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单击以编辑母版标题样式,单击以编辑母版文本样式,第二级,第三级,第四级,第五级,*,Urinary tract obstruction 泌尿系梗阻,Daohu Wang,Associate Professor,Department of urology,The 1st Affiliated Hospital,SUMS,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 vessel,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,pyelotubular,Benign prostatic hyperplasia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 unparallel 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,Infection: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 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(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 receptor 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 action 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 hydronephrosis,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 manifestations of BPH,Treatment for BPH,Referrence book:campbells urology,
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