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VV !"#$%&'()*+, Incont Pelvic Floor Dysfunct 2009; 3(4):99-103 !"#$%&'()*+,-./0 oÉéçêí=Ñêçã=_ÉåáÖå=mêçëí~íáÅ=eóéÉêéä~ëá~LiçïÉê=rêáå~êó=qê~Åí póãéíçãë=`çããáííÉÉ !"#$%&'() !"#$%&'(613!"#!$%&6!"#$%&'( !"#E-mail: [email protected] !"#$Ebenign prostatic hyperplasia, BPHF!"#$ !"#$%&'()*+,-./012*+-3456718 !"#$ !"#$%EF!"#$%&' !"#$%&'()*+,-./01234567&(89: !"#$%&'()*+,-./0!1230!45167 !"#$%&'()*+,-./0123456789$%: !"#$%&'()*+,-./"#0123)456789 !"#$%&'()*+,-.%/01 !"#$%&'()*+,-./01234567 !"#$%&'()*+,-./0,12345615 !"#$%&'()*+!,-.*+/012345678 !"#$%&'()*+,-./012325!"#$% 5 !"#$ 30 !"#$%&'()*+,-./ 5 30!"#$%&'()*+,-./0123456789: !"#$%&'()*+,-./01234056789: !"#$%&'()*%+,-./012%34567%8 !"#EGuidelinesF! !"#$%&'()*+,-./012340&567 !"#$%&'()*+,-./0&12345(6789: !"#$%&'()2005 ICS Jumadilova Z !"#$%& !"#$%&'()*Eoveractive bladder, OABF!"#$ !"#47%!"#$%&'("36%!"#$%& !"#$%9%!"#$%&'()*+8%!"# !"#$xPleil, 2005z!"#$%&'()*+,-./( !"#$%&'()*+, !"#$ !"#$%&!'()*+,-./012345067 !"#$%&'()*+,-./0123456789:;< !"#$%&'()EprostatismF!"#$%&'()* !"#$%&'()*+,-./01234567"( !"#$%Ebenign prostatic enlargement, BPEF!"#$% Ebenign prostatic obstruction, BPOF!"#$%&'()*+,) !"#$%&'()*+,-./012345678,9: !"#$%&'()*+,!&'(-./001!" !"#$%&'()*!"Ebladder outlet obstruction, BOOF !"#$%&'()*+,-./01234567#$%&' !"#$%&'()*+,-.$/012&34"#,56$ !"#$%&'()*+,-./0123&,456789: !"#$%&'()*+,-'./012345678 !"#$%&'()*+,-./012xBarendrecht et al, 2008; Martin and de la Rosette, 2009z !"#$%&'()*+,-./0123 !"#$%&'()*+,-./0123456789: !"#$%&'()*+,-./0123456E LUTS severityF!"Ebother scoreF!"Edigital rectal examination, DREF!"#$%Eprostate-specific antigen, PSAFEurinalysisF !"Evoiding diaryF!"#$%&'()*+,-./0 !"#$%&'()*Einternational prostate symptom score, IPSSF 8 !"#$%&'()*+,"-./0123Emaxi- mum flow rate, QmaxF!"Eflow patternF!Eresidual urineF AUA !"#$%&'()*+',-./012345 !"#$%&'()* 8 !"#$%&'()*+,-. !"#$%&'()*+,-./01234&5'67Eα- blockerF!5-α E5-α reductase inhibitorsF!"# !"#$7!"#$%&'(Ewatchful waitingF!" ! !"#$%&'()*+,-68%!"#$%&' 50%!"#$%&'()*+,-./01234567289 !"#$%&'()*+,-./012)3456789:) !"#$%&'()*+,-./012345(6708 5-α !"#$%&'()*+,-./01'23! !"#$%&'()EantimuscarinicsF!"#$%&'() !Epostvoid residual urine, PVRF!"#$%&'()*! !"#$%&'()*+ !"#$%&'()*+,-./0#$12345 EhermaturiaF!"#$%&'()*+,-./0123"

oÉéçêí=Ñêçã= ÉåáÖå=mêçëí~íáÅ=eóéÉêéä~ëá~LiçïÉê ... · 2009-12-25 · NMM!"#$%&'()*+, LUTS cause little or no bother (IPSS< 7) Predominant nocturia

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VV

�� !"#$%&'()*+,Incont Pelvic Floor Dysfunct 2009; 3(4):99-103

�� !"#$%&'()*+,-./0

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póãéíçãë=`çããáííÉÉ

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�� !"#$�� !"#$%E�� F�� !"#$%&'��

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��

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�� !"#$%&'()*+,-./0&12345(6789:

