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| 1 | Benign prostatic hyperplasia and male lower urinary symptoms:A guide for family physicians显示文摘Male patients with lower urinary tract symptoms(LUTS)and benign prostatic hyperplasia(BPH)are increasingly seen by family physicians worldwide due to ageing demographics.A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful.Good history taking,physical examination,targeted blood or urine tests,and knowing the red flags for referral are the mainstay of stratifying these patients.Case selection is always key in clinical practice and in the setting of the family physician.The best patient to manage is one above 40 years of age,symptomatic with nocturia,slower stream and sensation of incomplete voiding,has a normal prostatespecific antigen level,no palpable bladder,and no haematuria or pyuria on the labstix.The roles of α blockers,5-α reductase inhibitors,and antibiotics in a primary care setting to manage this condition are also discussed. | Farhad Fakhrudin Vasanwala Michael Yuet Chen Wong Henry Sun Sien Ho Keong Tatt Foo | 2017 | Asian Journal of Urology2017，4，3： | 5 |
| 2 | Can intravesical prostatic protrusion predict bladder outlet obstruction even in men with good flow?显示文摘Objective:Men with benign prostate hyperplasia(BPH)with good urinary flow may still have bladder outlet obstruction(BOO).Intravesical prostatic protrusion(IPP)has been shown to be able to predict BOO.We aim to investigate the use of IPP to predict BOO in men with good urinary flow.Methods:One hundred and fourteen consecutive men(>50 years old)presenting with lower urinary tract symptoms suggestive of BPH were recruited in 2001 and 2002.They were evaluated with serum prostate specific antigen(PSA),uroflowmetry and transabdominal ultrasound measurement of IPP and prostate volume(PV).Pressure-flow urodynamic studies were performed on all men and BOO was defined by BOO index>40.Men with Qmax12.0 mL/s were considered to have good flow.Results:Among the 114 men,61 patients had good urinary flow.Their median age,PV and Qmax were 66 years,32.9 mm3 and 14.5 mL/s respectively.14/61(23.0%)patients had BOO and their distribution of IPP were as follows:Grade 1 e 0/20(0%)obstructed,Grade 2 e 6/22(27.3%)and Grade 3 e 8/19(42.1%).Sensitivity of Grade 2/3 IPP for BOO was 100% while specificity of Grade 3 IPP was 76.6%.The area-under-curve(AUC)for IPP was greater than that for PV(0.757 vs.0.696).Conclusion:Even in men with good flow,high grades of IPP were more likely to have BOO and hence,may be a useful adjunct to predict BOO. | Alvin Lee Han Jie Lee Kok Bin Lim Hong Hong Huang Henry Ho Keong Tatt Foo | 2016 | Asian Journal of Urology2016，3，1： | 4 |
| 3 | Solving the benign prostatic hyperplasia puzzle显示文摘1.Introduction Benign prostatic hyperplasia(BPH)is a common urological condition,and yet there are many puzzles waiting to be solved.This perspective is to help explain some of these puzzles,based on our recent publications and previous clinical studies on BPH.2.Why small prostates obstruct and some big prostates do not obstruct? | Keong Tatt Foo | 2016 | Asian Journal of Urology2016，3，1： | 2 |
| 4 | Patients with small prostates and low-grade intravesical prostatic protrusion e A urodynamic evaluation显示文摘Abstract Objective:Despite high-grade intravesical prostatic protrusion(IPP)being closely related to bladder outlet obstruction(BOO),up to 21%of patients with low IPP remain obstructed.This study evaluates the characteristics and urodynamic findings of men with small prostates and low IPP.Methods:One hundred and fourteen men aged>50 years old with lower urinary tract symptoms(LUTS)were assessed with symptoms,uroflowmetry,serum prostate-specific antigen(PSA),transabdominal ultrasound measurement of prostate volume(PV),IPP and post-void residual urine(PVRU).All patients underwent pressure flow studies.Patients with PV<30 mL and IPP10 mm were examined for parameters correlating with BOO or impaired detrusor contractility.Results:Thirty-six patients had PV<30 mL and IPP<10 mm.Nine patients(25.0%)had urodynamic BOO,all with normal bladder contractility.Fourteen patients(38.9%)had poor detrusor contractility and all had no BOO.PV,PVRU and IPP were significantly