RESUMO
This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the conservative and pharmacological treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding watchful waiting, behavioral therapy, phytotherapy and pharmacological mono- and combination therapy. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.
Assuntos
Terapia Comportamental/normas , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/terapia , Conduta Expectante/normas , Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Medicina Baseada em Evidências , Alemanha , Humanos , Masculino , Fitoterapia/normas , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Urologia/normasRESUMO
This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.
Assuntos
Guias de Prática Clínica como Assunto , Prostatectomia/normas , Hiperplasia Prostática/terapia , Stents , Obstrução do Colo da Bexiga Urinária/prevenção & controle , Medicina Baseada em Evidências , Alemanha , Humanos , Masculino , Prostatectomia/métodos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Urologia/normasRESUMO
In some countries plant extracts have belonged to the most popular drugs for the treatment of the benign prostatic syndrome (BPS) for decades; however, only few of the large number of published studies meet the criteria of the WHO benign prostatic hyperplasia (BPH) consensus conference. The few placebo-controlled long-term (study period >6 months) studies suggest a positive effect of some extracts (saw palmetto fruit, ß-sitosterol, urtica, rye grass and a saw palmetto/urtica combination) on lower urinary tract symptoms (LUTS), urinary flow rate, post-void residual volume but effects on prostate volume or prostate-specific antigen (PSA) were only inconsistently demonstrable. To date no study has proven an effect on disease progression, such as acute urinary retention or need for surgical interventions. Due to the controversial data various extraction techniques and compositions of various products, neither American, European, British nor German BPH guidelines recommend plant extracts for the indication BPS although some placebo-controlled trials provided encouraging data. Further prospective studies according to WHO standards are required to determine the role of plant extracts for the management of BPS. For the indication of prostate cancer (PCa) plant extracts have been evaluated for disease prevention and management of several tumor stages but none of these studies have provided convincing evidence that plant extracts are superior to placebo and none of the Pica guidelines have recommended their use.Based on current knowledge plant extracts can never supplement evidence-based PCa management and should be used only in addition to the standard treatment. There is no scientific evidence for the use of dietary supplementation with high doses of vitamins or selenium-containing products.
Assuntos
Antineoplásicos/uso terapêutico , Medicina Baseada em Evidências , Fitoterapia/estatística & dados numéricos , Extratos Vegetais/uso terapêutico , Hiperplasia Prostática/tratamento farmacológico , Neoplasias da Próstata/tratamento farmacológico , Comorbidade , Humanos , Masculino , Efeito Placebo , Prevalência , Hiperplasia Prostática/epidemiologia , Neoplasias da Próstata/epidemiologia , Resultado do TratamentoRESUMO
The 19th Annual Conference of the Working Group on Kidney Transplantation (KTX) of the Academy of German Urologists took place on 10-12 November 2011 in Mainz. The main topics at the meeting were surgical and technical aspects, immunosuppressive therapy, transplant rejection, pregnancy, sexuality, and psychological conflicts of kidney transplant recipients. The speakers documented the pertinence of interdisciplinarity for KTX and were not only from the field of urology but also from anesthesiology, gynecology, surgery, dermatology, nephrology, radiology, and psychosomatic medicine. The Bernd Schönberger Prize was awarded at the end of the event.
Assuntos
Pesquisa Biomédica/tendências , Transplante de Rim/efeitos adversos , Transplante de Rim/tendências , Urologia/tendências , HumanosAssuntos
Hiperplasia Prostática/diagnóstico , Diagnóstico Diferencial , Progressão da Doença , Medicina Baseada em Evidências , Humanos , Masculino , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Resultado do Tratamento , Ultrassonografia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/terapia , Urodinâmica/fisiologiaRESUMO
Two groups of drugs, alpha blockers and 5-alpha-reductase inhibitors (5ARI), are currently widely used for the medical treatment of benign prostatic syndrome (BPS). Alpha blockers are characterized by a rapid onset of efficacy. If given at an adequate dose, all alpha blockers have a similar efficacy, yet quantitative differences regarding side effects exist. The onset of clinical efficacy of 5ARIs is delayed and dependent on prostate volume. Symptom improvement is generally less pronounced than with alpha blockers, yet this difference declines with time. 5ARI, in contrast to alpha blockers, reduce prostate volume and the risk of long-term BPS complications such as prostate surgery or acute urinary retention. The combination therapy of alpha blockers and 5ARI is superior to either monotherapy; however, this superiority becomes evident only after prolonged (>1 year) therapy. Because of additive side effects, this combination should be reserved for BPS patients with a high risk of progression. Regarding plant extracts, no definitive recommendation can be given because of a limited number of high-quality clinical trials. The use of antimuscarinics in men with BPS with a dominance of storage symptoms and without significant obstruction is promising, although further trials, particularly with a longer study duration, are required.
Assuntos
Inibidores de 5-alfa Redutase , Antagonistas Adrenérgicos alfa/administração & dosagem , Antagonistas Muscarínicos/administração & dosagem , Hiperplasia Prostática/tratamento farmacológico , Antagonistas Adrenérgicos alfa/efeitos adversos , Humanos , Masculino , Antagonistas Muscarínicos/efeitos adversos , Síndrome , Urologia/tendênciasAssuntos
Comportamento Cooperativo , Relações Interprofissionais , Transplante de Rim/história , Transplante de Rim/tendências , Obtenção de Tecidos e Órgãos/história , Obtenção de Tecidos e Órgãos/tendências , Urologia/tendências , Previsões , Alemanha , História do Século XX , História do Século XXI , HumanosRESUMO
The RAND appropriateness method was used to explore the relevance of risk factors for disease progression in the treatment choice for patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). A total of, 12 international experts assessed the appropriateness of various treatments for 243 risk profiles. Highest appropriateness rates were found for alpha1-adrenoceptor antagonists (68% of profiles) and combination therapy (46%). A large prostate volume was the dominant argument in favour of 5alpha-reductase inhibitors and combination therapy, but was irrelevant for the choice of surgery. Considerable postvoid residual, severe symptoms and poor maximum flow rate were the most important factors in favour of surgery.