Müller R M, Thalmann G N, Studer U E
Urologische Universitätsklinik Bern, Bern.
Ther Umsch. 2006 Feb;63(2):129-34. doi: 10.1024/0040-5930.63.2.129.
Benign Prostatic Hyperplasia is a common entity among the aging male population. Its prevalence is increasing with age and is around 80% in the over 80-years old. The androgen-estrogen ratio changes in favor of the estrogens, which leads to a growth of prostatic tissue, presenting histologically as hyperplasia. BPH can cause irritative or obstructive symptoms or both. Nowadays we speak of bladder storage or bladder voiding symptoms, summarised as LUTS (Lower Urinary Tract Symptoms). LUTS has a structural and a functional component, the structural being caused by the size of the adenoma itself the functional depending on the muscle tone of the bladder neck and the prostatic urethra. To investigate LUTS, we use validated symptom scores, sonography for residual urine and eventually a urodynamic evaluation. There are 3 grades of BPH. The indication for an interventional therapy is relative in BPH II, and absolute in BPH III. Prior to treatment, other diseases mimicking the same symptoms, have to be ruled out and adequatly treated. Electro-resection of the prostate (TUR-P) remains the standard therapy and the benchmark any new technology has to compete with. TUR-P has good short- and longterm results, but can be associated with a considerable perioperative morbidity, and the learning curve for the operator is long. The most promising of the newer techniques is the Holmium-Laser-Enucleation of the prostate (Laser-TUR-P), showing at least identical short- and median-term results, but a lower perioperative morbidity than TUR-P For several minimally-invasive techniques, indications are limited. TUMT TUNA, WIT and laser-coagulation all produce a coagulation necrosis of the prostatic tissue by thermic damage with secondary tissue shrinking. Urodynamic results however, are not comparable to TUR-P or Laser-TUR-P, and significantly more secondary interventions within 2 to 5 years are required. Minimal-invasive techniques present a favorable alternative for younger patients without complications of BPH, and for older patients with relevant comorbidities, and can usually be performed under local anaesthesia. The morbidity is low and further therapies remain possible later, if necessary.
良性前列腺增生在老年男性人群中很常见。其患病率随年龄增长而增加，80岁以上人群中患病率约为80%。雄激素与雌激素的比例变化有利于雌激素，这导致前列腺组织生长，组织学上表现为增生。良性前列腺增生可引起刺激性或梗阻性症状，或两者兼有。如今，我们所说的膀胱储尿或膀胱排尿症状，统称为下尿路症状（LUTS）。下尿路症状有结构和功能两个组成部分，结构部分由腺瘤本身的大小引起，功能部分取决于膀胱颈和前列腺尿道的肌张力。为了研究下尿路症状，我们使用经过验证的症状评分、超声检查残余尿量，并最终进行尿动力学评估。良性前列腺增生有3个等级。在II级良性前列腺增生中，介入治疗的指征是相对的，而在III级良性前列腺增生中是绝对的。在治疗前，必须排除并适当治疗其他表现出相同症状的疾病。经尿道前列腺电切术（TUR-P）仍然是标准治疗方法，也是任何新技术必须与之竞争的基准。经尿道前列腺电切术有良好的短期和长期效果，但可能伴有相当高的围手术期发病率，而且手术医生的学习曲线较长。最新技术中最有前景的是钬激光前列腺剜除术（激光-TUR-P），其短期和中期效果至少与经尿道前列腺电切术相同，但围手术期发病率低于经尿道前列腺电切术。对于几种微创技术，其适应证有限。经尿道微波热疗（TUMT）、经尿道针刺消融术（TUNA）、水热疗法（WIT）和激光凝固术都是通过热损伤使前列腺组织发生凝固性坏死，继而组织收缩。然而，尿动力学结果与经尿道前列腺电切术或钬激光前列腺剜除术不可比，并且在2至5年内需要更多的二次干预。微创技术为没有良性前列腺增生并发症的年轻患者以及有相关合并症的老年患者提供了一个不错的选择，并且通常可以在局部麻醉下进行。发病率低，如果必要，以后仍可进行进一步治疗。
