This document provides an overview of benign prostatic hyperplasia (BPH), including its epidemiology, terminology, evaluation, medical and surgical treatment options, and pathophysiology. Some key points include:
- BPH is a histological diagnosis defined as nonmalignant hyperplasia of the prostate gland. It often presents clinically as lower urinary tract symptoms and prostate enlargement.
- Evaluation involves assessment of symptoms, physical exam including DRE, urinalysis, and consideration of PSA. Objective tests like flow rate and residual urine may be used depending on symptom severity.
- Medical therapy options aim to reduce bladder outlet obstruction and include alpha-blockers which relax smooth muscle, and 5-alpha
This document provides an overview of benign prostatic hyperplasia (BPH), including its epidemiology, terminology, evaluation, medical and surgical treatment options, and pathophysiology. Some key points include:
- BPH is a histological diagnosis defined as nonmalignant hyperplasia of the prostate gland. It often presents clinically as bothersome lower urinary tract symptoms and an enlarged prostate.
- Evaluation involves medical history, physical exam including DRE, urinalysis, and symptom assessment. Additional tests like flow rate and residual urine may be used if symptoms are moderate to severe.
- Medical therapy options are alpha-blockers which target the dynamic component of obstruction, and 5-alpha-re
Mens urological health cme bph-luts- final- nov 13 2013Ihsaan Peer
The document provides guidance on evaluating patients with benign prostatic hyperplasia and lower urinary tract symptoms (BPH-LUTS). It recommends obtaining a medical history, physical exam including digital rectal exam and urinalysis, and using validated symptom assessment tools. PSA testing should be offered to men over 50 according to Canadian guidelines, and storage symptoms persisting after treatment may indicate conditions like overactive bladder requiring further evaluation.
The document discusses pharmacotherapy for overactive bladder. It provides an overview of overactive bladder terminology, prevalence, diagnosis, and differential diagnosis. It then focuses on the rationale for pharmacologic treatment of overactive bladder, including the use of antimuscarinic drugs which are the mainstay of treatment by inhibiting involuntary bladder contractions. Clinical trials demonstrate the efficacy of drugs like tolterodine in reducing overactive bladder symptoms and improving quality of life.
Male lower urinary tract symptoms (LUTS), previously known as prostatism, are common in aging men. LUTS include storage symptoms like urgency, frequency, and nocturia as well as voiding symptoms like weak stream and incomplete emptying. While LUTS were traditionally attributed to benign prostatic hyperplasia (BPH), it is now recognized that storage symptoms are similar to overactive bladder (OAB) seen in women. Medical therapy for LUTS has evolved from surgery to treat obstruction to current use of alpha-blockers, 5-alpha-reductase inhibitors, and antimuscarinic medications to treat both storage and voiding symptoms, with or without BPH. Proper evaluation
The document summarizes benign prostatic hyperplasia (BPH). It describes the anatomy of the prostate gland and discusses terminology related to BPH. BPH involves benign enlargement of the prostate, which can obstruct the urethra and cause urinary symptoms. Risk factors include increasing age, genetics, and metabolic conditions. Evaluation of BPH involves medical history, physical exam including digital rectal exam, and may include urinalysis, blood tests, questionnaires, ultrasound, and urodynamic studies.
This document discusses urinary incontinence (UI) in older adults. It covers the prevalence of UI increasing with age, especially in women and those in long-term care. Risk factors include obesity, functional impairment, and medications. Age-related changes to the lower urinary tract are described for both men and women. The pathophysiology of different types of UI is explained. Screening, evaluation, treatments including lifestyle changes, behavioral therapies, and medications are outlined.
Benign Prostate Hyperplasia: Aetiology, Pathology , Diagnosis and Medical therapy is a document that discusses benign prostate hyperplasia (BPH). It covers the etiology, pathology, diagnosis, and medical therapy of BPH. The document discusses risk factors for BPH like age, genetics, and hormones. It describes the pathological features of BPH including epithelial and stromal cell hyperplasia. Diagnosis involves history, exam, lab tests like PSA and ultrasound. Medical therapy options presented are watchful waiting, alpha blockers, 5-alpha-reductase inhibitors, and anticholinergics.
This document summarizes key aspects of primary biliary cholangitis (PBC), formerly known as primary biliary cirrhosis. It discusses the epidemiology, risk factors, natural history, presentation, diagnosis and management of PBC. If left untreated, PBC progresses through several clinical phases over many years, eventually leading to liver failure and death in some patients. Prognosis is generally better in asymptomatic patients than in those with symptoms.
This document provides an overview of benign prostatic hyperplasia (BPH), including its epidemiology, terminology, evaluation, medical and surgical treatment options, and pathophysiology. Some key points include:
- BPH is a histological diagnosis defined as nonmalignant hyperplasia of the prostate gland. It often presents clinically as bothersome lower urinary tract symptoms and an enlarged prostate.
- Evaluation involves medical history, physical exam including DRE, urinalysis, and symptom assessment. Additional tests like flow rate and residual urine may be used if symptoms are moderate to severe.
- Medical therapy options are alpha-blockers which target the dynamic component of obstruction, and 5-alpha-re
Mens urological health cme bph-luts- final- nov 13 2013Ihsaan Peer
The document provides guidance on evaluating patients with benign prostatic hyperplasia and lower urinary tract symptoms (BPH-LUTS). It recommends obtaining a medical history, physical exam including digital rectal exam and urinalysis, and using validated symptom assessment tools. PSA testing should be offered to men over 50 according to Canadian guidelines, and storage symptoms persisting after treatment may indicate conditions like overactive bladder requiring further evaluation.
The document discusses pharmacotherapy for overactive bladder. It provides an overview of overactive bladder terminology, prevalence, diagnosis, and differential diagnosis. It then focuses on the rationale for pharmacologic treatment of overactive bladder, including the use of antimuscarinic drugs which are the mainstay of treatment by inhibiting involuntary bladder contractions. Clinical trials demonstrate the efficacy of drugs like tolterodine in reducing overactive bladder symptoms and improving quality of life.
Male lower urinary tract symptoms (LUTS), previously known as prostatism, are common in aging men. LUTS include storage symptoms like urgency, frequency, and nocturia as well as voiding symptoms like weak stream and incomplete emptying. While LUTS were traditionally attributed to benign prostatic hyperplasia (BPH), it is now recognized that storage symptoms are similar to overactive bladder (OAB) seen in women. Medical therapy for LUTS has evolved from surgery to treat obstruction to current use of alpha-blockers, 5-alpha-reductase inhibitors, and antimuscarinic medications to treat both storage and voiding symptoms, with or without BPH. Proper evaluation
The document summarizes benign prostatic hyperplasia (BPH). It describes the anatomy of the prostate gland and discusses terminology related to BPH. BPH involves benign enlargement of the prostate, which can obstruct the urethra and cause urinary symptoms. Risk factors include increasing age, genetics, and metabolic conditions. Evaluation of BPH involves medical history, physical exam including digital rectal exam, and may include urinalysis, blood tests, questionnaires, ultrasound, and urodynamic studies.
