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1 Continuing Education Column Benign Prostatic Hyperplasia Choung Soo Kim, MD. Department of Urology, Ulsan University College of Medicine E mail : cskim@amc.seoul.kr J Korean Med Assoc 2007; 50(7): Abstract Benign prostatic hyperplasia (BPH), a pathological terminology that means benign proliferation of prostatic tissue, is commonly used as a clinical terminology indicating low urinary tract symptoms (LUTS) resulting from prostate enlargement. It mainly arises from the transition zone of the prostate by stimulation of dihydrotestosterone (DHT), and its incidence is about 21~28% in men with age over fifty. LUTS related to BPH consist of frequency, residual urine sense, nocturia, interruption, urgency, weak stream, and hesitancy. The International Prostate Symptom Score (IPSS) is currently being used for the evaluation of the patient in the clinical setting. The size of the prostate (>30 g), an elevated serum prostate specific antigen level (PSA: >1.5ng/mL), high IPSS ( 20), and a large amount of post void residual urine (>100ml) are considered as risk factors of BPH aggravation. Physical examination including digital rectal examination, urinalysis, serum PSA, and uroflowmetry with residual urine measurement are performed as basic test items for BPH. Standard initial treatment of BPH is medical therapy: mainly alpha adrenergic blockers and 5 alpha reductase inhibitors, and optionally anticholinergics, desmopressin, and phytotherapy. The standard surgical treatment of BPH nowadays is transurethral resection of prostate (TURP) but open prostatectomy or minimally invasive treatment such as transurethral incision of prostate (TUI), thermal therapy, and photoselective vaporization of prostate (PVP) can be applied in selected cases. Keywords : Benign prostatic hyperplasia; Low urinary tract symptoms; Alpha adrenergic blockers; Transurethral resection of prostate 626

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9 Kim CS Table 1. Absolute indication Recurrent acute urinary retention Bladder stone related to BPH Deterioration of renal function Recurrent hematuria Recurrent UTI Relative indication Low urinary symptoms worsening quality of life Large amount of post void residual volume 634

10 Benign Protatic Hyperplasia 11. Stolzenburg. J, Schwalenberg. T, Horn L, Neuhaus J, Constantinides C, Liatsikos E. Anatomical Landmarks of Radical Prostatecomy. Eur Urol 2003; 21: Baisch H, Otto U, Fack H. Growth of human prostate carcinomas with and without hormone alpha dehydrotestosterone. Eur Urol 1998; 34: Roehborn CG, McConneli JD. Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell Walsh urology. 9th ed. China: Elsevier Inc, 2007: Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and urinalysis. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell Walsh urology. 9th ed. China: Elsevier Inc, 2007: O'Leary M. The importance of standardisation and validation of symptom scores and quality of life: the urologist's point of view. Eur Urol 1997; 32(S2): McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW, Lepor H, McVary KT, Nyberg LM, Clarke HS, Crawford ED, Diokno A, Foley JP, Foster HE, Jacobs SC, Kaplan SA, Kreder KJ, Lieber MM, Lucia MS, Miller GJ, Menon M, Milam DF, Ramsdell JW, Schenkman NS, Slawin KM, Smith JA; Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The long term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003; 349: Ranjan P, Dalela D, Sankhwar S. Diet and benign prostatic hyperplasia: Implications for prevention Urology 2006; 68: Kirby R, Lepor H. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell Walsh urology. 9th ed. China: Elsevier Inc, 2007: Gretzer MB, Partin AW. Prostate cancer tumor markers. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell Walsh urology. 9th ed. China: Elsevier Inc, 2007: Pannek J, Brands FH. Additional aids in detection of prostate carcinomas? PSA prostatic volume quotient, PSA doubling time, age dependent PSA reference values and PSA in urine. Urologe A 2000; 39: Lee T. Urodynamic study. In: Kim JC, Kim HJ, Park CH, Oh SJ, Lee KS, Lee JZ, Chung BS, Choo MS, eds. Textbook of voiding dysfunction and female urology. 1st ed. Korea: Ilchokak, 2003: Kirby RS, Coppinger SWC, Corcoran MO, Chapple CR, Flanniqan M, Milrov EJ. Prazosin in the treatment of prostatic obstruction: A placebo controlled study. Br J Urol 1987; 60: Kirby RS, O'Leary MP, Carson C. Efficacy of extended release doxazosin and doxazosin standard in patients with concomitant benign prostatic hyperplasia and sexual dysfunction. BJU Int 2005; 95: Wilt TJ, MacDonald R, Nelson D. Tamsulosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: A systematic review of efficacy and adverse effects. J Urol 2002; 167: Lukacs B, Grange JC, Comet D, McCarthy C. History of 7,093 patients with lower urinary tract symptoms related to benign prostatic hyperplasia treated with alfuzosin in general practice up to 3 years. Eur Urol 2000; 37: Roehrborn CG, Boyle P, Nickel JC, Hoefner K, Andriole G; ARIA3001 ARIA3002 and ARIA3003 Study Investigators. Efficacy and safety of a dual inhibitor of 5 alpha reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 2002; 60: Fagelman E, Lowe FC. Herbal medications in the treatment of benign prostatic hyperplasia (BPH). UCNA 2002; 29: Fitzpatrick JM. Minimally invasive and endoscopic manage- 635

11 Kim CS ment of benign prostatic hyperplasia. Kirby R, Lepor H. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell Walsh urology. 9th ed. China: Elsevier Inc, 2007: Peer Reviewer Commentary 636

페링야간뇨소책자-내지-16

페링야간뇨소책자-내지-16 야간뇨의진단과치료 - 실제적접근 - Reference 1. Choo MS, Ku JH, Park CH et al. Prevalence of Nocturia in a Korean Population Aged 40 to 89 Years. Neurourol Urodyn 2008; 27:60-64. 2. Weiss JP. Prevalence