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Benign prostatahyperplasi (BPH)

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition:
Förstorad prostata till följd av tillväxt av körtelvävnad som ofta leder till symtom.
Förekomst:
Drabbar med stigande ålder i princip alla män men alla behöver inte behandling.
Symtom:
Symtom delas upp i lagringssymtom (till exempel urinträngningar, nokturi) och tömningssymtom (till exempel svag stråle, urinretention). Kan utvärderas med skattningsskalor.
Kliniska fynd:
Palpation av prostatan kan påvisa förstorad prostata och används för att göra andra orsaker mindre sannolika.
Diagnostik:
Vid diagnostiken brukar bedömning av urinsticka, kreatinin och ibland PSA och mätning av resturin ingå.
Behandling:
Behandling består av egenbehandling vid lättare besvär, tillägg av läkemedel vid måttliga besvär och invasiva procedurer vid svårare besvär eller komplikationer.
  1. Thorpe A, Neal D. Benign prostatic hyperplasia. Lancet 2003; 361: 1359-67. PubMed  
  2. SBU (2011). Godartad prostataförstoring med avflödeshinder - En systematisk litteraturöversikt. (Hämtad 2017-08-03) www.sbu.se  
  3. Guthrie EW. Drugs that can aggravate benign prostatic hypertrophy (BPH). Prescriber's Letter 2004; 20: 1-4.
  4. Oishi K, Boyle P, Barry MJ, et al. Committee 1: Epidemiology and natural history of benign prostatic hyperplasia. In: Denis L, Griffiths K, Khoury S, et al, eds. Fourth International Consultation on BPH, Proceedings. Plymouth, UK: Health Publication Ltd., 1998: 23-59.
  5. Prostatacancer. Nationellt vårdprogram. Regionala cancercentrum i samverkan; 2020. cancercentrum.se  
  6. Pearson R, Williams PM. Common Questions About the Diagnosis and Management of Benign Prostatic Hyperplasia. Am Fam Physician. 2014 Dec 1;90(11):769-774. PMID:25611711.
  7. Füllhase C, Chapple C, Cornu JN, et al. Systematic review of combination drug therapy for non-neurogenic male lower urinary tract symptoms. Eur Urol. 2013 Aug;64(2):228-43. PMID: 23375241. PubMed  
  8. Lepor H. Alpha-blockers for the Treatment of Benign Prostatic Hyperplasia. Urol Clin North Am. 2016 Aug;43(3):311-23. PMID: 27476124. PubMed  
  9. EAU Guidelines. Edn. presented at the EAU Annual Congress Barcelona 2019. ISBN 978-94-92671-04-2. (Hämtad 2019-12-10). uroweb.org  
  10. Marberger MJ. Long term effects of finasteride in patients with benign prostatic hyperplasia: a double-blind, placebo-controlled multicenter study. PROWESS Study Group. Urology 1998; 51: 677 - 86. PubMed  
  11. McConnell JD. The long term effects of medical therapy on the progression of BPH. results from the MTOPS trial. J Urol 2002; 167: 265. PubMed  
  12. Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. A randomized controlled trial. JAMA 2006; 296: 2319-28. Journal of the American Medical Association  
  13. Baldwin KC, Ginsberg PC, Roehrborn CG, Harkaway RC. Discontinuation of alpha-blockade after initial treatment with finasteride and doxazosin in men with lower urinary tract symptoms and clinical evidence of benign prostatic hyperplasia. Urology 2001; 58: 203 - 9. PubMed  
  14. Gacci M, Corona G, Salvi M, et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with α-blockers for urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 2012; 61: 994-1003. PubMed  
  15. Wang CJ, Lin YN, Huang SW, Chang CH. Low dose oral desmopressin for nocturnal polyuria in patients with benign prostatic hyperplasia: A double-blind, placebo controlled, randomized study. J Urology 2011; 185: 219-23. PubMed  
  16. Wei L, Lai EC-C, Kao-Yang Y-H, et al. CCBY Open access Research Incidence of type 2 diabetes mellitus in men receiving steroid 5α-reductase inhibitors: population based cohort study. BMJ 2019; 365: l1204. doi:10.1136/bmj.l1204 DOI  
  17. Park T, Choi JY. Efficacy and safety of dutasteride for the treatment of symptomatic benign prostatic hyperplasia (BPH): a systematic review and meta-analysis.. World J Urol 2014; 32(4): 1093-105. pmid:24500194 PubMed  
  18. Lucia MS, Epstein JI, Goodman PJ, et al. Finasteride and high-grade prostate cancer in the Prostate Cancer Prevention Trial. J natl Cancer Inst 2007; 99: 1375-83. PubMed  
  19. Wilt T, Ishani A, Mac Donald R, Stark G, Mulrow C, Lau J. Beta-sitosterols for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2000;(2):CD001043. PMID:10796740. PubMed  
  20. Tacklind J, MacDonald R, Rutks I, Wilt TJ. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2012 Dec 12;12:CD001423. PMID:23235581. PubMed  
  21. Vela-Navarrete R, Alcaraz A, Rodríguez-Antolín A, et al.. Efficacy and safety of a hexanic extract of Serenoa repens (Permixon® ) for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH): systematic review and meta-analysis of randomised controlled trials and observational studies. BJU Int. 2018 Dec;122(6):1049-1065. Epub 2018 Jun 6. PMID: 29694707.
