Special Issue Urologic Diseases in Elderly Men Choong Hyun Lee, M.D. Department of Urology Kyung Hee University School of Medicine & Hospital E mail :

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1 Urologic Diseases in Elderly Men ChoongHyun Lee, M.D. Department of Urology Kyung Hee University School of Medicine & Hospital chlee@khu.ac.kr Abstract WWith the increasing life expectancy, health care providers are faced with a task to support the aging population to remain healthy and vital. Especially in Korea, the elderly population is increasing rapidly, and the urology, as a medical specialty, has become one of the biggest concerns. Four major, noncancerous diseases adversely affecting male individuals over 50 years of age include erectile dysfunction (ED), benign prostatic hyperplasia (BPH), cardiovascular disease (CVD), and depression. BPH is the most common benign neoplasm in aging men and the pathologic process also contributes to the development of lower urinary tract symptoms. The management of BPH has undergone tremendous changes in recent years. The introduction of new oral therapeutic agents has revolutionized the diagnosis and therapeutic approaches to ED. An increasing number of men are currently seeking medical attention for their sexual and voiding concerns, often visiting private physicians. In this article I will specifically focus on the guidelines for clinical evaluation and treatment of BPH and ED to update physicians' knowledge to improve the quality of clinical services. These guidelines highlight the evolving field of minimally invasive medical therapy through a tailored approach to meet each individual's expectation including oral agents as the first-line therapy. In case the firstline therapy fails, a referral to a specialist is recommended. Keywords : Guideline; Benign prostatic hyperplasia; Erectile dysfunction; Aging male 236

2 Initial Evaluation History DRE & Focused PE Urinalysis PSA in Select Patients Mild Symptoms (AUA/IPSS7) or No Bothersome Symptoms AUA/IPSS Symptom Index Assessment of Patient Bother Moderate/Severe Symptoms (AUA/IPSS8) Optional Diagnostic Tests Uroflow PVR Presence of Refractory Retention or Any of the following clearly related to BPH Persistent Gross Hematuria Bladder Stones Recurrent UTIs Renal Insufficiency Surgery Discussion of Treatment Options Patient Chooses Noninvasive Therapy Patient Chooses Invasive Therapy Optional Diagnostic Tests Pressure Flow Urethrocystoscopy Prostate Ultrasound Watchful Walting Medical Therapy Minimally Invasive Therapies Surgery DRE:, AUA: IPSS:, PE:, PSA:, PVR:, UTI: 2003 BPH 237

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11 Vauhgan ED Jr, Wein AJ, eds. Campbell s urology. 8th ed. Philadelphia: WB Saunders, 2002: Feldman HA, Goldstein I, Hatzichiristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: Krane RJ, Goldstein I, Saenz De Tajada I. Medical progress: impotence. N Engl J Med 1989; 321: (1960~2050) ( PJ/PJ0102.xls) 12. Zakaria L, Anastasiadis AG, Shabsigh R. Common conditions of the aging male: erectile dysfunction, benign prostatic hyperplasia, cardiovascular disease and depression. Int Urol Nephrol 2001; 33: ,.. 1. :, 1997: AUA practice guideline committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: diagnosis and treatment recommendations. J Urol 2003; 170: Roehrborn CG, Malice M, Cook TJ, Girman CJ. Clinical predictors of spontaneous acute retention in man with LUTS and clinical BPH: a comprehensive analysis of pooles placebo broups of several large clinical trials. Urology 2001; 58: Lam JS, Cooper KL, Kaplan SA. Changing aspects in the evaluation and treatment of patient with benign prostatic hyperplasia. Med Clin N Am 2004; 88: Lepor H, Lowe FC. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Walsh PC, Retic AB, 10. Goldstein I, Leu TF, PadmaNathan H, Rosen RC, Steers WD, Wicker PA. Oral Sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998: 338: Sharaby JS, Benet AE, Melman A. Penile revascularization: impotence. Urol Clin North Am 1995; 22: Wespes W, Amar E, Hatzichristou D, Montorsi F, Pryor J, Vardi Y. Guidelines on erectile dysfunction. Eur Urol 2002; 41: Leiblum SR, Rosen RC, Platt M, Cross RC, Black C. Sexual attitudes and behavior of a crosssectional samples of US medical students: effect gender, age, and year of study. J Sex Educ Ther 1993; 19: Meuleman EJ, Diemont WL. Investigation of erectile dysfunction: diagnostic testing for vascular factor in erectile dysfunction: impotence. Urol Clin North Am 1995; 22: Broderick GA, Lue TF. Evaluation and nonsurgical management of erectile dysfunction and priapism. In: Walsh PC, Retic AB, Vauhgan ED Jr, Wein AJ, eds. Campbell s urology. 8th ed. Philadelphia: WB Saunders, 2002: Kalsi JS, Cellek S, Munneer A, Kell PD, Ralph DJ, Minhas S. Current oral treatemnt for erectile dysfunction. Expert Opin Pharmacother 2002; 3: Corbin JD, Francis SH, Webb DJ. Phosphodiesterase type 5 as a pharmacologic target in erectile dysfunction. Urology 2002; 60(Suppl 2B):

슬라이드 1

슬라이드 1 Proposed Korean guideline for the diagnosis of BPH Hyun Woo Kim The Catholic University of Korea BPH Guideline AHCPR guideline on BPH (1994) AUA guideline on BPH (2003) EAU guideline on BPH (2004) International