外科-泌尿系梗阻课件.ppt

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1、Urinary tract obstruction（泌尿系梗阻）（泌尿系梗阻）Introductiona system of tubeobstruction will affect secretion and excretion of urinefinal results:hydronephrosis,renal failureobstruction at different placeCauses of obstructionclassification:mechanical and dynamical congenital,acquired and iatrogeniccommon cau

2、ses:stone,tumor,ectopic vessel,nephroptosis,stricture,BPH,reflux,pregnancyPathophysiology dilatation of the urinary tractearly stage:tubular wall hypertrophieslate stage:thinning of the tubular wallprolonged obstruction below the bladder:hydronephrosisurinary back flow pyelovenous and pyelolymphatic

3、 pyelosinus pyelotubularThe prostate Etiology still obscurtestosterone DHTgrowth factorsPathology Normal anatomical zonesBPH derived from TZdegree of obstruction unparallel to its sizehydronephrosis,detrusor hypertrophy,trabeculae,cellules,diverticulum,stones,hernia,infection,retentionPathology of B

4、PHClinical manifestationssymptom not parallel to prostate sizeprostatism:frequency,urgency,nocturiadysuriaretentionDiagnosis history and physical examDRE:enlarged prostate,middle furrow disappearTRUSurodynamicsothers:cystogram,cystoscopeManagement of BPHMedical treatment SurgeryMedical Treatment 5a-

5、reductasefinasteride,a-receptor inhibitor Phenoxybenzamine,Prazosin,Phytotheapeutic agentsCurrent AR-blockersNon-selective:Phenoxybenzamine Selective:Prazosin(Minipress)Terazosin(Hytrin)Doxazosin(Cardura)Alfuzosin(Xatral,Xatral SR,Xatral XL)Subtype selective(1a)Tamsulosin(Harnal)5a-reductaseDihydrot

6、estosterone(DHT)is synthesized from testosterone via the enzyme 5-reductase In the majority of androgen target tissues either testosterone or DHT binds to a specific androgen receptor to form a complex that can regulate gene expression.DHT is essential for prostate development and growth,the develop

7、ment of the external genitalia and male patterns of facial and body hair growth or male-pattern baldnessCurrent 5a-reductaseFinasterideDutasteridePlant ExtractsThe mode of action of phytotheapeutic agents is unknown The biological effects are unclear although a few RCTs show encouraging data These d

8、rugs are not recommended for the treatment of elderly men with LUTS suggestive of BPH indication of surgery not responsible to drugs repeat infection and hematuria with hydronephrosis,hydroureter,bladder stones or diverticula residual urine 40mlKey points of the chapterEtiology of urinary tract obstructionPathophysiological changes of UTOEtiology of BPHClinical manifestations of BPHTreatment for BPHReferrence book:campbells urology