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

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

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

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

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

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

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

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

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 前列腺增生的并发症 Complications

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 前列腺增生的并发症 Complications

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

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

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

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 ）

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

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

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

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

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

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

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

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’

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

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

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

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

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

开放式手术 Open surgery 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 前列腺癌根治外科手术 Radical Prostatectomy 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

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

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

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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