Microsoft PowerPoint - 5.AUA 2007 Report 조성용.ppt

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1 AUA 2007 Report Prostatitis & BPH 조성용 인제의대일산백병원

2 2007 AUA meeting 2007 AUA meeting: 5 월 19 일- 24 일 Anaheim Convention Center 총 1,964 편연제발표 전립선염관련연제 - 22 편 (1.1%) - General & Epidemiological Trend & Socioeconomics - Infection/inflammation of the Genitourinary Tract 전립선비대증관련연제 편 (5.1%) - Epidemiology & Natural History / Evaluation and Markers - Medical & Hormonal therapy - Surgical therapy & New technology - Basic research - Video

3 Table 1. Distribution of abstracts about Prostatitis in AUA 2007 meeting Type of Presentation Moderated Poster Moderated Poster Total Topics General & Epidemiological Trend & Socioeconomics Infection/inflammation of the Genitourinary Tract: Prostate & Genitalia No

4 Table 2. Distribution of abstracts about BPH in AUA 2007 meeting Type of Presentation Podium Topics Epidemiology & Natural History/Evaluation and Markers No 12 Moderated Poster Moderated Poster Video Video BPH: Medical & Hormonal Therapy BPH: Surgical Therapy & New Technology (I)-(II) Voiding Dysfunction and BPH Teaching Videos of Standard Urologic Procedures Podium BPH: Basic Research 12 Total 101

5 CP/CPPS Epidemiology & Risk factors Prostatitis Vs. BPH Prostatitis Vs. Prostate cancer Treatment effort

6 Epidemiology & Risk factors for CP/CPPS Medical condition Bio-psycho-social factors Stress cortisol variation

7 Prevalence and risk factors for prostatitis in a managed care population 85 Clemens et al. 전립선염을가진환자들은대조군과비교할때타질환들 (35 개의특정 ICD-9 진단 ) 에있어보다관련성이높은것으로생각된다. Urologic condition (10) Unexplained somatic symptom (19) Psychiatric condition (4)

8 Biopsychosocial factors in quality of life in men with chronic prostatitis/ CPPS 87 Nickel et al. 대상 : North America 7 개 3 차병원 NIH Chronic Prostatitis Cohort study 253 명의 CP/CPPS 환자 연구방법 : SF-12 를이용한삶의질을평가 결과 : 각항목의예측이가능 Physical score - urinary function pain contingent rest Mental score - pain catastrophizing perception of social support 결론 : biopsychosocial model 은 CP/CPPS 환자들의 behavioral therapy 에기초가될수있다.

9 Variations in psychometric profiles and awakening cortisol responses in men with chronic prostatitis/chronic pelvic pain syndrome 90 Anderson et al. 대상 : 33 명의 CP/CPPS 환자들과대조군 연구방법 : psychosocial profile 과 HPA axis function 을조사 결과및결론 -CP/CPPS 환자들이 stress 에더욱민감 -NIH-CPSI pain sub score 와신체적증상으로인한통증은관련성이있음 - 아침중발생되는 cortisol 의증가는 CPPS 환자에게서더욱높은증가를보이는것으로생각됨

10 Prostatitis Vs. BPH 96 Mishra et al.: AUR 은 acute 혹은 chronic intraprostatic inflammation 을가진환자에서더욱많이발생한다. Does intraprostatic inflammation have a role in the pathogenesis and progression of BPH? 1506 Sauver et al.: 전립선염의병력이있었던사람은추후에 prostatism, enlarged prostate, BPH 로진단될위험이 2.4 배높다. Association between prostatitis and development of benign prostate hyperplasia 98 - Nickel et al.: inflammation 은 IPSS scores 와연관되어있다. The relationship between prostate inflammation and lower urinary tract symptoms: Examination of baseline data from the reduce trial

11 Prostatitis Vs. Prostate cancer 97 Delongchamps et al.: 부검으로발견되는 chronic inflammation 은 BPH 와연관성이있어보이나 prostate cancer 와는관련성이적다. Evaluation of inflammation in autopsied prostates: Is prostatitis more associated with BPH or cancer?

