泌尿系统疾病课件：Benign Prostatic Hyperplasia

1、Benign Prostatic HyperplasiaCase PresentationBruce Crosby, 67 y.o. retired salesmanMarried, nonsmoker, drinks rarelyGenerally healthyTakes no medicationsHistoryIncreasing urinary symptoms X 7 yrsGet up to urinate 2 to 3 times every night, weak urine stream, feeling bladder not completely empties.No

2、hematuria, no retention, no previous urinary problemsAUA symptom index 10 (moderate symptoms), bothersome score 4GeneralUrologicalAppears healthyUrethral meatus normal, no phimosisPulse 64/minTestes - small left varicoceleBP 152/88 mm HgProstate size moderately enlarged, Consistency of prostate -rub

3、bery, firm.Median sulcus preserved, no nodules.Abdominal examination normalLimited neurological examination normalExaminationDiscussion Point # 1How confident are you in a diagnosis of BPH? What further investigations would you do (if any)? What is your next step?Please describe what is BPH.Should e

4、ach BPH need to be treated? What is the purpose to treat BPH? QUESTIONBenign Prostatic Hyperplasia It is NOT cancer (benign)Enlargement of the prostate glandwhat is BPH?Half of all men over the age of 60 will develop an enlarged prostateBy the time men reach their 70s and 80s, 80% will experience ur

5、inary symptomsEvery man except.understanding the prostateWalnut-shaped gland that forms part of the male reproductive systemSurrounds the urethra - the tube that carries urine from the bladder out of the bodySecretes semen which carries spermDuring orgasm, prostate muscles contract and propel ejacul

6、ate out of the penisunderstanding the prostatewhat causes BPH?BPH is part of the natural aging process, like getting gray hair or wearing glassesBPH cannot be preventedBPH can be treatedcommon symptomsFrequent and urgent need to urinate, especially at nightDribbling or leaking after urinationIntermi

7、ttent or weak streamStraining to urinatePain or burning during urinationFeeling that the bladder never completely emptieswhat causes these symptoms?Prostate grows with age and time Pressure on the urethra restricts urine flowignoring the symptoms.Risk of bladder and kidney damageImpact on quality of

8、 life.will not make them go away!nnwhen 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 lifeThe patient have frequent urinary tract infections“You dont realize how something like this (BPH) affects your quality of l

9、ife -until you get it back.”How to diagnosis clinical BPH?Could you please list the treatments of clinical BPH?QUESTIONhow is BPH diagnosed?AUA Symptom Score (questionnaire)Medical historyPhysical examinationProstate examUrinalysisPSA blood test Transrectal ultrasound of prostateenlarged prostate “W

10、atchful waiting”MedicationSurgical approaches open procedures Mini-invasive operationTUR-P Heat therapy laser operationtreatment optionsDiscussion Point # 2Mr. Crosby wants treatment of some sort. Which type of active treatment would you suggest? What are the advantages and disadvantages of that tre

11、atment?“watchful waiting”If the symptoms are mild, the condition should be monitored by the doc 1 to 2 times yearlythe doctor may offer suggestions that help reduce symptomsAvoid caffeine and alcoholAvoid decongestants and antihistaminesnmedicationFirst line of defense against bothersome urinary sym

12、ptomsManage the condition - dont fix itTwo major types:Muscle relaxants - relax the prostate and provide a larger urethral openingShrink the prostate glandNonpharmacological Therapy of BPHPhytotherapyProduced from plantsSaw palmetto, South African star grass, stinging nettleNo significant toxicityFe

13、w trials, results inconsistentMedical Therapy of BPHOften recommended for men with moderate symptoms and botherFor men with no absolute indications for surgery2 classes of agentsalpha-adrenoreceptor antagonists5- reductase inhibitorsAlpha-blockers in BPHBlock -adrenoreceptors Produce relaxation of s

14、mooth muscle in prostate and bladder neckRapid onset of actionThree agents availableterazosindoxazosintamsulosinUseful in large or small prostates5- Reductase InhibitorsFinasteride the only available agentImproves symptoms in placebo-controlled trialsLong latency period before effectMeta-analysis su

15、ggests useful only for men with large prostatesSexual side effects ( libido)BenefitsConvenientNo loss of work timeMinimal riskDisadvantagesExpensiveNot all are covered by MedicareDrug InteractionsMust be taken every dayManages the problem instead of fixing itmedicationside effects of medication Dizz

16、inessHeadachesFatigueImpotenceLoss of sexual drivesurgical treatmentTURP (transurethral resection of the prostate)“Gold Standard” of care for BPHUses an electrical “knife” to surgically cut and remove excess prostate tissueEffective in relieving symptoms and restoring urine flowthe “gold standard”-

17、TURPDisadvantagesGreater risk of side effects and complications1-4 days hospital stay1-3 days catheter4-6 week recoveryBenefitsWidely availableEffectiveLong lastingpossible side effects ofBleedingMay require blood transfusionElectrolyte imbalance (TUR Syndrome)May result in ICU (Intensive Care Unit)

18、 Urethral strictureIncontinenceImpotence Retrograde ejaculationTURPSurgical and Minimally Invasive Therapies for BPHTherapyCommentTURPGold standard. Very effective, durable response. Incontinence rate 1%. Requires hospitalization.TUIPTransurethral incision of prostate. Fewer complications, shorter s

19、tay, ? efficacy.TUNATransurethral needle ablation. Outpatient, proven efficacy, durability for 3 years.TUMTTransurethral microwave therapy. Outpatient. Few complications, ? efficacyStentUsed in retention. Short-term benefit, ? long-termWhat is the indications for surgical treatment of BPH?QUESTIONIndications of surgery for BPH Definitive indication:Recurrent retentionResidual urine 60mlBPH with complicationsHydronephropathyVesical stone, diverticulumHernia Severe hematouria due to enlarged prostate Relative indication:Moderate or severe IPSSNo improvement after medi