Gabuev A, Oelke M
Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover.
Aktuelle Urol. 2011 May;42(3):167-78. doi: 10.1055/s-0031-1271453. Epub 2011 May 20.
A re-evaluation of established tests and treatments has become necessary after publication of several new guidelines on BPH during the past two years. This article describes the latest developments concerning epidemiology, diagnosis, and treatment of BPH.
Diagnostic and treatment guidelines on BPH of the German, European, or North American urologists as well as UK doctors were reviewed according to key articles and latest modifications.
The only German epidemiological trial on BPH demonstrated that all components of the BPH disease (symptoms - prostate enlargement - bladder outlet obstruction) increase with ageing. 27 % of German men will have disease progression within the next 5 years. Risk factors for disease progression are: age, symptoms, prostate size, PSA, urinary flow rate, and postvoiding residual urine. Diagnosis aims to distinguish BPH from other diseases with similar symptoms, quantify the BPH components, and estimate the individual risk of disease progression. BPH is an exclusion diagnosis. Ultrasonic measurement of detrusor wall thickness at the anterior wall of bladders filled with ≥ 250 mL can securely detect bladder outlet obstruction if the value is ≥ 2 mm. Watchful waiting and lifestyle modifications are suitable for men with mild symptoms and low disease progression risk. All drugs used in BPH treatment reduce symptoms but have no influence on bladder outlet obstruction. α-blockers are first-line drugs and may be combined with muscarinic receptor antagonists or 5α-reductase inhibitors to further increase efficacy. Prostate surgery is indicated when drug treatment is insufficient, the patient develops complications in the upper or lower urinary tract (absolute indications), or has severe bladder outlet obstruction. Standard operations are TURP in small (≤ 80 mL) or open prostatectomy in large prostates (> 80 mL). Minimally invasive, alter-native surgeries may be considered in selected men and -offer advantages with regard to the risk of bleeding, duration of catheterisation, or maintenance of sexual function.
Current guidelines have integrated the latest knowledge and developments on BPH and are likely to improve assessment and treatment.
在过去两年间发布了多项关于良性前列腺增生（BPH）的新指南后，对既定检测方法和治疗手段进行重新评估变得很有必要。本文介绍了BPH在流行病学、诊断和治疗方面的最新进展。
根据关键文章和最新修订内容，对德国、欧洲、北美泌尿外科医生以及英国医生制定的BPH诊断和治疗指南进行了综述。
德国唯一一项关于BPH的流行病学试验表明，BPH疾病的所有组成部分（症状 - 前列腺增大 - 膀胱出口梗阻）均随年龄增长而增加。27%的德国男性在未来5年内会出现疾病进展。疾病进展的风险因素包括：年龄、症状、前列腺大小、前列腺特异性抗原（PSA）、尿流率和排尿后残余尿量。诊断旨在将BPH与具有相似症状的其他疾病区分开来，量化BPH的组成部分，并评估个体疾病进展风险。BPH是一种排除性诊断。当膀胱前壁充满≥250 mL尿液时，超声测量逼尿肌壁厚度，若值≥2 mm，则可可靠地检测出膀胱出口梗阻。观察等待和生活方式调整适用于症状轻微且疾病进展风险低的男性。所有用于BPH治疗的药物均可减轻症状，但对膀胱出口梗阻无影响。α受体阻滞剂是一线药物，可与毒蕈碱受体拮抗剂或5α还原酶抑制剂联合使用，以进一步提高疗效。当药物治疗无效、患者出现上尿路或下尿路并发症（绝对指征）或存在严重膀胱出口梗阻时，需进行前列腺手术。对于小前列腺（≤80 mL），标准手术是经尿道前列腺切除术（TURP）；对于大前列腺（>80 mL），则是开放性前列腺切除术。对于特定男性，可考虑采用微创替代手术，这些手术在出血风险、导尿持续时间或性功能维持方面具有优势。
当前指南整合了BPH的最新知识和进展，可能会改善评估和治疗效果。
