Evaluation and Treatment of Lower Urinary Tract Symptoms in Older Men
Evaluation and Treatment of Lower Urinary Tract Symptoms in Older Men
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DOI：
10.1016/j.juro.2008.11.127
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发表时间：
2009-04-01
影响因子：
6.6
通讯作者：
de la Rosette, J.
中科院分区：
文献类型：
--
作者：
Abrams, P.;Chapple, C.;de la Rosette, J.
目的：第六届国际前列腺癌和前列腺疾病的新发展咨询会议于2005年6月24日至28日在法国巴黎举行，以审查良性前列腺疾病的新发展。材料和方法：一系列委员会被要求产生的建议，对老年男性下尿路症状的评价和治疗。每个委员会都被要求根据国际咨询委员会的证据等级和牛津系统改编的分级系统对现有文献进行全面评估，并根据评估结果提出建议。协商会议赞同适当使用目前的术语下尿路症状/良性前列腺增生/良性前列腺肥大和良性前列腺梗阻，并建议放弃“临床良性前列腺增生”或“良性前列腺增生患者”等术语，并要求当局批准新的命名法。诊断评估描述了推荐和可选的测试，并且在确定调查和治疗时，通常将重点放在下尿路症状对个体患者的影响（困扰）上。强调了症状评估、对生活质量的影响、体格检查和尿分析的重要性。当尿失禁是一种令人烦恼的症状时，建议使用频率容量图来排除夜间多尿。我的建议总结在2算法，1为基本管理和1为专门管理的持续困扰下尿路symptoms.Conclusions：使用尿动力学和经直肠超声应限于情况下，结果可能有利于病人，如在选择手术。需要强调的是，尿路成像和内窥镜检查有特定的适应症，如试纸血尿。治疗应该是全面的，可能包括保守措施、生活方式干预和行为改变以及药物和手术。仅应使用具有强有力的临床有效性证据基础的治疗方法。
Purpose: The 6th International Consultation on New Developments in Prostate Cancer and Prostate Diseases met from June 24-28, 2005 in Paris, France to review new developments in benign prostatic disease.Materials and Methods: A series of committees were asked to produce recommendations on the evaluation and treatment of lower urinary tract symptoms in older men. Each committee was asked to base recommendations on a thorough assessment of the available literature according to the International Consultation on Incontinence level of evidence and grading system adapted from the Oxford system.Results: The Consultation endorsed the appropriate use of the current terminology lower urinary tract symptoms/benign prostatic hyperplasia/benign prostate enlargement and benign prostatic obstruction, and recommended that terms such as "clinical benign prostatic hyperplasia" or "the benign prostatic hyperplasia patient" be abandoned, and asked the authorities to endorse the new nomenclature. The diagnostic evaluation describes recommended and optional tests, and in general places the focus on the impact (bother) of lower urinary tract symptoms on the individual patient when determining investigation and treatment. The importance of symptom assessment, impact on quality of life, physical examination and urinalysis is emphasized. The frequency volume chart is recommended when nocturia is a bothersome symptom to exclude nocturnal polyuria. 'Me recommendations are summarized in 2 algorithms, 1 for basic management and 1 for specialized management of persistent bothersome lower urinary tract symptoms.Conclusions: The use of urodynamics and transrectal ultrasound should be limited to situations in which the results are likely to benefit the patient such as in selection for surgery. It is emphasized that imaging and endoscopy of the urinary tract have specific indications such as dipstick hematuria. Treatment should be holistic, and may include conservative measures, lifestyle interventions and behavioral modifications as well as medication and surgery. Only treatments with a strong evidence base for their clinical effectiveness should be used.