This document discusses urinary incontinence (UI) in older adults. It covers the prevalence of UI increasing with age, especially in women and those in long-term care. Risk factors include obesity, functional impairment, and medications. Age-related changes to the lower urinary tract are described for both men and women. The pathophysiology of different types of UI is explained. Screening, evaluation, treatments including lifestyle changes, behavioral therapies, and medications are outlined.
Benign Prostate Hyperplasia: Aetiology, Pathology , Diagnosis and Medical therapy is a document that discusses benign prostate hyperplasia (BPH). It covers the etiology, pathology, diagnosis, and medical therapy of BPH. The document discusses risk factors for BPH like age, genetics, and hormones. It describes the pathological features of BPH including epithelial and stromal cell hyperplasia. Diagnosis involves history, exam, lab tests like PSA and ultrasound. Medical therapy options presented are watchful waiting, alpha blockers, 5-alpha-reductase inhibitors, and anticholinergics.
This document summarizes key aspects of primary biliary cholangitis (PBC), formerly known as primary biliary cirrhosis. It discusses the epidemiology, risk factors, natural history, presentation, diagnosis and management of PBC. If left untreated, PBC progresses through several clinical phases over many years, eventually leading to liver failure and death in some patients. Prognosis is generally better in asymptomatic patients than in those with symptoms.
This document discusses the medical management of benign prostatic hyperplasia (BPH). It describes the pathology and pathophysiology of BPH, including the hyperplastic process that leads to nodule formation and bladder outlet obstruction. Clinical definitions related to BPH and lower urinary tract symptoms are provided. Assessment tools for lower urinary tract symptoms like the International Prostate Symptom Score are discussed. The document reviews differential diagnoses, treatments including watchful waiting, medications like alpha blockers and 5-alpha reductase inhibitors, and procedures. Side effects of medications and evidence for various treatment options are also summarized.
This document discusses voiding dysfunction and benign prostatic hyperplasia (BPH). It notes that BPH is very common in men over 60, affecting over 40% with symptoms. It impacts quality of life by interfering with daily activities. The prevalence increases significantly with age. Symptoms can include both irritative (storage) symptoms like urgency and obstructive (voiding) symptoms like hesitancy. The pathophysiology involves both static anatomical enlargement of the prostate and dynamic increased smooth muscle tone. Overactive bladder (OAB) symptoms affect a substantial proportion of men with BPH and lower urinary tract symptoms.
This document summarizes the evidence-based approach to managing male benign prostatic enlargement. It discusses the terminology, natural history, and management of lower urinary tract symptoms. The main treatment options for LUTS/BPO that are supported by evidence include alpha-1 adrenoceptor antagonists, 5-alpha reductase inhibitors, and combination therapy with both. Guidelines aim to guide best practice and provide consensus based on evidence.
Benign prostatic hyperplasia (BPH) is a common condition in aging men that results from hyperplasia of the prostate gland. Key points:
- BPH results in lower urinary tract symptoms in about 10% of men affected by middle age due to prostate enlargement obstructing urine flow.
- Evaluation involves medical history, physical exam including digital rectal exam, and urinalysis. Management focuses on lifestyle changes and medications like alpha-blockers and 5-alpha-reductase inhibitors.
- Differential diagnoses include urinary tract infections and prostate cancer, which require further workup and monitoring. Most patients see improvement in symptoms with medical treatment but some may require referral for surgical management.
This document provides an overview of benign prostatic hyperplasia (BPH), including its definition, epidemiology, clinical manifestations, complications, differential diagnosis, evaluation, and management. BPH involves noncancerous enlargement of the prostate and commonly causes lower urinary tract symptoms. It predominantly affects older men. Evaluation involves assessment of symptoms, physical exam including digital rectal exam, and tests like prostate-specific antigen. Management includes watchful waiting, lifestyle changes, medications like alpha-blockers and 5-alpha-reductase inhibitors, and potentially surgery for severe or treatment-resistant cases. Screening for prostate cancer with PSA is not universally recommended.
This document discusses overactive bladder (OAB), including its definition, symptoms, prevalence, impact, and treatment options. It defines OAB as a syndrome characterized by urgency, with or without urge incontinence, usually accompanied by frequency and nocturia. It notes that OAB is very common, affecting 11-22% of adults over 40, and is more prevalent in older individuals and females. While over half of females with OAB seek treatment, far fewer males do. Non-pharmacological treatments discussed include behavior modification, diet and fluid management, and pelvic floor exercises.
This document provides an overview of benign prostatic hyperplasia (BPH). It defines key terms related to BPH and lower urinary tract symptoms. It describes the histopathology and molecular etiology of BPH, risk factors such as aging and genetics, and the pathophysiology whereby BPH causes bladder outlet obstruction and changes in bladder function. It also discusses complications of BPH, correlations with severity measures, and a staging system for determining appropriate treatment.
Overactive bladder (OAB) is a common condition characterized by urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with or without urinary incontinence. OAB affects a significant portion of the global population but often goes untreated due to underdiagnosis and patients adapting to symptoms. Untreated OAB can negatively impact patients' quality of life, relationships, and productivity. Guidelines recommend behavioral therapies and pharmacologic treatments such as antimuscarinics and mirabegron as first-line options for managing OAB.
This document presents a class presentation on benign prostatic hyperplasia (BPH) given by Manidipa Bakshi. It defines BPH as an enlargement of the prostate gland that causes urination problems. It discusses the incidence, etiology, risk factors, pathophysiology, clinical manifestations, complications, diagnostic studies, medical management including drug and surgical options, and the nursing management focus on preoperative and postoperative care for patients undergoing procedures for BPH.
Cholecystectomy in patient with Liver Cirrhosis.pptxPushpa Lal Bhadel
This document discusses cholecystectomy in a patient with liver cirrhosis. It provides background on gallstone disease and cirrhosis. Laparoscopic cholecystectomy is generally safer than open for cirrhotic patients, though it carries higher risks than in non-cirrhotic patients due to issues like bleeding and difficult anatomy. Predictive models like Child-Pugh and MELD scores can help assess operative risk. While challenging, laparoscopic cholecystectomy can be performed in carefully selected cirrhotic patients by experienced surgeons.
