Professional Documents
Culture Documents
Bladder aging
Neuropathic Storage problems Storage symptoms
BPH Symptoms
Voiding (obstructive)
Symptoms Storage (irritative or filling
symptoms
Hesitancy
Urgency
Weak stream
Frequency
Straining to pass urine
Nocturia
Prolonged micturition
Urge incontinence
Feeling of incomplete
bladder emptying
Urinary retention
DR
BPH Symptoms
DIAGNOSTIC EVALUATION
Medical History
Symptom score questionnaires
The International Prostate Symptom Score (IPSS)
Frequency volume charts and bladder diaries
Physical examination and digital-rectal examination
Digital-rectal examination and prostate size evaluation
Urinalysis, Prostate-specific antigen (PSA),
PVR, uroflowmetry.
etc
International Prostate Symptom Score
(IPSS)
Score / Severity
0-7 Mild
8 - 19 Moderate
Barry MJ et al. J Urol 1992;148:1549-57. 20 - 35 Severe
DRE & TRUS prostat
TRUS prostat
Digital-rectal examination (transrectal ultrasonography)
Method of Digital Rectal
Examination (DRE)
COLOK DUBUR ~ Rectal Touche (RT)
Yang terpenting
Prostat keras,
nodul, atau asimetri
staging T
(tumor)
1. McConnell J et al. N Engl J Med. 2003;349:23872398; 2. Emberton M et al. IJCP. 2008;62:10761086; 3. Emberton M et al. BJU Int.
2011;107:876880.
BPH Management: treatment
- Alpha blocker
- Androgen suppression (5 ARIs)
- PDE 5 Inhibitor
- Combination Therapy
- Phytotherapy
DR
BPH Medical Treatment Options
- blockers
Mechanism of action: 1-blockers aim to inhibit
the effect of endogenously released noradrenaline
on smooth muscle cells in the prostate and
thereby reduce prostate tone and BOO
Molecular studies have further identified three
subtypes of the 1-AR(1A, 1B, and 1D).
Their relative distribution and concentration in the
prostate, bladder, neck, brain, and vascular
smooth muscle have been exploited to develop
uroselective 1-adrenergic antagonists and reduce
side effects.
Gratzke C. Eur Urol. 2015;67(6):1099-109.
Dhingra. Indian J Pharmacol. 2011;43(1):6-12.
Type of Alpha Adrenergic Receptor
1A 1B 1D
Primary subtype expressed in the Primary subtype expressed in the Primary subtype expressed in the
prostate. Regulates contraction blood vessels. Regulates bladder, spinal cord, and nasal
of the smooth muscle in the contraction of arterial blood passages. Thought to play a role
prostate, bladder base and neck, vessels in response to postural in bladder symptoms and nasal
urethra, seminal vesicles, and redistribution of blood volume.4-7 secretions.1,6
vas deferens.8-12
Terazosin1 1A = 1D = 1B
Alfuzosin1 1A = 1D = 1B
Tamsulosin1,2 1A = 1D >1B
Edwards J. Am Fam
5 ARI
Practical considerations:
Treatment with 5-ARIs should be considered
in men with moderate-to-severe LUTS and an
enlarged prostate (> 40 mL) and/or elevated
PSA concentration (> 1.4-1.6 ng/mL). Due to
the slow onset of action, they are suitable
only for long-term treatment (years).
Their effect on the serum PSA concentration
needs to be considered for prostate cancer
screening.
Gratzke C. Eur Urol. 2015;67(6):1099-
- blocker vs 5 ARI
Tidak Gejala
storage yang Poliuria nokturnal
Tidak yang dominan?
paling
Volume prostat dominan?
> 30 ml?
Tidak Ya
Ya
Ya
Edukasi & modifikasi
gaya hidup dengan/tanpa Tata laksana
-blocker Tidak jangka panjang?
Ya
Gejala storage
residual