前立腺症
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出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2016/03/17 01:57:41」(JST)
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Lower urinary tract symptoms (LUTS) refer to a group of medical symptoms, that affect approximately 40% of older men.[1] LUTS is a recent term for what used to be known as prostatism.[2]
Contents
- 1 Symptoms and signs
- 1.1 Filling (Storage) or irritative symptoms
- 1.2 Voiding or obstructive symptoms
- 2 Causes
- 3 Diagnosis
- 4 Treatment
- 5 Epidemiology
- 6 References
Symptoms and signs
Symptoms can be categorised into:
Filling (Storage) or irritative symptoms
- Increased frequency of urination
- Increased urgency of urination
- Painful urination
- Excessive passage of urine at night
Voiding or obstructive symptoms
- Poor stream (unimproved by straining)[3]
- Hesitancy (worsened if bladder is very full)[3]
- Terminal dribbling
- Incomplete voiding
- Overflow incontinence (occurs in chronic retention)[3]
- Episodes of near retention[3]
As the symptoms are common and non-specific, LUTS is not necessarily a reason to suspect prostate cancer.[2] Large studies of patients have also failed to show any correlation between lower urinary tract symptoms and a specific diagnosis.[4]
Causes
- Benign prostatic hyperplasia (BPH) with obstruction
- Detrusor muscle weakness and/or instability
- Urinary Tract Infection (UTI)
- Chronic prostatitis
- Urethral stricture
- Urinary stone
- Malignancy: prostate or bladder
- Neurological disease, e.g. multiple sclerosis, spinal cord injury, cauda equina syndrome
- IgG4-related prostatitis[5][6][7]
Diagnosis
The International Prostate Symptom Score (IPSS) can be used to gauge the symptoms, along with physician examination. Other primary and secondary tests are often carried out, such as a PSA (Prostate-specific antigen) test,[8] urinalysis, ultrasound, urinary flow studies, imaging, temporary prostatic stent placement, prostate biopsy and/or cystoscopy.
Placement of a temporary prostatic stent as a differential diagnosis test can help identify whether LUTS symptoms are directly related to obstruction of the prostate or to other factors worth investigation.
ICD 9 CM
- 600.00 Hypertrophy (benign) of prostate w/o urinary obstruction and other lower urinary tract symptoms (LUTS)
- 600.01 Hypertrophy (benign) of prostate with urinary obstruction and other LUTS
- 600.20 Benign localized hyperplasia of prostate w/o urinary obstruction and other LUTS
- 600.21 Benign localized hyperplasia of prostate with urinary obstruction and other LUTS
- 600.90 Hyperplasia of prostate, unspecified, w/o urinary obstruction and other LUTS
- 600.91 Hyperplasia of prostate, unspecified, with urinary obstruction and other LUTS
Treatment
A number of techniques to destroy part or all of the prostate have been developed. First line of treatment is medical, which includes alpha-1 blockade and antiandrogens. If the medical treatment fails, surgical techniques are done. Techniques include:
- TURP: trans-urethral removal of the prostate
- Transurethral microwave thermotherapy
- Thermal ablation
- High intensity focused ultrasonography
- Transurethral needle ablation
- Laser prostatectomy.
- Intraurethral prostatic stenting and balloon dilatation of the prostate.[9]
Voiding position
Other treatments include lifestyle advice,[10] for example sitting down while urinating. A meta-analysis[11] found that, for elderly males with LUTS:
- the post void residual volume (PVR, ml) was significantly decreased
- the maximum urinary flow (Qmax, ml/s) was increased, comparable with pharmacological intervention
- the voiding time (VT, s) was decreased
This urodynamic profile is related to a lower risk of urologic complications, such as cystitis and bladder stones.
Epidemiology
- Prevalence increases with age. The prevalence of nocturia in older men is about 78%. Older men have a higher incidence of LUTS than older women.[12]
- Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia.[13]
- Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating.
- It is estimated that the lifetime risk of developing microscopic prostate cancer is about 30%, developing clinical disease 10%, and dying from prostate cancer 3%.
References
- Speakman MJ, Kirby RS, Joyce A, Abrams P, Pocock R (May 2004). "Guideline for the primary care management of male lower urinary tract symptoms". BJU Int. 93 (7): 985–90. doi:10.1111/j.1464-410X.2004.04765.x. PMID 15142148.
- Juliao AA, Plata M, Kazzazi A, Bostanci Y, Djavan B (January 2012). "American Urological Association and European Association of Urology guidelines in the management of benign prostatic hypertrophy: revisited". Current Opinion in Urology 22 (1): 34–9. doi:10.1097/MOU.0b013e32834d8e87. PMID 22123290.
- NHS; Cancer Screening Programmes. Prostate Cancer Risk Management.
- ^ RoehrbornCG and McConnell JD: Etiology, pathophusiology, epidemiology, and natural history of benign prostatic hyperplasia. Campell's Urology. WB Saunders Co 2002; chapt 38, p1309.
- ^ a b Abrams P (April 1994). "New words for old: lower urinary tract symptoms for "prostatism"". BMJ 308 (6934): 929–30. doi:10.1136/bmj.308.6934.929. PMC 2539789. PMID 8173393.
- ^ a b c d Masu S (May 2014). "A Prevalence Study of Lower Urinary Tract Symptoms (LUTS) in Males" (PDF). International Journal of Medical Science and Public Health 3 (8): 927–30. doi:10.5455/ijmsph.2014.020520142.