This document discusses benign prostatic hyperplasia (BPH). It begins with the anatomy of the prostate gland and defines BPH as non-malignant prostate tissue growth due to aging. Risk factors for BPH include increasing age and family history. Clinical evaluation involves history, physical exam including digital rectal exam, and testing like PSA and ultrasound. Treatment options range from lifestyle changes and medications like alpha blockers and 5-alpha-reductase inhibitors for mild-moderate BPH to surgical interventions like TURP for severe cases. The document provides details on evaluation and management approaches for BPH.
Benign prostatic enlargement (BPE) is a common condition among aging men that can cause lower urinary tract symptoms (LUTS). The document discusses the epidemiology, pathophysiology, differential diagnosis, evaluation, and management of BPE. Key points include that BPE is caused by both aging and androgens, and its prevalence increases significantly with age. The diagnostic evaluation of BPE involves taking a patient history, physical exam including digital rectal exam, urinalysis, prostate-specific antigen level, renal function tests, and uroflowmetry to evaluate urine flow. BPE can cause obstructive or irritative voiding symptoms and complications like urinary retention if not properly managed.
This document provides an overview of benign prostatic hyperplasia (BPH), including its definition, risk factors, pathophysiology, clinical manifestations, diagnosis, management options, and references. It begins with learning objectives and outlines the topics to be covered. The presentation defines BPH as non-cancerous enlargement of the prostate gland that contributes to lower urinary tract symptoms in aging men. Risk factors include age over 40, family history, and certain medical conditions. Treatment depends on symptom severity and includes watchful waiting, medications like alpha blockers, minimally invasive procedures, and surgery.
This document provides an overview of benign prostatic hyperplasia (BPH), including its epidemiology, evaluation, and management. Some key points:
1. Histologically, BPH prevalence increases with age, affecting nearly 90% of men in their 80s. However, clinically significant lower urinary tract symptoms (LUTS) are more complex and affect around 45-62% of men in their 50s and 70s.
2. Evaluation of patients with LUTS involves assessing for other medical conditions, administering the International Prostate Symptom Score questionnaire, performing a physical exam, and optional urinalysis and PSA testing. More invasive testing may be needed for complex cases.
3.
Management of kidney transplant recipient (ayman refaie)FarragBahbah
1. The document discusses the management and follow-up of renal transplant patients, including important considerations at the initial visit post-transplant and routine follow-up visits.
2. It outlines the various risks transplant patients face, such as cardiovascular disease, diabetes, infection, malignancy, and drug-drug interactions.
3. Maintaining optimal immunosuppression while minimizing side effects is an art that requires monitoring multiple risk factors to support long-term graft and patient survival.
Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland that is common among aging men. It affects around 50% of men over 60 years of age and over 90% of men over 70. The hyperplasia is stimulated by hormones and affects prostate tissue. Common symptoms include difficulties with urination such as a weak stream, straining, and increased nighttime urination. Treatment options include medication, such as 5-alpha reductase inhibitors and alpha blockers, as well as surgical procedures for more severe cases.
A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and BPH.
This document provides information about prostate cancer including epidemiology, risk factors, diagnosis, staging, treatment options and outcomes. Some key points include:
- Prostate cancer is one of the most common cancers in men over 50 worldwide. Incidence is increasing.
- Risk factors include family history, race, diet, and environmental exposures.
- Screening includes digital rectal exam and prostate specific antigen (PSA) blood test. Biopsy is used to confirm diagnosis.
- Staging uses tumor size, grade using Gleason Score, and extent of spread. Treatment depends on stage but may include surgery, radiation therapy and hormone therapy.
This document outlines essential skills for new managers. It discusses 7 key behaviors including knowing your people and business, insisting on realism, setting clear goals and objectives, following through, rewarding performance, expanding capabilities, and knowing yourself. Specific tips are provided in each area, such as getting engaged with employees, focusing on execution, encouraging learning from mistakes, and coaching employees. The document emphasizes clear communication, handling conflicts well, building credibility through recognition, and avoiding common management mistakes like not listening to employees. Overall it provides guidance to new managers on effectively leading teams and getting work done through others.
Walmart's key strategies include maintaining low prices, expanding into new markets internationally and domestically, and creating a seamless omni-channel experience for customers. The company aims to dominate retail sectors by investing in technology, using a saturation store strategy, and aligning leadership between its stores, logistics network, and e-commerce capabilities.
This document discusses the medical management of benign prostatic hyperplasia (BPH). It describes the pathology and pathophysiology of BPH, including the hyperplastic process that leads to nodule formation and bladder outlet obstruction. Clinical definitions related to BPH and lower urinary tract symptoms are provided. Assessment tools for lower urinary tract symptoms like the International Prostate Symptom Score are discussed. The document reviews differential diagnoses, treatments including watchful waiting, medications like alpha blockers and 5-alpha reductase inhibitors, and procedures. Side effects of medications and evidence for various treatment options are also summarized.
This document discusses voiding dysfunction and benign prostatic hyperplasia (BPH). It notes that BPH is very common in men over 60, affecting over 40% with symptoms. It impacts quality of life by interfering with daily activities. The prevalence increases significantly with age. Symptoms can include both irritative (storage) symptoms like urgency and obstructive (voiding) symptoms like hesitancy. The pathophysiology involves both static anatomical enlargement of the prostate and dynamic increased smooth muscle tone. Overactive bladder (OAB) symptoms affect a substantial proportion of men with BPH and lower urinary tract symptoms.
This document summarizes the evidence-based approach to managing male benign prostatic enlargement. It discusses the terminology, natural history, and management of lower urinary tract symptoms. The main treatment options for LUTS/BPO that are supported by evidence include alpha-1 adrenoceptor antagonists, 5-alpha reductase inhibitors, and combination therapy with both. Guidelines aim to guide best practice and provide consensus based on evidence.
Benign prostatic hyperplasia (BPH) is a common condition in aging men that results from hyperplasia of the prostate gland. Key points:
- BPH results in lower urinary tract symptoms in about 10% of men affected by middle age due to prostate enlargement obstructing urine flow.
- Evaluation involves medical history, physical exam including digital rectal exam, and urinalysis. Management focuses on lifestyle changes and medications like alpha-blockers and 5-alpha-reductase inhibitors.
- Differential diagnoses include urinary tract infections and prostate cancer, which require further workup and monitoring. Most patients see improvement in symptoms with medical treatment but some may require referral for surgical management.
This document provides an overview of benign prostatic hyperplasia (BPH), including its definition, epidemiology, clinical manifestations, complications, differential diagnosis, evaluation, and management. BPH involves noncancerous enlargement of the prostate and commonly causes lower urinary tract symptoms. It predominantly affects older men. Evaluation involves assessment of symptoms, physical exam including digital rectal exam, and tests like prostate-specific antigen. Management includes watchful waiting, lifestyle changes, medications like alpha-blockers and 5-alpha-reductase inhibitors, and potentially surgery for severe or treatment-resistant cases. Screening for prostate cancer with PSA is not universally recommended.