12 Treatment effort for CP/CPPS 99 Giannarini et al.: Prulifloxacin 의안정성과유용성 100 Sherief et al.: Phytotherapy 는자체로도효과적이며알파차단제와병용시더효과적이다. 101 Cho et al.: Terazocin 의병용치료의효과및추후단독장기치료의효용성 102 Cornel et al.: Biofeedback physical therapy 중요성 103 Djavan et al.: IIIB 환자에게서 TUMT 의효용성

13 BPH Epidemiology & Natural History BPH Vs. Metabolic syndrome Combination Therapy PDE 5 inhibitor for LUTS Surgery for large prostate Basic research Primary care physicians role

14 Epidemiology & Natural History (BPH) 1500 Roehrborn et al.: 약물치료를받는환자의경우그렇지않은경우에비해수술을하게될가능성이높다. (4.6% vs. 0.9%) Health-related quality of life is the main predictor of progression to benign prostatic hyperplasia related surgery: outcomes data from the BPH registry patient survey 1507 Armitage et al.: 통계적으로 age-specific 1-year mortality 를조사하였을때 AUR 은전체연령에서 mortality 증가와관련이있으며특히 세에서 10.4 배의위험율을가진다. Acute urinary retention is associated with an increased risk of mortality

15 BPH Vs. Metabolic syndrome (I) 1504 Laven et al.: 출산시저체중이었던경우변화된 fetal adipose tissue 로인해성인에서 insulin resistance 를가지게되고이로인해 central obesity 와 sympathetic overactivity 를가지게되며중등도혹은중증의 LUTS 를가지게될가능성이높다. Birth weight, abdominal obesity, and the risk of lower urinary tract symptoms in a population based study of swedish men 1508 Kaplan et al.: 허리둘레가 LUTS 의 severity 와 sexual dysfunction 을예측할수있다는가정아래 LUTS 를호소하는 세의 88 명의남성을대상으로 인치, 인치, 40 인치이상으로나누었을때고혈압, 심장질환, 당뇨뿐만아니라배뇨증상과 sexual function 을악화시키는것으로생각된다. Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms, sexual dysfunction, and components of the metabolic syndrome

16 BPH Vs. Metabolic syndrome (II) 1548 Kaplan et al.: Obesity 는 metabolic syndrome 의다른요인들이존재할때전립선크기를증대시키는위험인자가되는것으로보인다. Association between BPH and the metabolic syndrome in the REDUCE population 1350 Lee et al.: Cytosine-adenonine repeat polymorphism of IGF-1 은 BPH 와 metabolic syndrome 모두에있어위험인자이다. CA repeat polymorphism in the IGF-1 is common risk factor of the metabolic syndrome and the BPH

17 Combination Therapy 1553, 1554 Kaplan et al.: Tolterodine 과 tamsulosin 의병용요법은 LUTS, bother, OAB symptoms 를모두개선시키며낮은 retention rate 를보인다. - Effects of tolterodine extended release and/or tamsulosin on bladder diary variables in men with lower urinary tract symptoms including overactive bladder - Effects of tolterodine extended release and/or tamsulosin on international prostate symptom scores in men with lower urinary tract symptoms including overactive bladder 1560 Cho et al.: Doxazosin 4mg + tamsulosin 0.2mg 는장기추적결과에서 doxazocin 4mg + finasteride 5mg 보다효과적이고 doxazocin 8mg 보다혈관확장성부작용이적다. The efficacy and safety of dose escalating methods in patients with benign prostatic hyperplasia and hypertension

18 PDE 5 inhibitor for LUTS (I) 1354 Matsumoto et al.: valdenafil 을이용한기능적분석에서 BOO 를가진 rat 군에서 protective effect 를가진것이발견되었으며이는 BPH 환자에서 PDE5 inhibitor 가 LUTS 에효과적인사실에대한기전설명이될것이다. Bladder protective effects of PDE5 inhibitor - efficacy of valdenafil on rat bladder with outlet obstruction 1564 Bae et al.: Udenafil 은 NO pathway 를통해방광평활근의이완을일으켜 LUTS 에효과를나타낼수있다. Relaxation effect of udenafil, a long-acting phosphodiesterase-5 inhibitor, on carbachol-induced bladder smooth muscle contraction

