Téma: 

Benign prostatic hyperplasia: natural history, pathophysiology, optimal treatment and failure of medical treatment

Michal Horňák, Vladimír Zvara

Objective: Medical treatment of benign prostatic hyperplasia (BPH) does not work for every patient. By identifying factors of progression of the disease we can predict the failure of medical treatment. The aim of the reviews article is to demonstrate a progressive nature of BPH and factors of progression. Material and methods: Based on searches of MEDLINE database the authors produced a literary summary of evidence of progressive nature of BPH and factors that influence the failure of medical treatment. Results: In some patients BPH can be a progressive disorder. Progression is defined as deterioration of clinical parameters during natural history. These parameters include continuous growth of prostate gland, worsening of lower urinary tract symptoms, decreased urinary flow, deterioration of quality of life, increased episodes of acute urinary retention and need of surgical management. Risk factors of progression include higher age, enlarged prostate volume, and increased serum levels of prostate specific antigen, bothersome symptoms, and large middle lobe of prostate. Conclusion: BPH is a progressive disorder. Probability of its progression can be predicted from parameters gained during the initial examination. Risk patients require effective prevention of progression, that would change natural history of the disease (so called disease modification). Slowing the progression of the disease by 5-α reductase inhibitors in patients with larger prostate volume has become the aim of treatment.

Ročník 2007  Témy časopisu Clinical urology 3 / 2007

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3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
4. Jurkovičová O, Spitzerová H, Cagáň S. Komorové arytmie a náhla srdcová smrť pri akútnom infarkte myokardu. Bratisl Lek Listy 1997; 98: 379-389.
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