This continuing medical education video is from a rural mission hospital in India
Euro flama tree euro flama tree is the least controversial eerie dynamic parameter it has been proposed that peak flow rate a less than 10 ml per second is associated with obstruction and over 15 ml per second is normal however any flow rate could be associated with either obstruction or lack of obstruction the potential drawbacks of euro fluently are as follows
The volume voided may not be sufficient for proper interpretation interrupted stream opposed to a dribble makes the calculations and interpretation difficult some patients may not be able to avoid as they normally do in the machine the same person may avoid the different streams at different time system metro gram of bladder pressure relief filling system a tree
Provides information on sensation compliant the present and threshold for involuntary bladder contraction and the functional capacity of the bladder during the filling wave the maximum voiding pressure and the post word residue are the parameters that are assisted men normally have a maximum voiding pressure of about 60 centimeters of water although there has been
Considerable disagreement regarding the use of pressure flow study for evaluation of outlet obstruction successful treatment of bph by prostatectomy is generally correlated with significant reduction of maximum voiding pressure however the trouble is that reduction a maximum voiding pressure may not translate into symptomatic improvement there is also a lack of
Correlation between the maximum voiding pressure and the symptoms the natural history of patients is bph the symptoms due to bph are progressive over time however spontaneous improvement could occur rally about 60% of the patient have worsening of their symptoms over a three to five year period the dreaded complication acute painful retention of urine that can occur
In about four to seventy-three percent of patients studied over a 10-year period the average reported incidence is about three percent in three years evaluation of patients with lower urinary tract symptoms here variety of symptom scores have been developed to objectively assess the severity of the symptom a group appointed by the food and drug administration of
Usa in 1975 first developed this it was then modified by the american neurological association and then adopted by the w-h-o at the international prostate symptom score seven questions are asked and the response are graded great fire is given when the symptom is always there and grade zero when it is not there grade three is given as the symptoms we present half
The time ungrateful if it is present more than half the time grade one is given as the symptom is present less than 20% of the time and great two if present between 20% and half the time just the scores range from zero to thirty five the questions are as follows over the last month how often have we had to have the sensation of not emptying your bladder completely
After you finish urinating over the last month how often you have to urinate again listen to us after you finish urinating over the last month how often you find that you stopped and started again several times while urinating over the last month how often you found it difficult to postpone urination over the last month how often you have you had a week stream well
Urinating over the last month how often he had to push her strain to begin urinating over the last month how many times did you most typically get up to urinate from the time we went to bed until the time you got up in the morning so the last question the score ring is different if more than or equal to fight and the score is given is 5 well one is given for the
Number of times equation greater equality like question is also asked and is graded as follows the question asked is this if you were to spend the rest of your life with your ordinary condition just the way as it is now how do you feel about it it’s one if they say pleased – mostly satisfied 3 do not know whether satisfied or not satisfied for unhappy 5 terrible any
A you is symptom score of 8 to 18 is moderate well more than that is severe symptom and less than that is mild there are several drawbacks are using only the symptoms go for evaluation they as followed they do not correlate with a predict bureau dynamically documented bledel flu obstruction a verity or non prostatic causes produces similar symptom it is difficult
To find out how badly the symptoms causes the patient some symptoms are bothersome while some others are not some studies have shown that symptoms caused change or three implies slight improvement while greater than nine implies marked improvement perhaps the softest but most important may be the quality of life index indication for treatment the indication for
Treatment varied widely over time depending on the risks for surgery and annasophia and available there modern medication and social background of the patient however there is an absolute or near absolute indication like the factory are repeated painful urinary retention acidemia due to be ph significant gross hematuria recurrent or residual infection due to b
Ph vesicle calculate due to b ph large residual urine whoa flu incontinence or a large bladder died vertically due to be played with a contractile bladder apart from these the decision for surgeries individualized to the needs of the patient a variety of treatment options are available one day alpha blockers i would half the urethral pressure in patients will be
Paid is contributed by alpha receptor about sixty to eighty five percent of these belong to the alpha one subtype phenoxy benjamin was the first non selective alpha blocker that was used precision which is a selective alpha one blocker was then developed since prices and required prices a dosage tara susan and doctor susan that permit once a day dosage were developed
Tamsulosin which is super selective alpha one blocker was then developed with the view to reduce the vascular and central side effects side effects include orthostatic hypotension dizziness fatigue nasal stuffiness and ejaculatory disturbances the phi alpha reductase inhibitors fenestrated is a competitive selective inhibitor of type 2 phi alpha reductase it does
Not reduce the headed the sister on level to castrate level because circulating set tested on still converted to dhd by type 1 phi alpha reductase in the skin and liver the prostatic dhd level is reduced by about 80 to 90 percent it does not lower class 1 testosterone it reduces the prostate volume by 20% and psa level by 50% treatment defenestrate reduces the
Chancel acute retention by about 75% this could be used in combination of alpha blockers however some studies have shown a statistically significant improvement with combination balloon dilation with 2 to fired most ferric pressure for 5 to 20 minutes was popular for a while until it was shown that the improvement was no greater than that after the simple cystoscope ii
Transcribed from video
CME VIDEOS BMH BPH PART 2 By Gnanaraj J