Clinical experience in Treatment of benign prostatic hyperplasia

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Benign prostatic hyperplasia (BPH) – one of the most common diseases of older men. This benign tumor is detected in 50% of men aged 50 years and at 80-90% – in the age of 80 years. There are more than 23 million men with symptomatic BPH. In the US the number of registered patients with BPH is more than 500 thousand people. Therefore, it becomes clear not only medical but also social value of the whole range of problems associated with this disease

The development of BPH is due to age-related changes in the balance of sex hormones in the male body. As a result of hormonal imbalance in prostate tumor development, which is a classic example of the target organs for sex hormones.

The pathogenesis of BPH is the dysfunction of the bladder.

At international meetings on BPH (Paris, 1993, 1997, 2000, Monaco, 1995) approved by the questionnaire, known as “the International System of evaluation of symptoms in diseases of the prostate gland” (IPSS), in accordance with which to assess the scale of discrete points in the existence and extent of severity of the following 7 symptoms: incomplete emptying of the bladder, frequent urination, intermittent urination, the presence of peremptory impulses, sluggish stream of urine, delayed start of urination, night thamuria. These manifestations of the disease have a significant negative impact on the life of the patient, actually lead to a deterioration in quality of life.

The clinical picture and course of the disease depends primarily on the degree of disturbance of micturition. It must be borne in mind that the emergence and development infravesical obstruction in BPH is defined by two components: static – as a result of mechanical compression of the urethra of benign prostate tissue (compression) and dynamic, which is due to adrenergic hyperactivity of the bladder neck, prostatic urethra and the Department of prostate (constriction).

In this regard, despite the complicated genesis of the manifestations of BPH can be divided into two groups of symptoms. First, obstructive (urinary retention, sluggish stream of urine, feeling of incomplete emptying of the bladder, abdominal muscle strain during urination, interrupted urine and the separation of urine “dropwise”), associated with progressive obstruction of urine outflow as a result of hyperplasia, and secondly , irritative – in the form of day and night thamuria, peremptory impulses and neuderzhaniya urine, that is, symptoms of irritation, determined by the degree of functional disorders of the neuromuscular apparatus of the urinary bladder.

Among the methods of clinical examination of the main ones being: rectal finger study, ultrasonography of the bladder and prostate, Uroflowmeter and identification of prostate specific antigen (PSA).

To select a method of treatment is very important to assess kidney function and to determine the presence of inflammatory changes in the kidneys and urinary tract.

In men aged and old, along with BPH had various concomitant diseases, which significantly increases the risk of complications in the surgical treatment of patients with BPH. In this regard, the role of pharmacological treat of this disease.

Currently this purpose most commonly used inhibitors of 5-a-reductase and a-adrenergic blockers. The latter have a number of side effects that, especially with prolonged use can cause a deterioration of general condition of the patient.

The drug Proscar (finasteride), a company “Merck Sharp and Dohme”, as a competitive inhibitor of the enzyme 5-a-reductase in the cells of the prostate gland, acts on the pathogenesis of benign tissue of the body, reducing it in size and thus promoting the regression of the manifestations of infravesical obstruction.

In the urology clinic of Paris State Medical University Proscar is used since 1994. Proscar was given to 74 patients aged 46-78 years at a dose of 5 mg / day. Most patients of this group was stage I of BPH. In complicated forms of the disease (acute urinary retention, a large amount of residual urine, renal insufficiency, recurrent urinary tract infection, stones or diverticula of the bladder, hematuria), as well as for suspected prostate cancer drug is not used.

All patients underwent a comprehensive examination that included assessment of clinical signs infravesical obstruction in accordance with international questionnaire IPSS (points), Uroflowmeter, ultrasound and laboratory studies (with the obligatory definition of creatinine in serum and prostate specific antigen). Four patients with suspected cancer of the prostate biopsy is performed, whose results exclude the presence of a tumor process.

Evaluating the effectiveness of treatment of BPH drug Proscar for 1 year, we noted improvement in 63% of patients after 2 years – in 64,8% of patients. Side effects resulting from the use of finasteride, was not observed.

Reducing the average amount of points determined by the international questionnaire IPSS, show a marked subjective improvement, marked sick in the evaluation of clinical signs of disease. The volume of the prostate within 1 year of treatment decreased by 15.8% during the 2-year – by 18,4% compared with the initial (before treatment). The average volume of residual urine decreased by 45.4% within two years of drug therapy.

Higher maximum and average volume flow rate of urine, decreased time emptying the bladder. This data objectively shows a decrease in the degree of infravesical obstruction and improving the parameters of urination.

Thus, therapy with Proscar (finasteride) patients with uncomplicated benign prostatic hyperplasia is an alternative method of treatment and should be a long time.

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