17. Valoración inicial de los pacientes que
presentan LUTS/CPO
Evaluación inicial
Historia
DRE
IPSS
EGO y. Urocultivo
PSA
Diario miccional
LUTS asociado
DRE anormal
Hematuria
Aumento del PSA
Dolor
Infección
Enfermedad neurologica.
28. Comparación de los efectos
fisiológicos
Bartsch G et al. In: Chatelain C et al, eds. Benign Prostatic Hyperplasia. Plymouth, UK:
Health Publication Ltd; 2001:423-457. Roehrborn CG et al. Urology. 2002;60:434-441.
29. Comparación de los efectos clínicos
PLESS NEJM 1998 for finasteride and Roehrborn et al Urology. 2002 Sep; 60(3)434-41 for dutasteride
34. Alfabloqueadores
Expectante
Cambios en el estilo de vida, revaloracion
Alfabloqueadores,
5ARIs o combinado
Expectante
Cambios en el estilo de vida
Revaloracion
5ARI para modificar la progresión en
pacientes de riesgo.
35. ALGORITMO DE TRATAMIENTO MEDICO
Pacient
e
IPSS 〈
7
IPSS 〉
7
Prostata Pequeña
PSA Bajo
Prostata Grande
PSA Alto
NO TX Tx preventivo?
5ARI
Molestia Moderada a
severa
Prostata Pequeña
PSA Bajo
Prostata Grande
PSA Alto
Alfa bloqueador
5ARI
TX combinado
36. Roberto Cortazar
Colección: El cuerpo cinetico.
Figura humana en la curvatura
del espacio
2011
Óleo y punta de plata sobre panel
200 x 140 cm
Colección particular
Notas del editor
Fig. 1 – Axial section of prostate and periprostatic fascias at midprostate: (a) anatomic (reproduced with permission from the Mayo Clinic);
(b) schematic. AFS = anterior fibromuscular stroma; C = capsule of prostate; DA = detrusor apron; DVC = dorsal vascular complex; ED = ejaculatory
ducts; FTAP = fascial tendinous arch of pelvis; LA = levator ani muscle; LAF = levator ani fascia; NVB = neurovascular bundle; PB = pubic bone;
PEF = parietal endopelvic fascia; PF = prostatic fascia; pPF/SVF = posterior prostatic fascia/seminal vesicles fascia (Denonvilliers’ fascia); PZ = peripheral zone; R = rectum; TZ = transition zone; U = urethra; VEF = visceral endopelvic fascia.
Fig. 3 – Axial section of sphincteric urethra:
DVC = dorsal vascular complex; LAF = levator ani fascia; MDR =median dorsal raphe; NVB = neurovascular bundle; PB = pubic bone;
PV/PPL = pubovesical/puboprostatic ligament; pp = puboperinealis muscle; PR = puborectalis muscle; R = rectum; RU = rectourethralis
muscle; SS = striated sphincter (rhabdosphincter); C SMS = circular smooth muscle sphincter (lissosphincter); L SMS = longitudinal smooth
muscle sphincter (lissosphincter); U = urethra; VEF = visceral endopelvic fascia.
Fig. 7 – Axial section through base of seminal vesicles to show proximity of distal pelvic plexus (neurovascular bundle [NVB]): (a) anatomic (reproduced with permission from the Mayo Clinic); (b) schematic.
B = bladder; PP = pelvic plexus; pPF/SVF = posterior prostatic fascia/seminal vesicle fascia (Denonvilliers’ fascia); R = rectum; SV = seminal vesicle; VD = vasdeferens VPM = vesicoprostatic muscle.
Variations in apical shapes of prostates. Started from left, the apex can overlap the urethral sphincter anteriorly, circumferentially, symmetrically bilaterally, asymmetrically unilaterally, or posteriorly with anterior apical notch and posterior lip. Reprinted with permission
from the Mayo Clinic.
*In men with life expectancy of >10 years in
whom the diagnosis of prostate cancer can alter
management.
†Particularly useful in patients with nocturia as
the leading symptom.
Urgencia, frecuencia, Pujo, Chorro, Intermitencia, Tenesmo, Nicturia
Calidad de vida “sin que algo esta mal “
Patients who crossed over to TURP or dutasteride >2 years later never achieved the same level of symptom reduction as those who had treatment initially
Distribución de los receptores alpha en la vía
5 ALPHA DIHIDROTESTOSTERONA O ANDROSTANOLONA , tiene una afinidad 3 x mas alta que la testosterona y 15-30 veces mas alta que los andróginos suprarrenales.
Medical therapy of prostatic synthoms, estudio Clinico , de diciembre 95 a nov 2001
Incremento en la puntuación del ipss.