DuBeau C E, Resnick N M
Division on Aging, Harvard Medical School, Boston, Massachusetts.
Adv Intern Med. 1992;37:55-83.
The prevalence of BPH ensures a continuing need for internists to be aware of the issues regarding the evaluation and treatment of prostatism, while the developing role of nonoperative therapy and the growing recognition of the importance of patient preferences have opened the way for an expanded involvement of the primary care practitioner in the management of these patients. Prostatism remains a difficult clinical problem since many of the symptoms and diagnostic tests are nonspecific, especially in the elderly. Basic questions regarding the role of bladder outlet obstruction (BOO) in the development of symptoms and in predicting outcome from surgery await further study. Against this background of uncertainty, however, is the reassurance that the natural history of the process results in serious complications in only the minority of patients. Important work is under way that will incorporate quality of life outcomes, compare surgery with "watchful waiting," and randomize patients to surgical and nonsurgical treatments. In the interim, the internist may help patients with prostatism significantly by appreciating the natural history of the condition, treating the conditions that mimic or exacerbate it, understanding the clinical utility and limitations of current evaluation methods, becoming aware of the growing array of nonsurgical and minimal-surgery options, and assisting patients in weighing therapeutic risks and benefits with their concerns about symptoms.
良性前列腺增生的高发病率使得内科医生持续需要了解有关前列腺增生评估和治疗的问题，而非手术治疗作用的不断发展以及对患者偏好重要性认识的日益提高，为初级保健医生更多地参与这些患者的管理开辟了道路。前列腺增生仍然是一个棘手的临床问题，因为许多症状和诊断测试都不具有特异性，尤其是在老年人中。关于膀胱出口梗阻（BOO）在症状发展和手术预后预测中的作用的基本问题有待进一步研究。然而，在这种不确定性的背景下，令人安心的是，该疾病的自然病程仅在少数患者中导致严重并发症。目前正在进行重要的工作，将纳入生活质量结果，比较手术与“观察等待”，并将患者随机分配到手术和非手术治疗组。在此期间，内科医生可以通过了解病情的自然病程、治疗模仿或加重该病情的疾病、理解当前评估方法的临床效用和局限性、了解越来越多的非手术和微创手术选择以及帮助患者权衡治疗风险和益处以及他们对症状的担忧，来显著帮助患有前列腺增生的患者。