associated with BOO,with IPP showing greatest positive correlation.Both Qmax and IPP were significantly associated with detrusor contractility.At 5-year follow-up,most patients responded to medical therapy.Only three out of nine patients(33.3%)with BOO eventually underwent surgery,and all had a high bladder neck seen on the resectoscope.Only one patient(7.1%)with poor detrusor contractility eventually required surgery after repeat pressure flow study revealed BOO.Conclusion:In men with small prostates and low IPP,the presence of BOO is associated with higher PV,PVRU and IPP,and most respond well to medical management.BOO can possibly be explained by elevation of the bladder neck by a small subcervical adenoma. | Han Jie Lee Alvin Lee Hong Hong Huang Palaniappan Sundaram Keong Tatt Foo | 2017 | Asian Journal of Urology2017，4，4： | 2 |
| 5 | Pathophysiology of clinical benign prostatic hyperplasia显示文摘A disease can be defined as an abnormal anatomy(pathology)and/or function(physiology)that may cause harm to the body.In clinical benign prostatic hyperplasis(BPH),the abnormal anatomy is prostate adenoma/adenomata,resulting in a varying degree of benign prostatic obstruction(BPO)that may cause harm to the bladder or kidneys.Thus clinical BPH can be defined as such and be differentiated from other less common causes of male lower urinary tract symptoms.Diagnosis of the prostate adenoma/adenomata(PA)can be made by measuring the intravesical prostatic protrusion(IPP)and prostate volume(PV)with non-invasive transabdominal ultrasound(TAUS)in the clinic.The PA can then be graded(phenotyped)according to IPP and PV.Multiple studies have shown a good correlation between IPP/PV and BPO,and therefore progression of the disease.The severity of the disease clinical BPH can be classified into stages from stage Ⅰ to Ⅳ for further management.The classification is based on the effect of BPO on bladder functions,namely that of emptying,normal if postvoid residual urine(PVRU)<100 mL;and bladder storage,normal if maximum voided volume(MVV)>100 mL.The effect of BPO on quality of life(QoL)can be assessed by the QoL index,with a score≥3 considered bothersome.Patients with no significant obstruction and no bothersome symptoms would be stage Ⅰ;those with no significant obstruction but has bothersome symptoms(QoL≥3)would be stage Ⅱ;those with significant obstruction(PVRU>100 mL;or MVV<100 mL),irrespective of symptoms would be stage Ⅲ;those with complications of the disease clinical BPH such as retention of urine,bladder stones,recurrent bleeding or infections would be stage Ⅳ.After assessment,further management can then be individualised.A low grade and stage disease can generally be watched(active surveillance)while a high grade and stage disease would need more invasive management with an option for surgery.The final decision making would take into account the patient’s age,co-morbidity,social economic background and his preferences/values. Proper understanding of pathophysiology of clinical BPH would lead to better selection of patients for individualised and personalised care andmore cost effective management. | Keong Tatt Foo | 2017 | Asian Journal of Urology2017，4，3： | 2 |
| 6 | Current consensus and controversies on male LUTS/BPH(part one)显示文摘It is an honor to be the guest editor of this special issue on Current Consensus and Controversy on Male Lower Urinary Tract Symptoms(LUTS)/Benign Prostatic Hyperplasia(BPH).As the title implies,one can write on a wide range of topics related to this urological problem that is common worldwide. | Keong Tatt Foo | 2017 | Asian Journal of Urology2017，4，3： | 0 |
| 7 | Current consensus and controversies on male LUTS/BPH(part two)显示文摘Part one of this special issue dealt with the historical development,epidemiology,aetiology and pathophysiology of clinical benign prostatic hyperplasia(BPH).With the current definition that clinical BPH is prostate adenoma/adenomata(PA)causing a varying degree of obstruction irrespective of symptoms,the disease can be diagnosed with transabdominal ultrasound in the clinic with confidence and managed accordingly. | Keong Tatt Foo | 2018 | Asian Journal of Urology2018，5，1： | 0 |
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