- ^ Clinical Knowledge Summary; Urological cancer — suspected
- ^ Rodolfo Montironi, Marina Scarpelli, Liang Cheng, Antonio Lopez-Beltran, Maurizio Burattini, Ziya Kirkali, Francesco Montorsi (December 2013). "Immunoglobulin G4-related disease in genitourinary organs: an emerging fibroinflammatory entity often misdiagnosed preoperatively as cancer". European Urology 64 (1): 865–872. doi:10.1016/j.eururo.2012.11.056. PMID 23266239.
- ^ Yoshimura Y, Takeda S, Ieki Y, Takazakura E, Koizumi H, Takagawa K (1 Sep 2006). "IgG4-associated prostatitis complicating autoimmune pancreatitis". Internal Medicine (Japanese Society of Internal Medicine) 45 (15): 897–901. doi:10.2169/internalmedicine.45.17522. PMID 16946571.
- ^ Nishimori I, Kohsaki T, Onishi S, Shuin T, Kohsaki S, Ogawa Y, Matsumoto M, Hiroi M, Hamano H, Kawa S (17 Dec 2007). "IgG4-related autoimmune prostatitis: two cases with or without autoimmune pancreatitis". Internal Medicine (Japanese Society of Internal Medicine) 46 (24): 1983–1989. doi:10.2169/internalmedicine.46.0452. PMID 18084121.
- ^ The Prostate-Specific Antigen (PSA) Test: Q & A — National Cancer Institute
- ^ Fitzpatrick JM. Non-surgical treatment of BPH. Edinburgh: Churchill Livingstone, 1992.
- ^ Y. de Jong, R.M. ten Brinck, J.H.F.M. Pinckaers, A.A.B. Lycklama à Nijeholt. "Influence of voiding posture on urodynamic parameters in men: a literature review" (PDF). Nederlands Tijdschrift voor urologie. Retrieved 2014-07-02.
- ^ de Jong, Y; Pinckaers, JH; Ten Brinck, RM; Lycklama À Nijeholt, AA; Dekkers, OM (2014). "Urinating Standing versus Sitting: Position Is of Influence in Men with Prostate Enlargement. A Systematic Review and Meta-Analysis.". PLOS ONE 9 (7): e101320. doi:10.1371/journal.pone.0101320. PMC 4106761. PMID 25051345.
- ^ Boyle P, Robertson C, Mazzetta C, et al. (September 2003). "The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study". BJU Int. 92 (4): 409–14. doi:10.1046/j.1464-410x.2003.04369.x. PMID 12930430.
- ^ Enlarged prostate gland —treatment, symptoms and cause
Symptoms and signs: urinary system (R30–R39, 788)
|
|
Pain |
- Renal colic
- Costovertebral angle tenderness
- Dysuria
- Vesical tenesmus
|
|
Control |
- Urinary incontinence
- Enuresis
- Diurnal enuresis
- Giggling
- Nocturnal enuresis
- Post-void dribbling
- Stress
- Urge
- Overflow
- Urinary retention
|
|
Volume |
|
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Other |
- Lower urinary tract symptoms
- Nocturia
- Urinary urgency
- Urinary frequency
- Extravasation of urine
- Extrarenal uremia
- Urinoma
|
|
Eponymous |
- Addis count
- Brewer infarcts
- Murphy's punch sign
- Lloyd's sign
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UpToDate Contents
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English Journal
- Robotic-assisted simple prostatectomy: is there evidence to go beyond the experimental stage?
- Patel ND1, Parsons JK.
- Current urology reports.Curr Urol Rep.2014 Oct;15(10):443. doi: 10.1007/s11934-014-0443-0.
- Open simple prostatectomy (OSP) is an effective and durable treatment for select patients with symptomatic benign prostatic hyperplasia (BPH) and large-volume prostate glands (>80 cc), yet is associated with clinically significant risk of bleeding, transfusion, prolonged hospital length of stay
- PMID 25118852
- Impact of alpha blockers, 5-alpha reductase inhibitors and combination therapy on sexual function.
- Welliver C1, Butcher M, Potini Y, McVary KT.
- Current urology reports.Curr Urol Rep.2014 Oct;15(10):441. doi: 10.1007/s11934-014-0441-2.
- Medical treatments for lower urinary tract symptoms due to benign prostatic hyperplasia are frequently associated with changes in sexual function. While these medications are generally well-tolerated and have both reduced and delayed more invasive surgical options, the ramifications of long-term chr
- PMID 25118850
- A prospective interventional study in chronic prostatitis with emphasis to clinical features.
- Stamatiou KN1, Moschouris H2.
- Urology journal.Urol J.2014 Sep 6;11(4):1829-33.
- PURPOSE: Chronic bacterial prostatitis displays a variety of symptoms (mainly local pain exhibiting variability in origin and intensity). These symptoms often persist despite bacterial eradication. The purpose of this article is to exam the role of phytotherapeutic agents as complementary treatmen
- PMID 25194085
Japanese Journal
- In prostatism patients the ratio of human glandular kallikrein to free PSA improves the discrimination between prostate cancer and benign hyperplasia within the diagnostic 'gray zone' of total PSA 4-10 ng/mL
- Natural history of prostatism : high American Urological Association Symptom Scores among community-dwelling men and women with urinary incontinence
- International Prostate Symptom Score日本語訳の再現性と一次元性の検討
Related Links
- prostatism /pros·ta·tism/ (pros´tah-tizm) a symptom complex resulting from compression or obstruction of the urethra, due most commonly to nodular hyperplasia of the prostate. pros·ta·tism (prŏs′tə-tĭz′əm) n. A disorder characterized ...
- prostatism pros·ta·tism (prŏs'tə-tĭz'əm) n. A disorder characterized by decreased force of urination and dysuria, usually resulting from enlargement of the prostate gland.
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- 英
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