BPH - a natural course of the disease
Although the disease is generally not life-threatening men its manifestation as a voiding - LUTS considerably decreases the quality of life. Symptoms of voiding cause access to a doctor 30% of men after 65 years.
BPH (benign prostatic hyperplasia) is characterized by a multifactorial etiology. Currently, there is no rigorous evidence that smoking vasoresection excess food or alcohol increases the risk of development of prostate disease. There is some correlation between diseases such as high blood pressure, diabetes and BPH, however, since all these conditions accompany aging may prime a combination thereof. Recently, it was observed that diabetes and BPH occur together more often http://avodart-dutasteride.com/ than would be expected by simple coincidence. The only proven factors affecting the development of the disease - prostate adenoma, are age and the normal functioning of the testes.
There are few studies of the natural course of benign prostatic hyperplasia (BPH). The predicted risk of developing complications such dramatic as acute urinary retention in different studies varied from 4 to 73%, which in itself points to the inaccuracy of information on the natural history of the disease. One major study showed that 6.6% of patients in the placebo group developed acute urinary retention.
Despite the clear trend towards reducing the number of surgical procedures carried out in patients with BPH, such operations are carried out three of the 10 men. The risk of surgical treatment for BPH increases with age and with increasing severity of symptoms. Nighttime urination and changes in the urine stream are the most important prognostic factors.
Age is one of the main factors that influence the relationship between symptoms, urinary flow rate and prostate volume. With age, there is deterioration in urinary symptoms, it is accompanied by a deterioration of quantitative indicators urinating and increase in prostate volume.
Symptoms of voiding are the main reason for causing a man to seek medical help. Quantitative assessment of the severity of the symptoms and causes of anxiety is an important criterion for the selection of indications for treatment and its success.
BPH and its symptoms affect more on quality than on life expectancy. Treatment options to be discussed in conjunction with the patient physician in terms of aggressiveness of treatment method, its effectiveness, durability, cost and other factors.
The current method of dynamic active surveillance for patients diagnosed with BPH does not imply any medical or surgical exposure and essentially corresponds with the natural course of the disease.
Patients with BPH will want to know whether the symptoms worsen, stay the same or improve over time. Patients worried about the possibility of acute urinary retention, renal failure, severe urinary infection. Doctors urologists want to know the symptoms, urodynamic indices or other clinical data can predict the need for surgery. In one study, patients with lower urinary tract symptoms (LUTS) without absolute indications for surgery were observed for 3 years. As a result, 27% showed improvement of symptoms, 15% remained stable and 58% reported worsening. In general, there is a slow progression of symptoms over time.
There is very little information on the natural history of key urodynamic parameters in men with diagnosed BPH. In one study, the maximum urine flow rate (one of the key indicators defined at uroflowmetry) decreased on average from 13.1 to 11.9 ml / s. In another study reported a decrease with the age of the urine flow approximately 2.1 ml / sec for 10 years in normal aging. This reduction should be more pronounced in patients with impaired outflow of urine and initially low urine flow.
Acute urinary retention is a relatively common complication of BPH and is an indication for surgery in 25-30% of cases ..Although renal failure is a severe complication of BPH, its true incidence is not fully defined. This complication may occur with minimal symptoms of the disease. The optimal strategy is monitoring to determine renal failure in a reversible stage in men who are treated dynamic observation.
As kidney failure, the risk of urinary tract infections, particularly serious infections of the upper urinary tract with Urosepsis be finalized in men with BPH. Recurrent urinary tract infection yavyalyaetsya indication for surgery in a certain percentage of cases. Delaying surgery in men with symptomatic BPH can lead to irreversible decompensation of the bladder (the inability to restore the contractility of the muscles of the bladder). This provision is highly controversial. Clinical observations do not support the evidence that the operation is stitched with the violation of the outflow from the bladder leads to irreversible damage to its walls. Even men with signs of severe decompensation of the bladder show improvement after surgery.