This document discusses overactive bladder (OAB), including its definition, symptoms, prevalence, impact, and treatment options. It defines OAB as a syndrome characterized by urgency, with or without urge incontinence, usually accompanied by frequency and nocturia. It notes that OAB is very common, affecting 11-22% of adults over 40, and is more prevalent in older individuals and females. While over half of females with OAB seek treatment, far fewer males do. Non-pharmacological treatments discussed include behavior modification, diet and fluid management, and pelvic floor exercises.
This document provides an overview of benign prostatic hyperplasia (BPH). It defines key terms related to BPH and lower urinary tract symptoms. It describes the histopathology and molecular etiology of BPH, risk factors such as aging and genetics, and the pathophysiology whereby BPH causes bladder outlet obstruction and changes in bladder function. It also discusses complications of BPH, correlations with severity measures, and a staging system for determining appropriate treatment.
Overactive bladder (OAB) is a common condition characterized by urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with or without urinary incontinence. OAB affects a significant portion of the global population but often goes untreated due to underdiagnosis and patients adapting to symptoms. Untreated OAB can negatively impact patients' quality of life, relationships, and productivity. Guidelines recommend behavioral therapies and pharmacologic treatments such as antimuscarinics and mirabegron as first-line options for managing OAB.
This document presents a class presentation on benign prostatic hyperplasia (BPH) given by Manidipa Bakshi. It defines BPH as an enlargement of the prostate gland that causes urination problems. It discusses the incidence, etiology, risk factors, pathophysiology, clinical manifestations, complications, diagnostic studies, medical management including drug and surgical options, and the nursing management focus on preoperative and postoperative care for patients undergoing procedures for BPH.
Cholecystectomy in patient with Liver Cirrhosis.pptxPushpa Lal Bhadel
This document discusses cholecystectomy in a patient with liver cirrhosis. It provides background on gallstone disease and cirrhosis. Laparoscopic cholecystectomy is generally safer than open for cirrhotic patients, though it carries higher risks than in non-cirrhotic patients due to issues like bleeding and difficult anatomy. Predictive models like Child-Pugh and MELD scores can help assess operative risk. While challenging, laparoscopic cholecystectomy can be performed in carefully selected cirrhotic patients by experienced surgeons.
This document discusses benign prostatic hyperplasia (BPH). It begins with the anatomy of the prostate gland and defines BPH as non-malignant prostate tissue growth due to aging. Risk factors for BPH include increasing age and family history. Clinical evaluation involves history, physical exam including digital rectal exam, and testing like PSA and ultrasound. Treatment options range from lifestyle changes and medications like alpha blockers and 5-alpha-reductase inhibitors for mild-moderate BPH to surgical interventions like TURP for severe cases. The document provides details on evaluation and management approaches for BPH.
Benign prostatic enlargement (BPE) is a common condition among aging men that can cause lower urinary tract symptoms (LUTS). The document discusses the epidemiology, pathophysiology, differential diagnosis, evaluation, and management of BPE. Key points include that BPE is caused by both aging and androgens, and its prevalence increases significantly with age. The diagnostic evaluation of BPE involves taking a patient history, physical exam including digital rectal exam, urinalysis, prostate-specific antigen level, renal function tests, and uroflowmetry to evaluate urine flow. BPE can cause obstructive or irritative voiding symptoms and complications like urinary retention if not properly managed.
This document provides an overview of benign prostatic hyperplasia (BPH), including its definition, risk factors, pathophysiology, clinical manifestations, diagnosis, management options, and references. It begins with learning objectives and outlines the topics to be covered. The presentation defines BPH as non-cancerous enlargement of the prostate gland that contributes to lower urinary tract symptoms in aging men. Risk factors include age over 40, family history, and certain medical conditions. Treatment depends on symptom severity and includes watchful waiting, medications like alpha blockers, minimally invasive procedures, and surgery.
This document provides an overview of benign prostatic hyperplasia (BPH), including its epidemiology, evaluation, and management. Some key points:
1. Histologically, BPH prevalence increases with age, affecting nearly 90% of men in their 80s. However, clinically significant lower urinary tract symptoms (LUTS) are more complex and affect around 45-62% of men in their 50s and 70s.
2. Evaluation of patients with LUTS involves assessing for other medical conditions, administering the International Prostate Symptom Score questionnaire, performing a physical exam, and optional urinalysis and PSA testing. More invasive testing may be needed for complex cases.
3.
Management of kidney transplant recipient (ayman refaie)FarragBahbah
1. The document discusses the management and follow-up of renal transplant patients, including important considerations at the initial visit post-transplant and routine follow-up visits.
2. It outlines the various risks transplant patients face, such as cardiovascular disease, diabetes, infection, malignancy, and drug-drug interactions.
3. Maintaining optimal immunosuppression while minimizing side effects is an art that requires monitoring multiple risk factors to support long-term graft and patient survival.
Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland that is common among aging men. It affects around 50% of men over 60 years of age and over 90% of men over 70. The hyperplasia is stimulated by hormones and affects prostate tissue. Common symptoms include difficulties with urination such as a weak stream, straining, and increased nighttime urination. Treatment options include medication, such as 5-alpha reductase inhibitors and alpha blockers, as well as surgical procedures for more severe cases.
A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and BPH.
This document provides information about prostate cancer including epidemiology, risk factors, diagnosis, staging, treatment options and outcomes. Some key points include:
- Prostate cancer is one of the most common cancers in men over 50 worldwide. Incidence is increasing.
- Risk factors include family history, race, diet, and environmental exposures.
- Screening includes digital rectal exam and prostate specific antigen (PSA) blood test. Biopsy is used to confirm diagnosis.
- Staging uses tumor size, grade using Gleason Score, and extent of spread. Treatment depends on stage but may include surgery, radiation therapy and hormone therapy.
This document outlines essential skills for new managers. It discusses 7 key behaviors including knowing your people and business, insisting on realism, setting clear goals and objectives, following through, rewarding performance, expanding capabilities, and knowing yourself. Specific tips are provided in each area, such as getting engaged with employees, focusing on execution, encouraging learning from mistakes, and coaching employees. The document emphasizes clear communication, handling conflicts well, building credibility through recognition, and avoiding common management mistakes like not listening to employees. Overall it provides guidance to new managers on effectively leading teams and getting work done through others.
