前列腺的诊断.ppt

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1、良性前列腺增生症的诊断西安唐都医院张伟PSC2001-W-11666-SSBPH的解剖NormalBPH肥厚的逼尿肌梗阻的尿流率PROSTATEBLADDERURETHRARoehrbornCG,McConnellJD.In:WalshPCetal,eds.Campbell’sUrology.8thed.Philadelphia,Pa:Saunders;2002:1297-1336.概念LUTSLower-urinary-tractsymptomsBPEBenignprostaticenlargement(macroscopi

2、c)BOOBladder-outletobstructionBPHBenignprostatichyperplasia(microscopic/histologic)BPOBenignprostaticobstruction(BOOcausedbyBPE)临床的BPHLUTS+BPE+BOOSlideI.1AdaptedfromNordlingJetal.InBenignProstaticHyperplasia.Plymouth,UnitedKingdom:HealthPublication,2001:107-166.BPH的病

3、理生理:具有相互重叠又相互独立性SlideI.2LUTSEnlargedprostateBOOAdaptedfromNordlingJetal.InBenignProstaticHyperplasia.Plymouth,UnitedKingdom:HealthPublication,2001:107-166.BPH的病理生理:导致LUTS的诱因SlideI.3高龄缺氧梗阻夜尿增多年龄相关疾病神经性疾病局部疾病BladderLUTSLowerUrinaryTractSymptoms(LUTS)梗阻症状尿等待尿线细尿费力尿时间长尿不尽感

4、尿潴留刺激性症状尿急尿频夜尿急迫性尿失禁KirbyRSetal.Benignprostatichyperplasia.HealthPress,1995.LUTS1,2结果问题干扰日常活动及性功能BPH(BenignProstaticHyperplasia)BOO3(BladderOutletObstruction)尿潴留手术膀胱功能减退尿路感染结石肾功能受损1.AUAPracticeGuidelinesCommittee.JUrol.2003;170:530-547.2.RosenRetal.EurUrol.2003;44:637-

5、649.3.LeporH,LoweFC.In:WalshPCetal,eds.Campbell’sUrology.8thed.Philadelphia,Pa:Saunders;2002:1337-1377.良性前列腺增生症是一种进展性疾病BPH患者症状随年龄增加而进行性加重，并出现相应的并发症PLESS研究证实未予治疗的BPH进展迅速前列腺体积增加14％7％发生急性尿潴留10％需要手术治疗BPH临床进展的风险预测因素高龄前列腺肥大PSA升高下尿路症候群尿流率下降残余尿量症状和前列腺体积的关系AdaptedfromGirmanCJet

6、alJUrol1995;153:1510-1515.40–4950–5960–6970–79Age(years)3020100MildsymptomsModerate/severesymptoms%ofmenwithprostatevolume>50ml(N=2115)症状与最大尿流率的关系AdaptedfromGirmanCJetalJUrol1995;153:1510-1515.%ofmenwithpeakflowrate<10ml/sec40–4950–5960–6970–79Age(years)3020100Mildsym

7、ptomsModerate/severesymptoms(N=2115)PSA是BPH较强的预测因素p<0.00001fortrendacrossoddsratiosFreePSAvaluesadjustedforageandtotalPSAAdaptedfromMeigsJBetalJClinEpidemiol2001;54(9):935-944.Oddsratio54321011.91.84.40.0–0.070.08–0.100.11–0.170.18–2.43FreePSAvalue(N=1709)3.532.521.5

8、10.50随着前列腺体积的增大发生急性尿潴留的几率增加AdaptedfromJacobsenSJetalJUrol1997;158:481-487.1330>30Baselineprostatevolume(ml)Relative