ipertrofia prostatica benigna.PPT [Sola lettura] - E-learning

ALPHA-BLOCKER
Rationale
• The rationale for a-adrenergic blockers in the treatment of
BPH is based on the hypothesis that the pathophysiology
of clinical BPH is in part caused by BOO, which is
mediated by a1 adrenoceptors (a1 AR) associated with
prostatic smooth muscle (Caine, 1986).
• Several investigators subsequently demonstrated that the
tension of prostate smooth muscle is mediated by the a1
AR (Hieble et al, 1985; Lepor et al, 1988; Gup et al, 1989).
• The most definitive evidence that blockade of prostate a1
AR relieves BOO was the observed direct relationship
between the area density of prostate smooth muscle and
the change in the PFR in 26 subjects undergoing prostatic
biopsy before initiating a-blocker therapy with terazosin
(Shapiro et al, 1992).
Finasteride
FINASTERIDE
Rationale
• The rationale for androgen suppression is based
on the observation that the embryonic
development of the prostate is dependent on the
androgen dihydrotestosterone (DHT) (Shapiro,
1990).
• Testosterone is converted to DHT by the enzyme
5a-reductase. The genetic deficiency of 5areductase
in males results in a rudimentary
prostate and in feminized external genitalia
(Walsh et al, 1974).
• The development of BPH is also an androgendependent
process (Coffey and Walsh, 1990).
Laser
Termoterapia
< 40-60 grammi > 40-60 grammi
Microonde
Radiofrequenza
8