Urinary Problems In Aging Male - Chinese

Urinary problems in the aging male - What are the latest treatment? Dr Ho Siew Hong Consultant Urologist S H Ho Urology & Laparoscopy Centre Gleneagles Hospital 中老年男性泌尿问题 - 最新发展与治疗何肇康医生泌尿专科新加坡鹰阁医院

泌尿系统 The Urinary System
肾器官 - 生产尿
Kidneys – urine production
输尿管 – 将尿输入尿袋（膀胱）
Ureter – tube connecting kidneys to bladder
尿袋（膀胱） - 储存尿
Bladder – urine storage
尿道 - 将尿排出
Urethra – urine passage to the outside

中老年男性泌尿问题 - Problems in an aging man

Prostate problems - difficulty in urination - frequent urination
前列腺问题
小便困难
经常小便
但每一次只小一点点

Cancer changes
- prostate, bladder, kidney
癌症变化
前列腺
膀胱
肾器官

前列腺问题 Prostate Problems
前列腺肿胀 / 增生
Enlargement/hyperplasia
癌症变化
Cancer change

前列腺位子在哪？ Where is the Prostate ?
90% 男性不知道这器官是什么
90% men do not know of this organ
马来话 ‘ langsat’
Size of ‘langsat’
膀胱下面，环绕着尿管
Below bladder ， surrounds urine tube

前列腺增生 Prostate Enlargement (BPH)
非癌症型的增生
Non-cancer enlargement
与男性荷尔蒙 / 睾酮变化有关
Related to hormones changes
缓慢的逐渐的增生
Gradual enlargement
Before After

前列腺增生的症状 Signs of Prostate Enlargement
小便困难
Difficulty in passing urine
逼尿
Straining
尿流变又细又慢
Slow stream of urine
尿不尽
Not able to complete urination

早晚不分，经常小便，但每一次只小一点点
Frequent urination in day or night
尿失禁
Urine incontinence
前列腺增生的症状 Signs of Prostate Enlargement

前列腺增生非常普偏 Prostate Enlargement is common Berry SJ et al. J Urol 1984; 132: 474 –9 11% 29% 48% 77% 87% 92% 0 20 40 60 80 100 31 – 40 41 – 50 51 – 60 61 – 70 71 – 80 80+ Precentage (%)

前列腺增生的并发症 Complications
尿存膀胱过久
Urine retained in bladder
膀胱炎
Bladder infection
膀胱石
Bladder stone

尿排不出
Obstruction of urine flow
得由塑胶管利尿
Urine drainage by tube

尿水逆流导致肾埙伤
Urine flows back into kidney,
causing kidney damage
膀胱水压过高，
埙坏膀胱肌肉
High pressure in bladder weakens
bladder wall muscles

减低尿管水压 Decreases pressure on urine tube
阿尔法受体阻滞剂 Alpha blockers
哌唑嗪 Prazosin, Terazosin, Alfuzosin, Doxazosin
前列腺增生内科治疗 Medical Treatment Narrow urine tube

将前列腺分量降小 30% Decreases size of prostate by 30%
阿尔法还原酶抑制剂 Alpha reductase inhibitors
Finasteride, Dutasteride
前列腺增生内科治疗 Medical Treatment Shrunken prostate Narrow urine tube

将多余的前列腺割去
Obstructing part of prostate removed
危险性非常低
Low risk surgery
无外表皮肤伤痕
No external wound
只须住院一两天
1-2 days stay in hospital only
经尿道前列腺电切（ TURP ）

前列腺外科内窥镜治疗 Scope Surgery TURP video

最新内窥镜治疗 Latest scope surgery for prostate
开刀时用的液体较稳定
Use of a more stable fluid during surgery
失血较少
Less bleeding
日间手术
Day surgery’ procedure
Plasmakinetic video

最新激光治疗 Laser surgery for prostate
采用激光将多余的前列腺割去
‘ Burning’ of prostate tissue PVP, holmium, diode lasers
失血较少
Less bleeding
日间手术
‘ Day surgery’ procedure
有待长期报道
Awaiting long term results

前列腺癌 Prostate cancer
幸好比前列腺增生来得罕见
Less common than prostate enlargement
病发率随着年龄增涨
Increases with age
到了晚期才有症状
No symptoms until advanced stage
Cancer

验血报告 Blood test - 前列腺特异性抗原 PSA (Prostate Specific Antigen)
‘ 前列腺特异性抗原如果高，并非代表一定有癌；也可能意味前列腺发炎或有严重前列腺增生’
‘ A high PSA reading is suggestive of prostate cancer. It can also be due to prostate enlargement or infection’
前列腺癌检查 Tests for Prostate Cancer

