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1、Urinarytractobstruction（泌尿系梗阻）DaohuWangAssociateProfessorDepartmentofurologyThe1stAffiliatedHospitalSUMSIntroductionasystemoftubeobstructionwillaffectsecretionandexcretionofurinefinalresults:hydronephrosis,renalfailureobstructionatdifferentplaceCausesofobstructionclassification:mech
2、anicalanddynamicalcongenital,acquiredandiatrogeniccommoncauses:stone,tumor,ectopicvessel,nephroptosis,stricture,BPH,reflux,pregnancyPathophysiologydilatationoftheurinarytractearlystage:tubularwallhypertrophieslatestage:thinningofthetubularwallprolongedobstructionbelowthebladder:hydr
3、onephrosisurinarybackflowpyelovenousandpyelolymphaticpyelosinuspyelotubularBenignprostatichyperplasia（良性前列腺增生症）Introductionacommoncauseofbladderoutletobstructionsymptomsappearafter50yearsTheprostateEtiologystillobscurtestosteroneDHTgrowthfactorsPathologyNormalanatomicalzonesBPHderiv
4、edfromTZdegreeofobstructionunparalleltoitssizehydronephrosis,detrusorhypertrophy,trabeculae,cellules,diverticulum,stones,hernia,infection,retentionPathologyofBPHPathologyofBPHClinicalmanifestationssymptomnotparalleltoprostatesizeprostatism:frequency,urgency,nocturiadysuriaretentionC
5、omplications–Infection:cystitis,epididymitis–Haematuria:－bladderstone－infection–RenalimpairmentDiagnosishistoryandphysicalexamDRE:enlargedprostate,middlefurrowdisappearTRUSurodynamicsothers:cystogram,cystoscopeDifferentiatediagnosisprostatecancerbladdercancerurethralstrictureneuroge
6、nicbladderManagementofBPHMedicaltreatmentSurgeryMedicalTreatment5a-reductase—finasteride,a-receptorinhibitor–Phenoxybenzamine,Prazosin,PhytotheapeuticagentsTheoryofa-blockerCurrentAR-blockersNon-selective:Phenoxybenzamine•Selective:–Prazosin(Minipress)–Terazosin(Hytrin)–Doxazosin(Ca
7、rdura)–Alfuzosin(Xatral,XatralSR,XatralXL)•Subtypeselective(1a)–Tamsulosin(Harnal)5a-reductaseDihydrotestosterone(DHT)issynthesizedfromtestosteroneviatheenzyme5-α-reductase•InthemajorityofandrogentargettissueseithertestosteroneorDHTbindstoaspecificandrogenreceptortoformacomplexthatc
8、anregulategeneexpre
