泌尿系梗阻 中山大学 外科学.ppt

Urinary tract obstruction （泌尿系梗阻）,Daohu Wang Associate Professor Department of urology The 1st Affiliated Hospital SUMS,Introduction,a system of tube obstruction will affect secretion and excretion of urine final results: hydronephrosis, renal failure obstruction at different place,Causes of obstruction,classification: mechanical and dynamical congenital, acquired and iatrogenic common causes: stone, tumor, ectopic vessel, nephroptosis, stricture, BPH, reflux, pregnancy,Pathophysiology,dilatation of the urinary tract early stage: tubular wall hypertrophies late stage: thinning of the tubular wall prolonged obstruction below the bladder: hydronephrosis urinary back flow pyelovenous and pyelolymphatic pyelosinus pyelotubular,Benign prostatic hyperplasia（良性前列腺增生症）,Introduction a common cause of bladder outlet obstruction symptoms appear after 50 years,The prostate,Etiology,still obscur testosterone DHT growth factors,Pathology,Normal anatomical zones BPH derived from TZ degree of obstruction unparallel to its size hydronephrosis, detrusor hypertrophy, trabeculae, cellules,diverticulum, stones, hernia, infection, retention,Pathology of BPH,Pathology of BPH,Clinical manifestations,symptom not parallel to prostate size prostatism: frequency, urgency, nocturia dysuria retention,Complications, Infection: cystitis, epididymitis Haematuria: bladder stone infection Renal impairment,Diagnosis,history and physical exam DRE: enlarged prostate, middle furrow disappear TRUS urodynamics others: cystogram, cystoscope,Differentiate diagnosis,prostate cancer bladder cancer urethral stricture neurogenic bladder,Management of BPH,Medical treatment Surgery,Medical Treatment,5a-reductasefinasteride, a-receptor inhibitor Phenoxybenzamine, Prazosin, Phytotheapeutic agents,Theory of a-blocker,Current AR-blockers,Non-selective: Phenoxybenzamine Selective: Prazosin (Minipress) Terazosin (Hytrin) Doxazosin (Cardura) Alfuzosin (Xatral, Xatral SR, Xatral XL) Subtype selective (1a) Tamsulosin (Harnal),5a- reductase,Dihydrotestosterone (DHT) is synthesized from testosterone via the enzyme 5-reductase In the majority of androgen target tissues 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 baldness,Current 5a-reductase,Finasteride Dutasteride,Plant Extracts,The 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 responsible to drugs repeat infection and hematuria with hydronephrosis, hydroureter, bladder stones or diverticula residual urine 40ml,Surgical choices,open surgery retropubic suprapubic perineal endoscopic surgery TURP or TVP TULP,TURP,Key points of the chapter,Etiology of u