Walmart's key strategies include maintaining low prices, expanding into new markets internationally and domestically, and creating a seamless omni-channel experience for customers. The company aims to dominate retail sectors by investing in technology, using a saturation store strategy, and aligning leadership between its stores, logistics network, and e-commerce capabilities.
The document discusses strategy evaluation and control. It describes evaluating strategies by examining their underlying bases, comparing expected vs actual results, and taking corrective actions. Strategy evaluation is complex due to many factors like environmental uncertainty. Firms should continuously evaluate strategies using frameworks like Rumelt's criteria or the balanced scorecard, which assesses financial and non-financial metrics. Contingency planning and auditing also support effective evaluation. Current challenges include balancing art and science in strategic processes and deciding strategy transparency.
This document outlines a marketing plan with the following sections:
1. Situational analysis which examines external and internal factors.
2. Marketing objectives including financial, market share, and promotional goals.
3. Marketing strategies covering segmentation, targeting, positioning and various promotional approaches.
4. Marketing mix addressing the product, pricing, placement, and promotion elements of the marketing strategy.
5. Action plan with pre-launch, launch, and engagement activities including materials, events, and visits.
6. Budgets and timelines for the various marketing tactics in the second, third and fourth quarters.
Netiquette is defined as etiquette on the Internet and involves understanding how different aspects of the Internet work in order to communicate effectively and appropriately. Some basic rules of netiquette include being brief, using proper formatting like white space, using descriptive subject lines, staying on topic, being careful with attachments, and copying a minimal number of people on emails. Following netiquette is important to have polite and productive online conversations and avoid issues like flaming.
This document provides information on various hair care products sold in Egypt, including creams, lotions, oils, serums, and shampoos. It lists the product names, descriptions, prices, packaging information, and key ingredients. The products are aimed at treating hair loss, strengthening hair, stimulating hair growth, and providing scalp and hair care. The document appears to be from an Egyptian company marketing several lines of men's and women's hair care products.
This document outlines objectives and content for a unit on antimicrobial medications. It discusses key terms like antimicrobial, antibiotic, and mechanisms of action. The objectives are to review common concepts of antimicrobial therapy including mechanisms of action, indications, nursing implications, and dosage calculations. Content covers different drug types, sources, targets, effects, spectrum of activity, resistance, and ideal properties. Combination drug therapy is also addressed.
This document discusses principles of antimicrobial therapy. It defines antimicrobial drugs as substances that kill or inhibit the growth of microorganisms like bacteria, viruses, fungi and protozoa. It also defines key terms like antibacterial, antiviral, antifungal, bacteriostatic, bactericidal and antibiotic. The document outlines factors to consider in antimicrobial therapy like the infection site, patient factors, drug factors, minimum inhibitory concentration and mechanisms of microbial resistance. It discusses using drug combinations to treat infections and defines antimicrobial spectrum.
David Livermore discusses the challenges of predicting the future of antimicrobial resistance. He notes that while past trends can be extrapolated, unexpected "black swan" events involving the spread of new resistance genes have dramatically changed the resistance landscape. Examples he provides include the emergence and spread of various beta-lactamases and carbapenemases. Livermore argues it is difficult to reliably predict which resistance mechanisms may emerge or spread in the future. He advocates diversifying antibiotic development to hedge against unpredictability, rather than trying to pick individual "winners."
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How MJ Global Leads the Packaging Industry.pdfMJ Global
MJ Global's success in staying ahead of the curve in the packaging industry is a testament to its dedication to innovation, sustainability, and customer-centricity. By embracing technological advancements, leading in eco-friendly solutions, collaborating with industry leaders, and adapting to evolving consumer preferences, MJ Global continues to set new standards in the packaging sector.
At Techbox Square, in Singapore, we're not just creative web designers and developers, we're the driving force behind your brand identity. Contact us today.
Storytelling is an incredibly valuable tool to share data and information. To get the most impact from stories there are a number of key ingredients. These are based on science and human nature. Using these elements in a story you can deliver information impactfully, ensure action and drive change.
How to Implement a Real Estate CRM SoftwareSalesTown
To implement a CRM for real estate, set clear goals, choose a CRM with key real estate features, and customize it to your needs. Migrate your data, train your team, and use automation to save time. Monitor performance, ensure data security, and use the CRM to enhance marketing. Regularly check its effectiveness to improve your business.
Digital Marketing with a Focus on Sustainabilitysssourabhsharma
Digital Marketing best practices including influencer marketing, content creators, and omnichannel marketing for Sustainable Brands at the Sustainable Cosmetics Summit 2024 in New York
Industrial Tech SW: Category Renewal and CreationChristian Dahlen
Every industrial revolution has created a new set of categories and a new set of players.
Multiple new technologies have emerged, but Samsara and C3.ai are only two companies which have gone public so far.
Manufacturing startups constitute the largest pipeline share of unicorns and IPO candidates in the SF Bay Area, and software startups dominate in Germany.
Anny Serafina Love - Letter of Recommendation by Kellen Harkins, MS.AnnySerafinaLove
This letter, written by Kellen Harkins, Course Director at Full Sail University, commends Anny Love's exemplary performance in the Video Sharing Platforms class. It highlights her dedication, willingness to challenge herself, and exceptional skills in production, editing, and marketing across various video platforms like YouTube, TikTok, and Instagram.
Best practices for project execution and deliveryCLIVE MINCHIN
A select set of project management best practices to keep your project on-track, on-cost and aligned to scope. Many firms have don't have the necessary skills, diligence, methods and oversight of their projects; this leads to slippage, higher costs and longer timeframes. Often firms have a history of projects that simply failed to move the needle. These best practices will help your firm avoid these pitfalls but they require fortitude to apply.
Easily Verify Compliance and Security with Binance KYCAny kyc Account
Use our simple KYC verification guide to make sure your Binance account is safe and compliant. Discover the fundamentals, appreciate the significance of KYC, and trade on one of the biggest cryptocurrency exchanges with confidence.
HOW TO START UP A COMPANY A STEP-BY-STEP GUIDE.pdf46adnanshahzad
How to Start Up a Company: A Step-by-Step Guide Starting a company is an exciting adventure that combines creativity, strategy, and hard work. It can seem overwhelming at first, but with the right guidance, anyone can transform a great idea into a successful business. Let's dive into how to start up a company, from the initial spark of an idea to securing funding and launching your startup.
Introduction
Have you ever dreamed of turning your innovative idea into a thriving business? Starting a company involves numerous steps and decisions, but don't worry—we're here to help. Whether you're exploring how to start a startup company or wondering how to start up a small business, this guide will walk you through the process, step by step.
