泌尿系梗阻中山大学外科学

1、Introduction a system of tube obstruction will affect secretion and excretion of urine final results: hydronephrosis, renal failure obstruction at different place Causes of obstruction classification: mechanical and dynamical congenital, acquired and iatrogenic common causes: stone, tumor, ectopic v

2、essel, nephroptosis, stricture, BPH, reflux, pregnancy Pathophysiology dilatation of the urinary tract early stage: tubular wall hypertrophies late stage: thinning of the tubular wall prolonged obstruction below the bladder: hydronephrosis urinary back flow pyelovenous and pyelolymphatic pyelosinus

3、pyelotubular Benign prostatic hyperplasia （良性前列腺增生症）（良性前列腺增生症） Introduction a common cause of bladder outlet obstruction symptoms appear after 50 years The prostate Etiology still obscur testosterone DHT growth factors Pathology Normal anatomical zones BPH derived from TZ degree of obstruction unpar

4、allel to its size hydronephrosis, detrusor hypertrophy, trabeculae, cellules,diverticulum, stones, hernia, infection, retention Pathology of BPH Pathology of BPH Clinical manifestations symptom not parallel to prostate size prostatism: frequency, urgency, nocturia dysuria retention Complications Inf

5、ection: cystitis, epididymitis Haematuria: bladder stone infection Renal impairment Diagnosis history and physical exam DRE: enlarged prostate, middle furrow disappear TRUS urodynamics others: cystogram, cystoscope Differentiate diagnosis prostate cancer bladder cancer urethral stricture neurogenic

6、bladder Management of BPH Medical treatment Surgery Medical Treatment 5a-reductasefinasteride, a-receptor inhibitor Phenoxybenzamine, Prazosin, Phytotheapeutic agents Theory of a-blocker Current AR-blockers Non-selective: Phenoxybenzamine Selective: Prazosin (Minipress) Terazosin (Hytrin) Doxazosin

7、(Cardura) Alfuzosin (Xatral, Xatral SR, Xatral XL) Subtype selective (1a) Tamsulosin (Harnal) 5a- reductase Dihydrotestosterone (DHT) is synthesized from testosterone via the enzyme 5-reductase In the majority of androgen target tissues either testosterone or DHT binds to a specific androgen recepto

8、r to form a complex that can regulate gene expression. DHT is essential for prostate development and growth, the development of the external genitalia and male patterns of facial and body hair growth or male-pattern baldness Current 5a-reductase Finasteride Dutasteride Plant Extracts The mode of act

9、ion of phytotheapeutic agents is unknown The biological effects are unclear although a few RCTs show encouraging data These drugs are not recommended for the treatment of elderly men with LUTS suggestive of BPH indication of surgery not responsible to drugs repeat infection and hematuria with hydron

10、ephrosis, hydroureter, bladder stones or diverticula residual urine 40ml Surgical choices open surgery retropubic suprapubic perineal endoscopic surgery TURP or TVP TULP TURP Key points of the chapter Etiology of urinary tract obstruction Pathophysiological changes of UTO Etiology of BPH Clinical ma

11、nifestations of BPH Treatment for BPH Referrence book: campbells urology Pathology Normal anatomical zones BPH derived from TZ degree of obstruction unparallel to its size hydronephrosis, detrusor hypertrophy, trabeculae, cellules,diverticulum, stones, hernia, infection, retention Diagnosis history and physical exam DRE: enlarged prostate, middle furrow disappear TRUS urodynamics others: cystogram, cystoscope Differentiate diagnosis prostate cancer bladder cancer urethral stricture neurogenic bladder Management of BPH Medical treatment Surgery Medical Treatment 5a-re