antiandrogenic and TURP-瑞金医院-潘家骅.pptVIP

The prevalence increase with age-60y male：50％-80y male：83％ The severe BOO more frequently occurs in asiatic than american In China mainland, 98.1％ of BPH patients have severe LUTs when go to the doctor’s office The BPH guideline of CUA PLESS (n=3040)trial with follow-up more than 4 years： Proscar could reduce the risk of BPH related surgery up to 55% 1. McConnell JD, Bruskewitz R, Walsh P,et al., The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med. 1998;338(9):557-63. Ref 1, P560, Fig 2; P559, Col1, Para1, L3-6 Recurrent urinary retention Recurrent hematuria Repetitive UTIS Bladder stones Bilateral hydronephrosis and kidney function impairement The BPH guideline of CUA Different new techniques emerged while TURP remains the “Gold standard” The peroperative and postoperative hemorrhage is always the critical risk for TURP surgery-Intimidate patient’s life-Challenge surgeons volition-obstacle for residency training Shall we have other solutions? PVP-No multi-center randomized controlled clinical trail-Not appropriate for the large prostate-Single-use laser fiber，high medical cost PKRP -No privileges are granted for reducing the peroperative or postoperative bleeding compared to classic TURP (Meta analysis) Henry S.S. Ho and Christopher W.S. Cheng. Bipolar transurethral resection of prostate:a new reference standard? Curr Opin in Urol. 2008 (18):50–55. Muta M. Issa. A technological advances in transurethral resection of the prostate: Bipolar versus Monopolar TURP. J Endourol,2008;(22) Puchner first take the 5-a reductase inhibitor as the treatment for BPH related hematuria in 1995 Many clinical research revealed the efficacy of fenasteride in the treatment of BPH related hematuria Some proved the clinical value of preoperative finasteride administration for the patients with large prosta