ISSN:0963-0643    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Recent research clearly shows that symptoms of benign prostatic hyperplasia are frequent among older men, many of whom do not seek medical attention. Older men and perhaps non-smokers are at higher risk of benign prostatic hyperplasia, which progresses slowly with waxing and waning symptoms and a relatively low rate of complications.

ISSN:0963-0643    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0963-0643    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Benign prostatic hyperplasia (BPH) is a very prevalent disease process in the aging male. It is characterized by symptoms referred to as 'prostatism'. Although it rarely threatens the life of the patient, it does affect the quality of his life; the evaluation of a patient with BPH should therefore focus on a quantitative assessment of the symptoms and the degree to which they bother the patient. The baseline evaluation of patients with BPH should also include medical history, focused physical examination, urinalysis, and assessment of renal function. Other tests, such as prostate-specific antigen measurement, residual urine measurement, uroflowmetry, pressure-flow studies, and imaging of the urinary tract, should be used after their benefits and risks have been weighed. Tests must be examined for their ability to differentiate BPH from other conditions, predict the outcome of therapy, and improve the selection process for certain treatments.

ISSN:0963-0643    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0963-0643    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Alpha blockers have been prescribed for the treatment of benign prostatic hyperplasia (BPH) since 1976. Recently, several multicenter, randomized, placebo-controlled studies have unequivocally established the safety and efficacy of long-acting selective alpha) blockers for the treatment of BPH. The advantages of the long-acting selective alpha1Cblockers over the non-selective alpha blockers include better tolerance and compliance. The efficacy of alpha blockade is presumably achieved by receptor-mediated relaxation of prostatic smooth muscle. The tension of prostatic smooth muscle has recently been shown to be mediated by the alpha1csubtype. The development of alphas selective antagonists may further improve the efficacy, tolerance, and compliance of this pharmacologic strategy for treating BPH.

ISSN:0963-0643    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Androgen suppression therapy represents an alternative to invasive approaches for the management of symptomatic benign prostatic hyperplasia. Androgen withdrawal from the prostate has been associated with the activation of specific genes involved with programmed cell death, or apoptosis. Luteinizing hormone-releasing hormone agonists, androgen receptor antagonists, and 5α-reductase inhibitors interrupt androgenic stimulation of prostatic growth by different mechanisms of action; consequently, their effectiveness and side effects vary. Although finasteride selectively inhibits 5α-reductase type 2 in the prostate, a second isozyme exists in the liver and skin after puberty and may account for incomplete clinical efficacy and the virilization seen in 5α-reductase deficiency after puberty. Two phase III clinical trials indicate that finasteride is a safe drug but, unfortunately, baseline prostatic volume, flow rate, and symptom severity do not predict treatment response. All forms of androgen suppression produce variable clinical improvement, measured by prostate size reduction, urodynamic obstruction, and symptom scores; this suggests a heterogeneity in the androgen dependence, tissue pathology, and obstructive physiology of benign prostatic hyperplasia.

ISSN:0963-0643    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The current literature on transurethral incision of the prostate as a therapeutic modality for patients with bothersome symptoms of benign prostatic hyperplasia and small prostates is reviewed. Transurethral incision is a safe alternative to transurethral resection of the prostate in selected patients. New surgical techniques and recently published trials will be discussed.

ISSN:0963-0643    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0963-0643    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Canine and clinical trials of laser ablation of the prostate (LAP) have demonstrated its ability to ablate hyperplastic tissue successfully. This therapy has emerged to challenge transurethral resection of the prostate (TURP), considered to be the 'gold standard' of prostatic surgery for at least 60 years. Three different techniques of laser energy delivery have been developed: transurethral ultrasound-guided laser-induced prostatectomy, visual endoscope-guided LAP, and interstitial transrectal ultrasound-guided ablation of the prostate. All three approaches appear effective and are relatively bloodless. The following discussion relates primarily to visual endoscopic LAP using 90*reflecting fibres. Urologists thus far have favoured this approach, which is simpler and more appealing because the visual endoscopic technique is more familiar than an ultrasound-guided system. Early results of randomized studies comparing LAP and TURP show equivalent short-term outcome when measured by symptom score, maximum flow rate, and residual urine volumes after voiding. The long-term outcome of laser prostatectomy will require further evaluation over several years to demonstrate equivalence to TURP.

ISSN:0963-0643    

出版商:OVID    

年代:1994

数据来源: OVID