Understanding User Needs and Satisfying ThemAggregage
https://www.productmanagementtoday.com/frs/26903918/understanding-user-needs-and-satisfying-them
We know we want to create products which our customers find to be valuable. Whether we label it as customer-centric or product-led depends on how long we've been doing product management. There are three challenges we face when doing this. The obvious challenge is figuring out what our users need; the non-obvious challenges are in creating a shared understanding of those needs and in sensing if what we're doing is meeting those needs.
In this webinar, we won't focus on the research methods for discovering user-needs. We will focus on synthesis of the needs we discover, communication and alignment tools, and how we operationalize addressing those needs.
Industry expert Scott Sehlhorst will:
• Introduce a taxonomy for user goals with real world examples
• Present the Onion Diagram, a tool for contextualizing task-level goals
• Illustrate how customer journey maps capture activity-level and task-level goals
• Demonstrate the best approach to selection and prioritization of user-goals to address
• Highlight the crucial benchmarks, observable changes, in ensuring fulfillment of customer needs
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The Genesis of BriansClub.cm Famous Dark WEb PlatformSabaaSudozai
BriansClub.cm, a famous platform on the dark web, has become one of the most infamous carding marketplaces, specializing in the sale of stolen credit card data.
Structural Design Process: Step-by-Step Guide for BuildingsChandresh Chudasama
The structural design process is explained: Follow our step-by-step guide to understand building design intricacies and ensure structural integrity. Learn how to build wonderful buildings with the help of our detailed information. Learn how to create structures with durability and reliability and also gain insights on ways of managing structures.
Structural Design Process: Step-by-Step Guide for Buildings
Jaffe-GeriatricsGR2014.pptx
1. Update on Benign Prostatic
Hyperplasia
William I. Jaffe, MD
Assistant Professor of Urology in Surgery
Penn Presbyterian Medical Center
University of Pennsylvania Health System
2. Nobel Prize Winners in Urology
Werner Forssmann- 1956
Charles B. Huggins- 1966
5. A Modern View of BPH
Clinical, Anatomic, and Pathophysiologic Changes
• BPH = Benign Prostatic
Hyperplasia
– Histologic: stromoglandular
hyperplasia1
• May be associated with
– Clinical: presence of
bothersome LUTS2
– Anatomic: enlargement of
the gland (BPE = Benign
Prostatic Enlargement)2
– Pathophysiologic: compression
of urethra and compromise of
urinary flow (BOO = Bladder
Outlet Obstruction)2
1. American Urological Association Research and Education Inc. BPH Guidelines 2003.
2. Nordling J et al. In: Chatelain C et al, eds. Benign Prostatic Hyperplasia. Plymouth, UK: Health Publication Ltd;
2001:107166.
All Men
>50 y
Histologic
BPH
BPE
Enlargement
`
BOO
Obstruction
LUTS/
Bother
6. Berry SJ, et al. J Urol. 1984;132:474-479.
CDC. 2003 National Diabetes Fact Sheet.
Available at http://www.cdc.gov/diabetes/pubs/estimates.htm. Accessed May 16, 2003.
CDC. 1998 Forecasted State-Specific Estimates of Self-Reported Asthma Prevalence.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00055803.htm. Accessed January 8, 2003.
BPH
(Men Ages 61 to 72)
Diabetes
(Adults Over 65)
Asthma
(Entire Population)
0 25 50 75
Prevalence of BPH Versus
Other Common Conditions
8. Rhodes T et al. J Urol. 1999;161:1174–1179.
Collins GN et al. Br J Urol. 1993;71:445–450.
Jacobsen SJ et al. Urology. 2001;58(Suppl 6A):5–16.
Natural History of BPH:
Prostate Volume Increases
• 631 white men ages 40 to 79
from Olmsted County,
Minnesota
• Prostate volume measured up to
4 times by transrectal ultrasound
during a 7-year follow-up period
• Estimated prostate growth rates
increased by 1.6% per year
across all ages
• Higher baseline prostate volume
associated with higher rates of
prostate growth
10. Roberts RO et al. J Urol. 2000;163:107–113.
0
5
10
15
20
25
30
35
40
40–44 45–49 50–54 55–59 60–64 65–69 70–74 75+
Age Groups (y)
Qmax
(mL/sec)
0
50
100
150
200
250
300
350
400
450
Volume
(mL)
Qmax Volume
Natural History of BPH:
Qmax and Voided Volume
11. 2.6 3
9.3
34.7
0
5
10
15
20
25
30
35
40
40 to 49 years 70 to 79 years
Incidence
of
Acute
Urinary
Retention
(per
1000
person
years)
Mild to Moderate Symptoms
Moderate to Severe Symptoms
Jacobsen SJ et al. J Urol. 1997;158:481–487.
Natural History of BPH: Risk of Acute
Urinary Retention Increases
• 2115 white men ages 40 to 79
from Olmsted County,
Minnesota
• Symptoms measured via
questionnaire
• Incidence of acute urinary
retention over 4 years
ascertained via review of
medical records
• 8344 person-years of data
obtained
12. 2 2
9
13
3
7
16
34
0
10
20
30
40
40–49 50–59 60–69 70–79
Age (y)
Without prostatic enlargement and obstructive symptoms
With prostatic enlargement and obstructive symptoms
Arrighi HM et al. Urology. 1991;38(suppl):4–8.
10-Year
Probability
of
Surgery
(%
of
Patients)
Natural History of BPH:
Risk of Surgery Increases
13. PSA… It’s not just for cancer
• Serine protease produced by epithelial cells
• Dissolves semen coagulum
• Most bound to antiproteases ACT
• Increased with-
– Malignancy
– Hyperplasia
– Infection/Inflammation
14. Serum PSA and Prostate Volume
Increases Correlate with Age
Roehrborn CG et al. J Urol. 2000;163:13-20.
15. Roehrborn CG et al. J Urol. 2000;163:13-20.
PSA as a Predictor of Future
Prostate Growth
%
Change
in
PV
at
48
Months
Prostate Volume
Annualized Growth Rates
• Low PSA tertile:
0.7 mL/year
• Middle PSA tertile:
2.1 mL/year
• High PSA tertile:
3.3 mL/year
16. Incidence of AUR and/or Surgery
Over 4 Years by PSA Tertiles
Roehrborn CG et al. Urology. 1999;53:473-480.
Left untreated 1 in 6 patients with a PSA of >1.4 ng/mL will experience AUR or
BPH-related surgery over a 4-year time period
%
Patients
Surgery/AUR
Baseline PSA tertiles (ng/mL)
17. What is “BPH”?
• “Prostatism” and “BPH”
• Benign Prostatic Hyperplasia is a
histological diagnosis
• New Urological Lexicon
19. LUTS
• Symptoms attributable to lower urinary tract
dysfunction
– storage (irritative) symptoms
– emptying (obstructive) symptoms
– may be associated with BPH, BPE, and BPO, but not
exclusive to these
Nordling J et al. Benign Prostatic Hyperplasia. 5th International Consultation
on Benign Prostatic Hyperplasia. Paris, France. June 25-28, 2000:107-166.