肿瘤 Lump 前列腺癌检查 Examination of the Prostate

前列腺超音波与活组织检查 Ultrasound and biopsy of Prostate

癌症还没扩散
Cancer still confined to prostate
能痊愈的机会很高
Very good chance for cure
前列腺癌根治手术，将整粒前列腺切除
Radical prostatectomy surgery
放射电疗
Radiation therapy
初期前列腺癌 Early Prostate Cancer

适合年龄较轻的病人
Usually performed for younger patients
将全部前列腺与大部分尿道切除
Total removal of prostate and urine tube
再将剩余的尿道结回膀胱
Bladder re-joined to rest of urine tube
前列腺癌根治外科手术 Radical Prostatectomy Surgery

开放式手术 Open surgery

腹腔镜手术
Laparoscopic (needle-hole) surgery

由机器协助
Assistance from robot
三维感关
3D view
比普通手术昂贵
High capital and recurring cost
前列腺癌机器协助手术 Robotic Prostatectomy Surgery

手术难度高
Technically more demanding
但是在腹腔以外开刀，也就能避免伤到小肠
Extraperitoneal, avoiding contact with intestine
如需将淋巴腺切除也可以
Removal of lymph nodes if necessary
比由机器协助手术便宜最少一万
Lower cost (by at least $10K)
腹腔镜前列腺癌外科手术 Laparoscopic prostatectomy

放射电疗 Radiation therapy
与开刀一样有效
Just as effective as surgery
电疗将前列腺销毁
Prostate destroyed by radiation
如果与抗癌荷尔蒙配合效率更加好
Combined with anti-male
hormone injection for better results

适合老年人
Suitable for even elderly patients
日间程序
Day procedure
治疗程序 6-7 星期
Treatment duration 6 - 7weeks
副作用少
Minimal side-effects
放射电疗 Radiation therapy

癌症已扩散与传移
Cancer has spread to other organs
骨，肝，肺
Bone, liver or lungs
最佳支持治疗来控制癌症
Control cancer growth and improve quality of life
Cancer 晚期前列腺癌 Advanced Prostate Cancer

前列腺癌得靠睾酮来生长
Prostate cancer depends on male hormones
如将体内睾酮减低，能控制癌
Suppression of male hormone
要体内睾酮减低，可用打针或吃抗癌荷尔蒙
Medications or injections
也可将睾丸切除
Removal of testicle
有效又无副作用
Effective with minimal side effects
晚期前列腺癌 Advanced Prostate Cancer

化学治疗
Chemotherapy
抗癌荷尔蒙失去效率时
When hormone therapy is not effective
许多新化疗比以前少付作用效率高
Many highly effective drugs with less side effects
晚期前列腺癌 Advanced Prostate Cancer

尿道尿管癌 Urinary Cancers Kidney 肾器官 Bladder 膀胱癌

尿道尿管癌的症状 Warnings of Cancer
尿有血（明显或不明显）
Blood in urine – obvious or not obvious
人疲劳
Lethargy
没胃口，人消瘦
Loss of appetite and weight
在排尿时背痛
Pain – back, sides; during passage of urine

肾癌的治疗 Treatment for Kidney Cancer
外科手术
Surgery
将失去一粒 / 部分的肾
Loss of a kidney or part of a kidney
初期癌症痊愈机会高
Early disease can be cured
晚期癌症痊愈机会低，预后差
Advanced conditions usually have poor outlook

后腹腔镜肾癌根治性切除术 Laparoscopic Nephrectomy Lap nephrectomy video

后腹腔镜肾癌根治性切除术 Laparoscopic Nephrectomy
将近收有的肾瘤度能由腹腔镜切除
Kidney cancer - almost all
cancer can be removed by key hole surgery

后腹腔镜肾癌切除手术 Laparoscopic Partial Nephrectomy
Removal of only a portion of kidney in early and small kidney cancer

尿袋癌的治疗 Treatment for Bladder Cancer
初期膀胱癌可采用内窥镜小手术
Early bladder cancers can be treated with minimally invasive surgery
将化疗剂注射进尿袋可获得更好的治疗效果
Chemotherapy solution can be placed in the bladder for better cure

总结 Conclusions
前列腺疾病在年长的男士们是常见的
Prostate problems are very common in the aging male
药物和手术治疗非常的有效
Medical and surgical treatments are very effective
随着年龄增长，患上前列腺癌，肾癌和尿袋癌的风险也增加
Risk of prostate, kidney and bladder cancer increases with age
必须做定期健康检验来发现早期癌症，当癌症还可以医治时
Regular health examinations are necessary to diagnose cancer in the early stage, when it is curable

Thank you

Urinary Problems In Aging Male - Chinese

by Siewhong Ho on Oct 26, 2008

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