The method of determining the treatment of patients with benign prostatic hyperplasia

 

(57) Abstract:

The invention relates to medicine, in particular to urology, and for the treatment of BPH. To determine the type of treatment investigate the volumetric rate of urination by uroflowmetry. Then assign within 2 weeks of receiving1-blocker such as tamsulosin. Re uroflowmetry. In case of increase of the studied parameters after treatment1-continue blocker drug therapy, in case of deterioration is carried out surgical treatment. The method effectively solves the problem of the choice of treatment in each case, reducing the time and improving the quality of treatment. 2 C.p. f-crystals.

The invention relates to medicine, namely to urology.

In the Russian Federation in 2000 recorded 317,9 prostate diseases per 100,000 male population, the majority fell on benign prostatic hyperplasia (BPH).

According to N. A. Lopatkina (Benign prostatic hyperplasia / Ed. by N. A. Lopatkina, M., 1999), there has been a gradual increase in the frequency of BPH from 11.3% in those aged 40-49 years to 81.4% at age 80. Up to 30% of men 40-year-old who is CSO treatment is directly related to time spent by the operation. However, often missed the timing of surgical treatment. Therefore, from 20 to 30% of men are not satisfied with the results of operations do not indicate that reducing symptoms of urinary disturbances and improve the quality of life.

At present, there is alternative methods of conservative medical treatment of BPH. Isolated from plant materials and synthesized various pharmacological agents, acute painful symptoms of BPH. Leading role among the drugs play-blockers: terazosin, prazosin, alfuzosin, doxazosin, and tamsulosin, which effectively prevent and eliminate already existing spastic contraction of the muscles of the prostate, improves impaired blood circulation and restore energy reserves tissues of the bladder wall, thus contributing to the elimination of dysuria.

The prostate gland is the external sphincter of the bladder. The inflammation it causes convulsive inconsistent contractions. The occurrence of persistent spasm of the smooth muscle structures of the prostate, bladder neck and prostatic Department urethra underlies the development of the dynamic component and the Terazosin and Alfuzosin operate on a1receptors of the bladder and blood vessels, HELL, fat metabolism. Thus, these drugs have also hypotensive action that may adversely affect the results of the treatment group of patients with normal or low blood pressure, and require dose titration. Tamsulosin being uroselective-blocker, does not have these disadvantages.

Regardless of the type-blocker treatment effectiveness does not exceed 85%. Current practice involves changing-blocker, replacing it with a medicated another type of drug actions, and so on, and only then the question arises about surgical intervention. Unfortunately, it is sometimes lost time compensatory ability of the detrusor, which reduces the efficiency of the operation.

The proposed method of determining the treatment of patients with benign hyperplasia of the prostate is to re uroflowmetry 2 weeks after admission-blocker such as tamsulosin, and in case of improvement of urodynamic indices continue the medication, but in case of deterioration perform surgical allowance. This method allows you to quickly (within 2 weeks) to define indications to one or another Flowmetry after 1 week the speaker was not clear; repeat studies after 3 weeks and no longer had meaning, because the conclusion can be done for the 2 weeks of taking-blockers. Therefore, the extension increases the cost of the treatment and unnecessary delay in treatment.

The method is as follows. When you first call the patient to the doctor, performing the necessary minimum clinical research and diagnosis of BPH are uroflowmetry and prescribe tamsulosin in standard dose of 0.4 mg per day. Repeat uroflowmetry 2 weeks. If the rate of urination increases by 30-40%, continue medication. If the rate of urination does not change or even decreases, indicating exhaustion of the compensatory capacity of the detrusor, the continuation of conservative therapy is not feasible; the patient surgical intervention.

Example 1. Patient I., aged 57. Complains about the weakening of the jet of urine, feeling of incomplete emptying of the bladder, frequent urges to urinate, including 3-5 times a night. Objectively external genitals by palpation without deviation from the norm. Per rectum: USD free. Prostate moderately enlarged, round, smooth groove, the consistency of ptree: Qmax=10 ml/s

Assigned tamsulosin dose of 0.4 daily. After 2 weeks nocturia decreased to 1 urination, metric IPSS decreased by half. When the control uroflowmetry Qmax=14 ml/s (increased by 40%). Treatment tamsulosin was continued; during the year (period) steady positive effect.

Example 2. Patient N., 52 years. Complains of a sluggish stream of urine, increased need to urinate at night gets up to urinate 2-4 times. Palpation - moderate enlargement of the prostate, the groove smooth, the consistency of the prostate tight elastic, there is no pain. The transrectal us - prostate volume 26 ml of the Indicator on the scale IPSS - 14. Uroflowmetry - Qmax=12 ml/s

Assigned tamsulosin dose of 0.4 daily. After 2 weeks figure IPSS increased to 17, remained nocturia. Control uroflowmetry - Qmaxdecreased to 8 ml/s (33.3%). Treatment with tamsulosin was discontinued. TOUR the patient refused, fearing retrograde ejaculation. Performed percutaneous adenomectomy with good immediate and long-term outcomes: nocturia decreased to 1 times per day, IPSS equal to 7, Qmax=14 ml/s

Thus, the proposed method allowed us quickly (within 2 what about the treatment, and also to reduce its cost.

The method was tested in a municipal hospital, Novosibirsk 11, and urogenital clinic Novosibirsk TB research Institute. Just was observed in 11 patients; 7 of them in the future, continued conservative therapy, and 4 were operated.

1. The method of determining the treatment of patients with benign prostatic hyperplasia, comprising determining the speed of urination by uroflowmetry, characterized in that two weeks is prescribed1-blocker, followed by re-uroflowmetry, and in the case of increasing the rate of urination continue medical therapy, and in case of deterioration of this indicator appoint surgical treatment.

2. The method according to p. 1, characterized in that as1-blocker use tamsulosin.

3. The method according to p. 1, characterized in that the increase in urinary flow rates of 30-40%.

 

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