Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms

Benigna hiperplazija prostate dio je procesa starenja muškaraca i hormonalno je ovisna o produkciji dihidrotestosterona. Smetnje mokrenja koje proizlaze iz povećanja prostate i opstrukcije vrata mokraćnog mjehura nazivaju se smetnjama donjeg urinarnog trakta (LUTS). Kliničke manifestacije LUTS-a uključuju učestalo, urgentno mokrenje, noćno mokrenje, smanjen ili isprekidan mlaz mokraće ili osjećaj nepotpunog pražnjenja mjehura. Rizik od akutne retencije urina (AUR) i potreba kirurškog liječenja povećavaju se sa životnom dobi. Bolesnici s blagim LUTS-om tretiraju se savjetima o promjeni životnih navika i vježbama za jačanje mišića dna zdjelice. Antagonisti alfaadrenergičkih receptora čine prvu liniju farmakološkog liječenja. Kombinirana terapija antagonistima alfaadrenergičkih receptora i inhibitorima 5-alfa-reduktaze može značajno reducirati rizik od progresije bolesti i izbjeći dugoročne komplikacije poput AUR-a i potrebe kirurškog liječenja. Kirurško je liječenje indicirano u bolesnika s umjerenim do jakim LUTS-om koji ne reagiraju adekvatno na farmakoterapiju ili se kod njih razvije AUR ili neka od apsolutnih indikacija za kirurški zahvat.Benign prostatic hyperplasia is considered a normal part of the aging process in men and is hormonally dependent on dihydrotestosterone production. The voiding dysfunction that results from prostate gland enlargement and bladder outlet obstruction is termed lower urinary tract symptoms (LUTS). Clinical manifestations of LUTS include urinary frequency, urgency, nocturia, decreased or intermittent force of stream, or a sensation of incomplete emptying. The risk of acute urinary retention (AUR) and the need for surgical treatment increase with age. Patients with mild LUTS should be managed with lifestyle advice and pelvic floor muscle exercise. Alpha-blockers should be offered as a first-line treatment to men with bothersome LUTS who request treatment. Treatment with combined alpha-blocker and 5-alpha-reductase inhibitor therapy can significantly reduce the risk of disease progression and avoid long-term complications such as acute urinary retention and surgery. Surgery is appropriate for patients with moderate to severe LUTS who have not responded to drug treatment, or who have developed AUR or any absolute indication for surgery