Benign prostatic hyperplasia. Part 5

Posted by admin on November 28th, 2009 No Comments

Uroflowmetry

Since Renfish’s first attempts at measuring urinary flow in 1897, simple, increasingly cheap, effective and consistent mechanisms have been developed. Normative data combining ageing, voided volume and uroflow have been attempted, but their value is questionable. The QMax, a key indicator, is not sufficient to diagnose BOO. Uroflow, which is the product of bladder contractions and urethral capacity, can be affected by stricture and by abdominal straining as well as psychological stress. Variations within individuals of 4.1 ml/sec or more have been observed and, for this reason, paired readings may be valuable. Regression to the mean, found in repeated measures in a cohort selected originally for low QMax, emphasizes the dangers of isolated uroflow readings in diagnosing benign prostatic hyperplasia. Despite these caveats, it would appear that QMax readings of >20 ml/sec are unlikely to be associated with BPE of >40 gm.

Symptom scores

Barry underlined the benefits of using validated instruments such as the American Urological Association (AUA) Symptom Index and the International Prostate Symptom Score (I-PSS) Symptom Index, which has an additional specific ‘quality of life’ question and is widely used in Europe. The earlier Boyarsky Index was developed for evaluative rather than predictive purposes, whereas the Madsen-Iversen Index was designed to aid selection of patients for surgical intervention. It is important to recognize at the outset that higher scores on many of these symptom indices do not diagnose benign prostatic hyperplasia, nor even distinguish adequately between BOO, bladder neck or urethral stricture. Indeed, such scores may be achieved by women! The increasing recognition of the importance of the effect upon the patient’s quality of life of lower urinary tract symptoms (LUTS) has been recognized in the US by the introduction of a questionnaire on troublesomeness. This Symptom Problem Index has four questions asking:

1. How much physical discomfort did the urinary problems cause?

2. How much worry did the patient have because of urinary problems?

3. How bothersome was urination over the past month?

4. How much time had the problems kept the patient from doing the kind of things they would usually do?

Management of Benign Prostatic Hyperplasia (BPH): Clinical Presentation Patients with benign prostatic hyperplasia experience symptoms of prostatism which are considered either irritative or obstructive in nature (Table 1). The symptomatology of benign prostatic hyperplasia (BPH) often varies, and significant intra- and interindividual variation in symptoms exists. Nocturia, urinary urgency and frequency and ...
Alfuzosin The original formulation of alfuzosin, marketed in Europe since 1997, is a uroselective agent that is taken three times daily. In 2000, Sanofi-Synthelabo (now Sanofi-Aventis) launched a twice-daily, sustained-release formulation of alfuzosin, Xatral SR, in the United Kingdom, Spain, and Germany. A once-daily, controlled-release ...
Benign Prostatic Hyperplasia:Current Therapies Treatment of benign prostatic hyperplasia (benign prostatic hyperplasia) is directed primarily toward managing symptoms and improving patients' quality of life (QoL). The two dominating classes of pharmacological agents used to treat benign prostatic hyperplasia are alpha Mockers and 5-alpha-reductase inhibitors (5-ARIs). Both drug classes ...
The management of benign prostatic hyperplasia: Diagnostic Indicators An indexing tool called the International Prostate Symptoms Score (IPSS) II can help evaluate key lower urinary tract symptoms. The patient's score on this test gives a highly accurate assessment of the effect of lower urinary tract symptoms on the quality of a man's ...
Hexokinase Inhibitors Overview In benign prostatic hyperplasia, hyperplasia of the prostate gland increases the number of smooth-muscle cells, and smooth-muscle tension causes bladder outlet obstruction leading to lower urinary tract symptoms . Drugs that reduce total prostate volume, either by slowing cell multiplication or inducing cell ...

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