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1、Urinary tract obstruction 泌尿系梗阻泌尿系梗阻Daohu WangAssociate ProfessorDepartment of urologyThe 1st Affiliated HospitalSUMSIntroductiona system of tubeobstruction will affect secretion and excretion of urinefinal results: hydronephrosis, renal failureobstruction at different placeCauses of obstructionclas
2、sification: mechanical and dynamical congenital, acquired and iatrogeniccommon causes: stone, tumor, ectopic vessel, nephroptosis, stricture, BPH, reflux, pregnancyPathophysiology dilatation of the urinary tractearly stage: tubular wall hypertrophieslate stage: thinning of the tubular wallprolonged
3、obstruction below the bladder: hydronephrosisurinary back flow pyelovenous and pyelolymphatic pyelosinus pyelotubularBenign prostatic hyperplasia良性前列腺增生症良性前列腺增生症Introduction a common cause of bladder outlet obstruction symptoms appear after 50 yearsThe prostate Etiology still obscurtestosterone DHTg
4、rowth factorsPathology Normal anatomical zonesBPH derived from TZdegree of obstruction unparallel to its sizehydronephrosis, detrusor hypertrophy, trabeculae, cellules,diverticulum, stones, hernia, infection, retentionPathology of BPHPathology of BPHClinical manifestationssymptom not parallel to pro
5、state sizeprostatism: frequency, urgency, nocturiadysuriaretentionComplications Infection: cystitis, epididymitis Haematuria: bladder stone infection Renal impairmentDiagnosis history and physical examDRE: enlarged prostate, middle furrow disappearTRUSurodynamicsothers: cystogram, cystoscopeDifferen
6、tiate diagnosis prostate cancerbladder cancerurethral strictureneurogenic bladderManagement of BPHMedical treatment SurgeryMedical Treatment 5a-reductasefinasteride, a-receptor inhibitor Phenoxybenzamine, Prazosin,Phytotheapeutic agentsTheory of a-blockerCurrent AR-blockersNon-selective: Phenoxybenz
7、amine Selective: Prazosin (Minipress) Terazosin (Hytrin) Doxazosin (Cardura) Alfuzosin (Xatral, Xatral SR, Xatral XL) Subtype selective (1a) Tamsulosin (Harnal)5a- reductaseDihydrotestosterone (DHT) is synthesized from testosterone via the enzyme 5-reductase In the majority of androgen target tissue
8、s either testosterone or DHT binds to a specific androgen receptor to form a complex that can regulate gene expression. DHT is essential for prostate development and growth, the development of the external genitalia and male patterns of facial and body hair growth or male-pattern baldnessCurrent 5a-
9、reductaseFinasterideDutasteridePlant ExtractsThe mode of action of phytotheapeutic agents is unknown The biological effects are unclear although a few RCTs show encouraging data These drugs are not recommended for the treatment of elderly men with LUTS suggestive of BPH indication of surgery not res
10、ponsible to drugs repeat infection and hematuria with hydronephrosis, hydroureter, bladder stones or diverticula residual urine 40mlSurgical choicesopen surgery retropubic suprapubic perinealendoscopic surgery TURP or TVP TULPTURPKey points of the chapterEtiology of urinary tract obstructionPathophysiological changes of UTOEtiology of BPHClinical manifestations of BPHTreatment for BPHReferrence book: campbells urology
