diagnosis of BPH? What further investigations would you do (if any)? What is your
3、next step?,Please describe what is BPH. Should each BPH need to be treated? What is the purpose to treat BPH?,QUESTION,Benign Prostatic Hyperplasia It is NOT cancer (benign) Enlargement of the prostate gland,what is BPH?,Half of all men over the age of 60 will develop an enlarged prostate By the tim
4、e men reach their 70s and 80s, 80% will experience urinary symptoms,Every man except.,understanding the prostate,Walnut-shaped gland that forms part of the male reproductive system Surrounds the urethra - the tube that carries urine from the bladder out of the body,Secretes semen which carries sperm
5、 During orgasm, prostate muscles contract and propel ejaculate out of the penis,understanding the prostate,what causes BPH?,BPH is part of the natural aging process, like getting gray hair or wearing glasses BPH cannot be prevented BPH can be treated,common symptoms,Frequent and urgent need to urina
6、te, especially at night Dribbling or leaking after urination Intermittent or weak stream,Straining to urinate Pain or burning during urination Feeling that the bladder never completely empties,what causes these symptoms?,Prostate grows with age and time Pressure on the urethra restricts urine flow,i
7、gnoring the symptoms.,Risk of bladder and kidney damage Impact on quality of life,.will not make them go away!,n,n,when should BPH be treated?,BPH needs to be treated ONLY IF: the symptoms are severe enough to bother the patient and affect his quality of life The patient have frequent urinary tract
8、infections,“You dont realize how something like this (BPH) affects your quality of life - until you get it back.”,How to diagnosis clinical BPH? Could you please list the treatments of clinical BPH?,QUESTION,how is BPH diagnosed?,AUA Symptom Score (questionnaire) Medical history Physical examination
9、 Prostate exam Urinalysis PSA blood test Transrectal ultrasound of prostate,enlarged prostate,“Watchful waiting” Medication Surgical approaches open procedures Mini-invasive operation TUR-P Heat therapy laser operation,treatment options,Discussion Point # 2,Mr. Crosby wants treatment of some sort. W
10、hich type of active treatment would you suggest? What are the advantages and disadvantages of that treatment?,“watchful waiting”,If the symptoms are mild, the condition should be monitored by the doc 1 to 2 times yearly,the doctor may offer suggestions that help reduce symptoms Avoid caffeine and al
11、cohol Avoid decongestants and antihistamines,n,medication,First line of defense against bothersome urinary symptoms Manage the condition - dont fix it Two major types: Muscle relaxants - relax the prostate and provide a larger urethral opening Shrink the prostate gland,Nonpharmacological Therapy of
12、BPH,Phytotherapy Produced from plants Saw palmetto, South African star grass, stinging nettle No significant toxicity Few trials, results inconsistent,Medical Therapy of BPH,Often recommended for men with moderate symptoms and bother For men with no absolute indications for surgery 2 classes of agen
13、ts alpha-adrenoreceptor antagonists 5- reductase inhibitors,Alpha-blockers in BPH,Block -adrenoreceptors Produce relaxation of smooth muscle in prostate and bladder neck Rapid onset of action Three agents available terazosin doxazosin tamsulosin Useful in large or small prostates,5- Reductase Inhibi
14、tors,Finasteride the only available agent Improves symptoms in placebo-controlled trials Long latency period before effect Meta-analysis suggests useful only for men with large prostates Sexual side effects ( libido),Benefits Convenient No loss of work time Minimal risk,Disadvantages Expensive Not a
15、ll are covered by Medicare Drug Interactions Must be taken every day Manages the problem instead of fixing it,medication,side effects of medication,Dizziness Headaches Fatigue Impotence Loss of sexual drive,surgical treatment,TURP,(transurethral resection of the prostate),“Gold Standard” of care for
16、 BPH Uses an electrical “knife” to surgically cut and remove excess prostate tissue Effective in relieving symptoms and restoring urine flow,the “gold standard”- TURP,Disadvantages Greater risk of side effects and complications 1-4 days hospital stay 1-3 days catheter 4-6 week recovery,Benefits Widely available Effective Long lasting,possible side effects of,Bleeding May require blood transfusion Electrolyte imbalance (TUR Syndrome) May result in ICU (Intensive Ca