19 PDE 5 inhibitor for LUTS (II) 1547 Mcvary et al.: BPH 가동반된 ED 와 LUTS 를가진환자에서 Sildenafil 은 urinary symptoms 를향상시키지만 Qmax 를의미있게변화시키지는못했다. 배뇨증상이심한경우가그렇지못한군에비해증상완화효과가크며발기부전향상점수와배뇨증상향상점수는서로연관성이있었다. Improvement with sildenafil in men with moderate and severe lower urinary tract symptoms 1565 Stief et al.: Valdenafil 은 BPH 환자에서 Quality of Life 뿐만 LUTS 의증상개선에유의한효과가있었다. Valdenafil in the treatment of symptomatic benign prostatic hyperplasia

20 Surgery for large prostate (I) 1724 Lourenco et al.: TURP 와새로운 prostate ablation 방법들의효과를비교하기위한문헌분석에서새로운방법들은증상개선효과는비슷하지만수혈량과입원기간, 술후 retention 등에있어아직미치지못하는것으로생각된다. Clinical effectiveness of tissue ablative procedures for benign prostatic enlargement: Is TURP still the gold standard? 1737 Boegesvang et al.: 100ml 이상의전립선비대증치료에있어 Suprapubic transvesical prostatectomy 는수술의효과는좋지만수술중과수술후에출혈의위험이높아수혈의빈도가높다. Early and late complications to suprapubic transvesical prostatectomy for benign prostate enlargement

21 Surgery for large prostate (II) 1735 Humpherys et al.: Holmium laser enucleation 시전립선크기에따라환자군을 75cc 이하, cc, 125cc 이상으로분류하였을때모든군에서술후결과는동일하였다. 따라서큰전립선에서도적절한술기가될것이다. Holmium laser enucleation of the prostate: outcomes are independent of prostate size 1839 Araki et al.: 5A-reductase 를장기간사용한군과사용하지않은군의 KTP laser PVP 의술후결과를비교하였을때유의한차이가나타나지않았다. 또한평균전립선크기는 70.8cc 로최대 131cc 의경우의수술에도안전하고효과적이었다. Decreased efficiency of Potassium-Titanyl-Phosphate (KTP) laser Photoselective Vaporization Prostatectomy (PVP) with long-term 5A-reductase inhibition therapy: Is it true?

22 Basic research (I) 1349 Wei et al.: IL-8 은전립선염환자에서 EPS 시얻어질수있으며민감도 85.7%, 특이도 91.3% 로 CP 가동반된 BPH 의진단에사용될수있으며 cut-point 는 3992ng/ml 이다. Catheter 나연령은이수치에영향을끼치지않는다. IL-8 levels in expressed prostatic secretion of BPH with chronic prostatitis

23 1357 Kojima et al.: Basic research (II) 환자들에따라 alpha1-ar subtype 들이다르게발현되는사실은선택적 alpha1-ar antagonist 들의종류에따라효과가다르게나타나는것에대한설명이될수있다. Alpha1a-AR, alpha1d-ar, total alpha1-ar mrna 등의발현은연령이증가될때요도압과 LUTS 를증가시킬수있으며임상적 BPH 의주요요인으로파악될수있으며전립선의용적이증상과항상관련성이있지않은것에대한원인으로파악된다. Correlation between the expression level of alpha1-adrenocetor subtype mrna and patient age or prostate volume in benign prostatic hyperplasia patients

24 Primary care physicians role in Urologic disease 86 Clemens et al.: 556 명의 PCP 를대상으로 CP/CPPS 환자진료에대한설문지조사 -> 충분치못한경험으로적절한검사와치료가이루어지지못하는경우가많아이에대한교육이필요하다. Primary care physician practice patterns in the management of chronic prostatitis/ chronic pelvic pain syndrome 1566 Hollingsworth et al.: 2,388 건의 BPH HMO medical claims 를조사한결과 primary care physician 과비뇨기과전문의의진단과정은차이가있으며 urologist 들의경우신속하게각종검사를시행하여 medical therapy 를진행한다. 또한일반개업의들의경우내과전문의들에비해비뇨기과전문의로 refer 하는데더욱오랜시간이걸린다. (79 vs. 53 months) BPH management in an HMO setting: Diffenrences between primary care physicians and urologists

25 Thank you for your attention.

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