1.4
20. OAB: US Prevalence by Age
0
5
10
15
20
25
30
35
40
18-24 25-34 35-44 45-54 55-64 65-74 75+
Age (years)
Prevalence
(%)
Women
Men
OAB=overactive bladder. Stewart W, et al. World J Urol. 2003;20:327-336.
21. Differential Diagnosis
• Urethral stricture
• Bladder neck
contracture
• Bladder stones
• Urinary tract infection
• Interstitial cystitis
• Neurogenic bladder
• Inflammatory prostatitis
• Medications
• Carcinoma of the prostate
• Carcinoma in situ of the
bladder
1.8
26. Initial Evaluation
• Detailed medical history
• Physical exam
– including DRE and neurologic exam
• Urinalysis
• Serum creatinine no longer mandatory
• PSA*
• Symptom assessment (AUA-SS)
PSA = prostate-specific antigen
*Per physician’s clinical judgment
AUA BPH Guidelines 2003
4.4
27. Evaluation (Part 1)
Initial evaluation
• History
• DRE & focused exam
• Urinalysis
• PSA1
Objective Symptom Assessment
Moderate to severe
IPSS8
Offer treatment
alternatives
Minimally invasive
therapies
Surgery
Medical
therapy
Watchful
waiting
Cystoscopy, if important in
planning operative approach
Mild
IPSS7
1Optional in AHCPR Guidelines;
Recommended by International Consensus Committee Clinical Practice Guideline, Number 8.
AHCPR Publication No. 94-0582.
4.2
28. Evaluation (Part 2)
Moderate to severe
IPSS8
Additional
diagnostic tests
•Flow rate test1
•Residual urine1
•Pressure-flow2
Compatible
with obstruction
Not compatible
with obstruction
Non-BPH problems
identified and treated
Presence of:
• Refractory retention
Any of the following
clearly 2° BPH:
• Recurrent or persistent
gross hematuria
• Bladder stones
• Renal insufficiency
1Optional in AHCPR Guidelines;
Recommended by International Consensus Committee
2Optional in both AHCPR and International Consensus recommendations
Surgery
Initial evaluation
• History
• DRE & focused exam
• Urinalysis
• PSA1
Objective Symptom Assessment
4.3
29. Goals of Therapy for BPH
BPH Treatment Success measured by:
• ↓ symptoms (IPSS/AUA)
• ↓ bother (bother score) and ↑ QOL
• ↓ prostate size or arrest further growth
• ↑Increase in peak flow rate / Relieve obstruction
• Prevention of long-term outcomes/complications
• Acceptable adverse events profile
US Agency for Health Care Policy and Research. AHCPR publication 94-0582; O’Leary MP. Urology. 2000;56(suppl 5A):7-11.
31. Role of 1-Adrenoreceptors
1-ARs and Human LUTS
Smooth muscle
contraction
1A
Lumbosacral
1D
Instability
Irritative
symptoms
1D>1A
Resistance
vessels
1A
Aging effects
1B>1A
Spinal cord
Prostate Detrusor Vessels
Schwinn DA. BJU Int. 2000;86:11-22.
Jardin A et al. Benign Prostatic Hyperplasia. 5th International Consultation on Benign
Prostatic Hyperplasia. Paris, France. June 25-28, 2000:459-477.
Rudner XL et al. Circ. 1999;100:2336-2343.
2.8
34. Krieg M. Prog Cancer Res Ther. 1984;31:425–440.
Kyprianou N et al. Prostate. 1986;8:363–380.
Grino PB et al. Endocrinology. 1990;126:1165–1172.
Dihydrotestosterone (DHT) Action
• Testosterone is converted to DHT by two 5-
reductase isoenzymes
• The target for DHT is the androgen receptor
• DHT has approximately 5 times greater affinity for
the androgen receptor than testosterone
• The greater affinity makes DHT a more potent
androgenic steroid at physiologic concentrations
• The DHT/androgen receptor complex alters gene
expression
35. Clinical Efficacy of 5-ARIs
*Not from a comparative trial.
1. McConnell JD et al. NEJM. 1998;338:557-563. 2. Roehrborn C et al. Urology. 2002;60:434-441.
Finasteride1
48-Mo Controlled
Trial in 3040 Men
Dutasteride2
24-Mo Controlled
Trial in 4325 Men
Finasteride Placebo Dutasteride Placebo
Volume changes -18% +14% -26% -2%
IPSS reduction -3.3 -1.3 -4.5 -2.3
Qmax improvement +1.9 +0.2 +2.2 +0.6
AUR risk reduction 57% 57%
Surgery risk
reduction
55% 48%
36. Adverse Events
Finasteride1 Dutasteride2
Finasteride Placebo Dutasteride Placebo
Erectile dysfunction 8 4 7 4
Altered libido 6 3 4 2
Ejaculatory disorder 4 1 2 1
Gynecomastia and
breast tenderness
1 0.2 2 1
*Not from a comparative trial.
1. McConnell JD et al. NEJM. 1998;338:557-563. 2. Roehrborn C et al. Urology. 2002;60:434-441.
3. American Urological Association Research and Education Inc. BPH Guidelines April 2003: page 33
The new 5 alpha-reductase inhibitor Dutasteride has been shown to be of
similar efficacy as Finasteride in terms of symptom score and flow-rate
improvement, as well as in the prevention of disease progression, while
having a comparable safety profile.3
40. MTOPS
Doxazosin/Finasteride/Combination
MTOPS = Medical Therapy Of Prostatic Symptoms.
McConnell JD et al. NEJM, 2003.
• Double-masked, randomized, placebo-
controlled, multicenter study
• 3047 men aged 50 years with BPH
• Average follow-up: 4.5 years
• Primary outcome: time to clinical progression
– AUR
– Renal insufficiency due to BPH
– Recurrent UTI or urosepsis
– Incontinence
– 4-point rise in baseline AUA symptom score confirmed
within 2-4 weeks
• Secondary outcomes
– Changes in symptom and flow rate over time
– Rate of invasive therapies for LUTS/BPH
44. MTOPS Conclusions
• In selected patients, combination therapy is most effective in
– Reducing risk of clinical progression
– Improving AUA symptom score
– Improving maximum urinary flow rate
• Monotherapy significantly reduces risk of clinical progression
of BPH
• Finasteride (5ARI) and combination therapy significantly
reduce the risk of AUR and invasive therapy
• Doxazosin (-adrenergic blocker) prolongs time to progression
of AUR and invasive therapy, but does not reduce overall risk
• Both long-term monotherapy and combination therapy are
safe and effective
McConnell J et al. Program Abstracts of the American Urological
Association 2002 Annual Meeting (Abstract 1042, updated).