  22. Chughtai B, Simma-Chiang V, Kaplan SA. Evaluation and management of post-transurethral resection of the prostate lower urinary tract symptoms. Curr Urol Rep. 2014 Sep;15(9):434. doi: 10.1007/s11934-014-0434-1. DOI  
  23. Huang SW, Tsai CY, Tseng CS, et al. Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: Systematic review and network meta-analysis. BMJ 2019 ; 367: l5919. PMID: 31727627 PubMed  
  24. Godartad prostataförstoring med avflödeshinder En systematisk litteraturöversikt September 2011 www.sbu.se  
  25. Tang Y, Li J, Pu C, et al. Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and meta-analysis. J Endourol. 2014 Sep;28(9):1107-14. pmid:24754254 PubMed  
  26. Cornu JN, Ahyai S, Bachmann A, et al. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol. 2015 Jun;67(6):1066-96.pmid: 24972732 PubMed  
  27. McNeill SA, Daruwala PD, Mitchell ID, et al. Sustained release alfusosin and trial without catheter after acute urinary retention: a prospective, placebo controlled trial. BJU Int 1999; 84: 622-27. PubMed  
  28. Pickard RS, Emberton M, Neal DE. The management of men with acute urinary retention. Br J Urol 1998; 81: 712-20. PubMed  
  29. Glazener C, Boachie C, Buckley B, et al. Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy og transurethral resection of the prostate (MAPS): two parallell randomised controlled trials. Lancet 2011; 378: 328-37. PubMed  
  30. Andersen M, Walter S. Mikrobølgetermoterapi for benign prostatahyperplasi. Gennemgang af et Cochrane-review. Ugeskr Læger 2009; 171: 2281. Ugeskrift for Læger  
  31. Hoffman RM, Monga M, Elliot SP, MacDonald R, Witt TJ. Microwave therapy for benign prostatic hyperplasia. Cochrane Database of Systematic Reviews, issue 4, 2007. The Cochrane Library  
  32. SBU Alert. Mikrovågsbehandling vid prostataförstoring. Version 2. Stockholm: Statens beredning för medicinsk utvärdering (SBU); 2002. http://www.sbu.se www.sbu.se  
  33. Cornu JN. Bipolar, Monopolar, Photovaporization of the Prostate, or Holmium Laser Enucleation of the Prostate: How to Choose What's Best? Urol Clin North Am. 2016 Aug;43(3):377-84. PMID: 27476130. PubMed  
  34. Roehrborn CG, Barkin J, Gange SN, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol. 2017;24(3):8802-8813. PubMed  
  35. Platz EA, Joshu CE, Mondul AM, et al. Incidence and progression of lower urinary tract symptoms in a large prospective cohort of United States men. J Urol. 2012 Aug;188(2):496-501. PMID:22704110. PubMed  
  36. Jacobsen S, Jacobson D, Girman C, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol 1997; 158: 481-7. PubMed  
  • Jan-Erik Damber, professor och överläkare, Enheten för urologi, Sahlgrenska universitetssjukhuset, Göteborg
  • Remy Waardenburg, specialist i allmänmedicin, Vårdcentralen Hökarängen