How to shape-up LUTS/BPH guideline in Korea -Follow-up단국의대 비뇨기과학교실 김형지 INTRODUCTION BPH Guidelines Diagnostic guidelines Treatment guidelines Follow-up guidelines Guidelines EAU BPH guidelines AUA BPH guidelines Canadian BPH guidelines German BPH guidelines Japan BPH guidelines Australia BPH guidelines WHO BPH guidelines Malaysia, Singapore BPH guidelines Diagnostic guideline에 중점을 두고 있다. Treatment guideline은 나열식이 많다. Follow-up에 대한 기술은 많지 않다. EAU BPH guidelines - Follow-up Watchful waiting should be reviewed at 6 months and then annually, IPSS Uroflowmetry post-void residual urine volume. Alpha-blocker therapy should be reviewed after the first 6 weeks If symptomatic relief and no side-effects, alphablocker therapy may be continued. should be reviewed at 6 months and then annually, provided there is no deterioration of symptoms or development of absolute indications for surgical treatment. IPSS Uroflowmetry post-void residual urine volume 5-alpha-reductase inhibitors should be reviewed after 12 weeks and at 6 months to determine their response. Subsequent review is as for alpha-blocker therapy. IPSS Uroflowmetry post-void residual urine volume. Surgical management Within 6 weeks : discuss the histological findings and identify early post-operative morbidity. At 3 months : the final outcome. Patients who fail treatment should have urodynamic studies with pressure-flow analysis. IPSS: recommended Uroflowmetry: recommended post-void residual urine volume: recommended Urine culture: optional Histology: mandatory. Alternative therapies Long-term follow-up is recommended because of concerns about the efficacy and durability of alternative therapies. The intervals for follow-up will depend on the treatment modality employed. Minimally invasive therapies: within 6 weeks, at 3 months, at 6 months, and then annually. IPSS: recommended Uroflowmetry and post-void residual urine volume: recommended Urine culture: optional Histology where available: mandatory. Recommended follow-up tests after BPH treatment Treatment Modality Examination IPPS WW 5 ARI a-blockers surgical Non-surgical + + + + + uroflowmetry + + + + + postvoid urine residual culture urine volume + + + + + + + histology + + Recommended follow-up interval after BPH treatment Treatment Modality First year after treatment 6weeks WW 5 ARI a-blockers surgical Non-surgical + + + 12weeks 6month + + + + + + + + thereafter annually + + + + + Francois에 의한 guideline Medical management of non-complicated BPH Risk factors: prostate volume > 31 cm3, PSA > 1.6 ng/ml, RUV > 39 ml, flow max < 10.6 ml First line treatment of non-complicated BPH First line medical treatment failure: persistence of bothersome symptoms Francois, World Journal of Urology, 2006 Conclusion 대략 3개월 내지 6개월이면 임상평가를 하는 것으로 되어 있지만 임상평가에 대한 항목은 자세히 정해지지 않았다. 이는 evaluation에 대한 guideline이 정해지지 않은 것에 기인된 것으로 판단된다.
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