Family Physician's Approach to Lower Urinary Tract Symptoms
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Dr Ho Siew Hong lectured to Family Physicians on 22 Oct 08 at Serangoon Garden Country Club as part of the Continous Medical Education Program
![What is LUTS ? ,[object Object],[object Object],International Continence Society, American Urological Association, European Urological Association](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Family Physician's Approach to Lower Urinary Tract Symptoms
- 1. Approach to Lower Urinary Tract Symptoms (LUTS) in Males Dr Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital
- 5. Anatomy of BPH Normal BPH Prostate Bladder Urethra Hypertrophied detrusor muscle Obstructed urinary flow
- 6. Epidemiology of BPH: histological prevalence around the world Adapted from Roehrborn CG, McConnell JD. Etiology, Pathophysiology, Epidemiology, and Natural History of BPH. In: Walsh P, editor. Campbell’s Urology. 8th ed. Philadelphia: WB Saunders Co. 2002. p. 1308 Prevalence (%) 100 80 60 40 20 0 20–29 30–39 40–49 50–59 60–69 70–79 80–89 Age (years) Average Linear average
- 7. Risk of AUR versus other diseases (60 year old male) 10-year cumulative risk (%) 20 15 10 5 0 AUR Hip fx Hip fx Diabetes Stroke MI (women) (men) Jacobsen S. Urology 2001;58(6A):5
- 8. IPSS / AUA Symptom Score
- 9. Estimate size of prostate, Exclude nodule Detect hematuria, pyuria Creatinine
- 15. Primary endpoint: Mean change in IPSS from baseline Roehrborn et al . J Urol (In Press) -7 -6 -5 -4 -3 -2 -1 0 0 3 6 9 12 15 18 21 24 Treatment month Adjusted mean change in IPSS from baseline (ITT, LOCF) p<0.001 combo vs . tam p<0.001 combo vs . dut Tamsulosin -4.8 -4.5 -4.4 -4.3 -4.5 -4.4 -4.7 -4.5 Dutasteride -2.8 -3.4 -4.0 -4.2 -4.8 -4.9 -5.0 -4.9 Combination -4.8 -4.8 -5.4 -5.6 -6.0 -6.0 -6.2 -6.2
- 16. Secondary endpoint: Mean change in Qmax from baseline Roehrborn et al . J Urol (In Press) 0.0 0.5 1.0 1.5 2.0 2.5 3.0 0 6 12 18 24 Treatment month Adjusted mean change in Qmax (mL/sec) from baseline (ITT, LOCF) p<0.001 combo vs . tam p<0.006 combo vs . dut 1.2 0.9 1.1 0.9 Tamsulosin Dutasteride 1.5 1.8 1.9 1.2 Combination 2.0 2.0 2.3 2.4
- 17. Drug-related adverse events Roehrborn et al . J Urol (In Press) 1.0% 1.2% 1.4% 1.6% 1.7% 1.8% 2.4% 3.4% 4.2% 7.4% Combination (n=1610) 1.0% 0.6% 1.8% 0.7% 1.3% 0.3% 0.5% 2.8% 0.6% 6.0% Dutasteride (n=1623) 0.3% Breast tenderness 0.3% Nipple pain 0.8% Breast enlargement 1.7% Dizziness 0.9% Loss of libido 0.8% Semen volume decreased 0.8% Ejaculation failure 1.7% Altered (decreased) libido 1.1% Retrograde ejaculation 3.8% Erectile dysfunction Tamsulosin (n=1611)
- 22. What about the storage symptoms? TRABECULATION FREQUENCY NOCTURIA
- 27. Thank you