45. Combination Treatment with An
-Blocker Plus An Anticholinergic
for Bladder Outlet Obstruction:
A Prospective, Randomized,
Controlled Study
Athanasopoulos A, Gyftopoulos K, Giannitsas K,
Fisfis J, Perimenis P, Barbalias G.
J Urol. 2003;169:2253-2256
46. Detrol® and Tamsulosin
Combination Therapy in Men With
BOO and OAB
• Randomized, controlled trial (independent research)
– 50 men
– 52 to 80 years of age (average, 69 years)
– Mild/moderate BOO on PFS
– Concomitant IDO
• Study design
– Complete QoL 9 UROLIFE questionnaire prior to study onset
– 1-week tamsulosin 0.4 mg qd, then randomized to receive
concomitant Detrol® 2 mg bid or continue tamsulosin monotherapy
– Repeat QoL 9 and PFS at 12 weeks
IDO=idiopathic detrusor overactivity;
PFS=pressure flow studies.
Athanasopoulos A, et al. J Urol. 2003;169:2253-2256.
47. Detrol® and Tamsulosin Combination Therapy in
Men with BOO and OAB:
Effects on Urodynamic Parameters
Tamsulosin
(n = 25)
Tamsulosin+Tolterodine (n
= 25)
Mean Change
from Baseline
P Value
Mean Change
from Baseline
P Value
Maximum detrusor
pressure (cm H2O)
–5.2 0.0827 –8.24 0.0082
Maximum flow rate
(mL/second)
+1.16 0.0001 +1.32 0.0020
Pressure at maximum
unstable contraction (cm H2O)
–2.16 0.05690 –11.16 0.0001
Volume at first unstable
contraction (mL)
+30.40 0.0190 +100.40 0.0001
Athanasopoulos A et al. J Urol. 2003;169:2253-6.
48. Detrol® and Tamsulosin Therapy in
Men With BOO and OAB:
Effects on QoL
Baseline
12 Weeks
542.2
525
548.2
628.4
460
480
500
520
540
560
580
600
620
640
Tamsulosin
(n=25)
Tamsulosin + Detrol®
(n=25)
Mean
score
(QoL
9
UROLIFE)
P=NS
P=0.0003
Improved
QoL
Athanasopoulos A, et al. J Urol. 2003;169:2253-2256.
49. Detrol® and Tamsulosin Therapy in
Men With BOO and OAB:
Conclusions
• Efficacy
– Improved QoL
– Increased bladder capacity
• Safety
– No acute urinary retention was observed
– Did not affect quality of urinary flow
– Did not affect postvoid residual urine volume
• “The proposed combination of Detrol® and tamsulosin
appears to be an effective and relatively safe treatment
option in patients
with bladder outlet obstruction and
detrusor overactivity”
Athanasopoulos A, et al. J Urol. 2003;169:2253-2256.
58. BPH, LUTS & SEX
• LUTS and ED are common in middle age
and older men
• Sexual function is an important aspect of
quality of life
- sexual activity decreases with age
- sexual problems increase with age
59. BPH, LUTS & SEX
• Erectile dysfunction is often associated with
chronic diseases (i.e. diabetes, hypertension, … )
•25% of men over 60 years have BPH and HTN (4)
• Recent community-based studies have shown a
possible relationship between LUTS and sexual
dysfunction (1,2,3)
(1) Mc Farlane et al. - J.Clin.Epidemiol. 1996; 49:1171-76
(2) Franckel et al. - J.Clin.Epidemiol. 1998; 51:677-68
(3) Braun et al. - International Journal of Impotence Research 2000; 12:305-311
(4) Flack.Int. J. Clinical Practice 2002; 56(7): 527-530
60. Are they related?
● Affects similarly aged populations
● All have significant negative impact upon quality of life
● Association versus Pathophysiologic link?
● Proof of link requires robust epidemiologic data
analyzing a large cohort of a representative population
in a cross-sectional fashion
61. BPH and Sexual Dysfunction
• Chances of developing BPH and/or
sexual dysfunction increase with age
– sympathetic overreactivity
• Treatments may cause sexual dysfunction
– erectile dysfunction (ED)
– altered ejaculation
• Treatments should be tailored according to QOL
and sexual function issues
DaSilva FC et al. Eur Urol. 1997;31:272-280.
Zlotta AR et al. Eur Urol. 1999;36(suppl 1):107-112.
3.3
QOL = quality of life
62. MSAM-7
Objectives:
• To evaluate in a population of men aged 50 to 80
years
- The incidence of LUTS
- The sexuality and the incidence of sexual disorders
- The possible relationship between LUTS, sexual
dysfunction, and co-morbid medical conditions
63. Methodology:
•Patients
- 14,000 men aged 50 to 80 in
7 countries (US, UK, F, D, I, Sp, NL)
- In each country, the sample was representative of
the target population
MSAM-7
64. • Postal questionnaire
• - Demographic characteristics
- I-PSS and Quality of Life index
- Dan-PSS sex (6 questions)
- IIEF (15 questions)
- Co-morbidity factors
• 12,815 questionnaire were exploitable (89.9%)
Methodology:
MSAM-7
65. 65
Average Number of Sexual
Intercourse or Activity per Month
Base: Total sample
5.8 6.0
5.4
6.3 6.5
5.3 5.6
6.5
5.8
0
1
2
3
4
5
6
7
8
9
10
67. MSAM-7:
Sex Declined With Increasing Severity of
LUTS
*Among total sample.
Age (years)
N=12,815 (total sample)
Rosen R et al. Eur Urol. 2003; 44:637-649.
7.6
6.6
4.9
5.7
3.5
4.6
2.6
3.7
1.7
4.0
5.7
8.6
0
1
2
3
4
5
6
7
8
9
10
50-59 60-69 70-79
Average
Number
of
Sexual
Activities
per
Month*
None
Mild
Moderate
Severe
LUTS
69. Mechanisms for Co-existence
of ED and BPH
● Diminished quality of life theory
● Increased sympathetic tone theory
● Ischemia/Endothelial Dysfunction
● NO alteration theory
70. Sildenafil Citrate Improves LUTS
Mulhall et al, 2002
● Men (n=30) presenting with ED and LUTS (IPSS 10)
● No prior or current alpha-blocker therapy
● Treated with Viagra (standard fashion)
● Sequential assessment of IIEF and IPSS
● Statistically significant improvement in IPSS on Viagra