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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 王炯珵 | 老男人下泌尿道的評估和處理 | 2009/5/22 下午 03:33:55 | 0 |
| 原 文 | 題 目 | Evaluation and Treatment of Lower Urinary Tract Symptoms in Older Men |
| 作 者 | P. Abrams | |
| 出 處 | Journal of Urology | |
| 出版日期 | 2009 April, 181; 1779-1787 | |
| 評 論 |
在JU上如果看到P. Abrams或Alan J. Wein這些大師級的人物以「第一作者」的身份寫的論文，總會吸引我的注意，這篇「老男人下泌尿道的評估和處理」就是個例子。 本論文的主要重點就是二個圖，圖一基本上告訴我們如何做初步的評估，包括了病史詢問、LUTS的評估、困擾程度的評估、身體檢查、攝護腺檢查、尿液檢查、PSA和排尿日記的紀錄等，而根據初步的檢查結果我們可以做怎樣的初步處理。 圖二則是更進階地告訴我們如果有OAB、BOO或較大的攝護腺時該如何去做適當的藥物調整（如增加抗膽鹼藥或增加5甲型還原酶等），UDS的壓力流速檢查或手術的可能性等，在此限於版面的關係，無法將這二個非常實用的流程圖附上，歡迎大家直接找JU全文來看。 萬一找不到JU全文，也歡迎大家上網購買拙作「攝護腺肥大，小CASE」，中文版清楚易懂，在此「老王賣瓜自買自誇」一下，P. Abrams這些想法在三年前我早就把這些觀念寫入我的書內，而這些都要感謝多年來台灣尿失禁防治協會郭漢崇教授、林登龍教授、余宏政教授、唐一清教授及各位師長先進的教導，說實在的，不管國內或國外，這些大師們的智慧和處理病患的原則，都是很相近的。 |
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| abstract |
Purpose The 6th International Consultation on New Developments in Prostate Cancer and Prostate Diseases met from June 24–28, 2005 in Paris, France to review new developments in benign prostatic disease. Materials and Methods A series of committees were asked to produce recommendations on the evaluation and treatment of lower urinary tract symptoms in older men. Each committee was asked to base recommendations on a thorough assessment of the available literature according to the International Consultation on Incontinence level of evidence and grading system adapted from the Oxford system. Results The Consultation endorsed the appropriate use of the current terminology lower urinary tract symptoms/benign prostatic hyperplasia/benign prostate enlargement and benign prostatic obstruction, and recommended that terms such as “clinical benign prostatic hyperplasia” or “the benign prostatic hyperplasia patient” be abandoned, and asked the authorities to endorse the new nomenclature. The diagnostic evaluation describes recommended and optional tests, and in general places the focus on the impact (bother) of lower urinary tract symptoms on the individual patient when determining investigation and treatment. The importance of symptom assessment, impact on quality of life, physical examination and urinalysis is emphasized. The frequency volume chart is recommended when nocturia is a bothersome symptom to exclude nocturnal polyuria. The recommendations are summarized in 2 algorithms, 1 for basic management and 1 for specialized management of persistent bothersome lower urinary tract symptoms. Conclusions The use of urodynamics and transrectal ultrasound should be limited to situations in which the results are likely to benefit the patient such as in ion for surgery. It is emphasized that imaging and endoscopy of the urinary tract have specific indications such as dipstick hematuria. Treatment should be holistic, and may include conservative measures, lifestyle interventions and behavioral modifications as well as medication and surgery. Only treatments with a strong evidence base for their clinical effectiveness should be used. |
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