BPH国际巡讲-英文版.pptVIP

* * * * * A large study of TURP vs WW – 36% of patients crossed over to WW group in 5 yrs leaving 64% doing well in ww group (flaniganrcjurol 1998 veterans study). Increasing symptom bother and increasing post void residues – strongest predictors of failure. Lifestyle advice -reduction of fluid intake at specific times. Recommended daily intake of 1500mls should not be reduced. -avoidance of coffee and alcohol which have an irritant and diuretic effect -distraction techniques – mental tricks to take mind off the bladder and toilet. -bladder retraining – men are encouraged to hold on when they have sensory urgency – to increase their bladder capacity to aprox 400 mls and time between voids. * * * * * * * * * * * In addition to differences between the 2 studies mentioned on the slide: CombAT enrolled only patients known to be at elevated risk of BPH progression by including only those with prostate volume ≥30cc, PSA ≥1.5ng/mL and symptom score (IPSS questions 1 to 7) ≥12 point. MTOPS set no minimum thresholds for PSA or prostate volume and included patients with symptom scores (AUA-SI – equivalent to IPSS questions 1 to 7) between 8 and 30 points. Primary endpoints in the CombAT study were improvement in symptom score at 2 years and reduction in risk of AUR / prostate related surgery at 4 years. The primary endpoint in MTOPS was a composite endpoint of ‘BPH progression’. References McConnell JD et al. The long-term effect of doxazosin, finasteride and combination therapy on the clinical progression of BPH NEJM 2003; 349: 2387–98 Roehrborn CG et al. The effects of dutasteride, tamsulosin, and combination therapy on lower urinary tract symptoms in men with prostatic enlargement: Two-year results from the Combination of Avodart and Tamsulosin (CombAT) study. J Urol 2008; 179: 611-21 * * * * Practice in Europe Cornu et al Eur Urol 2010 Medical Management of BPH Related LUTS Medical Management of BPH Works: For the Correct Patient Benign Prostatic Hyperplasia Can Be