�� !"#$%&'()2005 ICS Jumadilova Z�� !"#$%&

�� !"#$%&'()*Eoveractive bladder, OABF�� !"#$

�� !"#47%�� !"#$%&'("36%�� !"#$%&

�� !"#$%9%�� !"#$%&'()*+8%�� !"#

�� !"#$xPleil, 2005z�� !"#$%&'()*+,-./(

�� !"#$%&'()*+,

�� !"#$

�� !"#$%&!'()*+,-./012345067

�� !"#$%&'()*+,-./0123456789:;<

�� !"#$ %&'()EprostatismF�� !"#$%&'()*

�� !"#$%&'()*+,-./0��123456 7"(

�� !"#$%Ebenign prostatic enlargement, BPEF�� !"#$%

�Ebenign prostatic obstruction, BPOF�� !"#$%&'()*+,)

�� !"�#$%&'()*+,-./012345678,9:

�� !"#$%&'()*+,� !&'(-./001� !"

�� !"#$%&'()*!"Ebladder outlet obstruction, BOOF��

�� !"#$%&'()*+,-./01234567#$%&'

�� !"#$%&'()*+,-.$/012&34"#,56$

�� !"#$%&'()*+,-./0123&,456789:

�� !"#$%& '()*+,- './012345678

�� !"#$%&'()*+,-./012xBarendrecht et al, 2008;

Martin and de la Rosette, 2009z�

�� !"#$%&'()*+,-./0123

�� !"#$%&'()*+,-./0123456789:

�� !"#$%&'()*+,-./0123��456ELUTS

severityF�� !"Ebother scoreF�� !"Edigital rectal examination,

DREF�� !"#$%Eprostate-specific antigen, PSAF�� EurinalysisF

�� !"Evoiding diaryF�� !"#$%&'()*+,-�./0

�� !"#$%&'()*Einternational prostate symptom score, IPSSF

�� � 8�� !"#$%&'()*+,"-./0123Emaxi-

mum flow rate, QmaxF�� !"Eflow patternF�� !Eresidual urineF�

�� AUA�� !"#$%&'()*+',-./012�345

�� !"#$%&'()* 8�� !"#$%&'()*+,-.

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blockerF�� !5-α�� �� E5-α reductase inhibitorsF�� !"#

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�� !

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��

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�� !"#$%&'()*+,

LUTS cause little or nobother (IPSS< 7)

Predominant nocturia

Frequency volume chart

Reassurance and F/U

Polyuria24-hour output ≥ 3 litersLife style modification

Fluid restriction

Nocturnal polyuria≥ 33% urine output at night

Fluid restrictionConsider desmopressin

SurgeryIndication matched

Recommended test for LUTSMedical history, LUTS severity (IPSS) and

bother score, DRE, PSA, UrinalysisVoiding diary (Option)

Further evaluationBothersome LUTS (IPSS > 8)

Recommended testFlow rate, Residual urine

Optional testSuprapubic echo or TRUS, UDS, Cystoscopy

Suggestive of BPO

SignificantBPO

Mixed OAB andBPO

Depends on size and anatomy of prostateα-blockers + / - 5α- Reductase inhibitors

Failure

Offer minimal invasive surgical treatment or Surgery

Complicated LUTSSuspicious DREHematuriaAbnormal PSAPainInfectionPalpable bladderNeurological disease

OABNo evidence of BOO

Cite OABguideline

First treatmentα-blockers + / -

5α- Reductase inhibitorsSecond treatment

+ / - Antimuscarinics (excludehigh risks)

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mL/sec�� !"#$%&' ()*+,-./ 10 mL/sec �� 88%

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��

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Rx

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Rx Rx

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�� ! 22%xMartin M, 2009z�

�� !"#$%&'()*500�� !"#$%&'()*+

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�� !"#$%&'()*+,-./012 34 56xRuszat et

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�� !ESelf managementF

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�� !"#$%&xBrown et al, 2004; Emberton M, 2006z�

�� !EPrevention therapyF

�� Permixon�Finasteride�� !"#$%&'()*+,-

�� !"Permixon�� !"#$%&'()*+,-./0123

�� !"#$%&'(")*+,-(./0123456Permixon

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�� !

Abrams P, Kaplan S, Millard R: Tolterodine treatment is safe in menwith bladder outlet obstruction (BOO) and symptomatic detrusor

overactivity (DO). Neurourol Urodyn 2001; 20:547-548.Abrams PH: Prostatism and prostatectomy: The value of urine flow rate

measurement in the preoperative assessment for operation. J Urol1977; 117:70-71.

Athanasopoulos A, Gyftopoulos K, Giannitsas K, Fisfis J, Perimenis P,Barbalias G: Combination treatment with an alpha-blocker plus ananticholinergic for bladder outlet obstruction: A prospective,randomized, controlled study. J Urol 2003; 169:2253-2256.

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