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1、Advances in the Management of BPH,Mr C DawsonConsultant UrologistEdith Cavell HospitalPeterborough,Advances in the Management of BPH,Mr C DawsonConsultant UrologistFitzwilliam HospitalPeterborough,The Scale of the Problem,Moderate to severe Lower Urinary Tract Symptoms(LUTS)occur in 25%of men over 5
2、0 years,and the incidence rises with ageApproximately 90%of men will develop histological evidence of BPH by 80 years of age,The Scale of the Problem,Increasing because:Men are living longerProportion of Men over 50 years will increaseMen are better informed about health matters,Difficulties in Diag
3、nosis and Management,The symptoms of BPH are the same as those of early Prostate CancerConfirmation of the presence of prostate cancer may be difficultThe need to treat(proven)cancer may not always be clear cut,Understanding Lower Urinary Tract Symptoms(after Abrams,Bristol,UK),Storage SymptomsFrequ
4、encyNocturiaUrgencyUrge incontinenceBladder Pain,Voiding Symptoms Slow stream Intermittent flow Hesitancy Straining Terminal dribble,Physical Signs,May be fewLook for obvious uraemiaPalpate for full bladderExamine urethral meatus and palpate urethra for strictureDIGITAL RECTAL EXAMINATION(DRE)!,Inve
5、stigations for BPH,Urea and electrolytes if clinically indicatedPSA(should we counsel patients?)Ultrasound urogramFlow rate(if you have access)IPSS,IPSS,A word about Prostate Cancer,No symptoms specific for early prostate cancerPresenting symptoms are therefore those of BPHBiopsy of the prostate sho
6、uld be performed in those with abnormal DRE,or PSA above age-specific reference range,Prostate Specific Antigen,Single-chain glycoprotein of 240 aa residues and 4 carbohydrate side chainsPhysiological role in lysis of seminal coagulumProstate specific,but NOT cancer specific,Prostate Specific Antige
7、n,In addition to prostate cancer,an elevated level may be found inIncreasing ageAcute urinary retention/Catheterisationafter TURP/Prostate BiopsyProstatitisBPHA reduced level may be found in patients treated with Finasteride,The Problem with PSA,Men with Prostate Cancer may have a normal PSAMen with
8、 BPH or other benign conditions may have a raised PSAMay not even be prostate-specific!What to do with men with a PSA of 4-10 ng/mlPSA=Persistent Source of Anxiety?,Refinements in the use of PSA,PSA densityPSA VelocityAge-Specific PSA40-49 Years old2.5ng/ml50-59 Years old3.5ng/ml60-69 Years old4.5ng
9、/ml70-79 Years old6.5ng/mlFree:Total PSA ratio(0.15 strongly suggests possibility of Ca Prostate),Prostate Specific Antigen,PossiblySomeAttributes,The Management of BPH,Advances in the Management of BPH,New treatment modalities for BPH,-blocker therapy(including selective blockers of-1a receptors)5-
10、reductase inhibitors-Finasteride(Proscar)Minimally invasive TechniquesTransurethral Microwave Thermotherapy(TUMT)Transurethral Needle ablation(TUNA)Transrectal high-intensity focused ultrasound(HiFU)Transurethral electrovaporisation(TUVP),Pharmacotherapy for BPH,Alpha-blockers remain an important th
11、erapySelective-1a receptor blockers may have fewer side effects,Alpha blocker therapy,Pharmacotherapy for BPH,Finasteride(Proscar)-PLESS study has confirmed that men with large prostates(40cc),taking long-term therapy,less likely to develop acute retention,or require surgical intervention,Minimally
12、invasive therapies,High energy TUMT,and TUNA,have proven clinical efficacy between that of drug therapy and TUVP or laser therapyHiFU currently requires GA,is costly and time consuming,and appears unlikely to be popular at presentThe subjective response after MITs and TURP appear similar,but objecti
13、ve results superior for TURP,Surgical Therapies,TURP still the gold standard therapy,with which all other therapies must be consideredLaser therapy expensive to set upSignificantly reduced blood loss Catheter may be required post operativelyOpen Prostatectomy rarely required,ECH Urology Department G
14、uidelines for the Management of BPH,Produced after discussion between working party of General Practitioners and ConsultantsAgreed within the department of Urology,Protocol for the management of BPH,Protocol for the management of BPH,Future perspectives for the management of BPH,Much more emphasis o
15、n Quality of Life Minimally invasive therapies are improving and may yet challenge the superiority of TURP,Conclusions-BPH,Remains an important cause of patient morbidityCorrect approach to assessment is importantMany men may have their symptoms relieved by alpha blocker therapy or Finasteride,which
16、 has also been shown to reduce the likelihood of surgery or acute urine retention,Conclusions-BPH,A large variety of MITs exist for BPH who fail drug therapy,but for most patients the gold standard surgical procedure remains TURPThe next few years will see many more techniques available to challenge
17、 the position of TURP,Thank you for your attention,MajpjMVcyzj21HLfrvy96dv02lPPfYgxUS7IYmZkyEmZ0kGeYZS3bpLCkYH1lt4EK7CxmUX3ijoYSOer7ZuaVWYgz4EpZrUirVpMzzvNtf1XZw5oswSXOtFaejnOcmfE1lZgnN1RSXg8wLCG8CVQ3XPJMvodPFWcpiYJgZazNSEPNIaklYSu7qSd1UpaxmZDlpN9zW7kljfsLCLi26Yv109ffbnDH8LbUN1G6ACURQ39eG12KHL9tXsZ1
18、jzgoCK8g1kuNOh5eFvcmVT5ZYVQt9zk3rp3qLnf02FovEXxVRxjCcFRNppiJljNiOuk6fONnyX7fyGg7sXZ49BmCN5oy9VesHpKzdjTKwjrkCEQCFDehVmGax3lrOEbw63VscA3YSijtUKoCyiLzAlVRp7l4QgPNHxvJFFDyjUVN3oHlMah0XBd4uTbkfPIhHtw0evPmYOrdhEDoPwvYhzlGplU1AU9mpyiCXH8gpPCBRYjq77VcnbXumNE1yGfyTsbSj89J63kRTKDkKUg3mdS5sJ4X5cQ8dK7oW9IkScss
19、ECQdz2O9UTlpRjAFPChjhLdzopQzwxQf8ozdzOhogwAooXpUF83BX4C3jRgjDJiiXEUDMaNz4vQ4n164vspddHvOIVuBBdMA4xp1YhiHk0vOJ8TL1BxogzVlMpmod6ianYGmksQq6NWCEd56hZF4wfaNyZcrGfNxnPiG6ZAxSkfmhJAKtNmCqbRmppeXp8inz4eq3HkWCMSORyMMX522xpHG6basNr6KQfbZsFbHjzyNlJrruLolKFcC84dqfijBO5Dy2NaBcNEBPgQrT12PgpcKx2or2YChN5DPjs80zzdtdAdTKuW4uVv9bbZu3K2SZ2aEhTlIC1UqrIWibkzwHh6p8gLv26zr01mJybfOzFc4T7kQH1IpPwOzMDnAKPLsLrznXGjFNIA9bSWWms6ibKZwQIKrMzalwbFrQJvOP1rPH8rx2KkyYqrtQk5VRwM1HSX,
