UROLOGIE PRO PRAXI / Urol. praxi. 2024;25(4):238-242 / www.urologiepropraxi.cz 240 účinků a selektivnější (tamsulosin, silodosin) jsou spojeny s častější retrográdní ejakulací. Inhibitory 5α reduktázy (finasterid, dutasterid) jsou doporučovány k dlouhodobé terapii s vysokou mírou doporučení. Je prokázán jejich gradující efekt po řadu měsíců a let a jsou efektivní v prevenci progrese onemocnění, i jako prevence akutní retence moči. Nepříznivé jsou častější nežádoucí účinky na sexualitu pacientů. Zatímco EAU doporučuje nasazení u prostat nad 40 ml, v AUA guidelines již pro 30 ml žlázy. Z inhibitorů 5fosfodiesterázy se do doporučení k terapii LUTS dostal pouze tadalafil, nutno podotknout, že jako pojišťovnami nehrazená terapie. Objektivní efekt na urodynamické parametry není měřitelný, zlepšuje IPSS, s výhodou je nasazení u pacientů se souběžnou erektilní dysfunkcí. NON-INVASIVE THERAPIES STATEMENT TEN: Clinicians should discuss incontinence management strategies (eg, pads, diapering, barrier creams) with all patients who have urgency urinary incontinence. (Expert Opinion) Patients who present with UUI symptoms should be evaluated and counseled regarding potential strategies used to manage incontinence (eg, liners, pads, diapers, barrier creams, external catheters, absorbent washable protective briefs or underwear) and to mitigate the impact of leaking on QoL. It is important to note that no randomized controlled trials (RCTs) have compared the clinical effectiveness of, or patient satisfaction with, these strategies. The clinician should present a description, as well as the risks and benefits, of each of the options to the patient in the context of shared decision-making. STATEMENT ELEVEN: Clinicians should offer bladder training to all patients with OAB (Strong Recommendation; Evidence Level: Grade A) STATEMENT TWELVE: Clinicians should offer behavioral therapies to all patients with OAB. (Clinical Principle) Behavioral therapies for OAB, such as fluid management, caffeine reduction, physical activity/ exercise, dietary modifications, and mindfulness offer patients with OAB some efficacy, excellent safety, and few if any adverse effects. However, the success of these measures is highly dependent on patient acceptance, adherence, and compliance. While the research on the effectiveness of behavioral therapies is highly variable, bladder training has been extensively studied and is recommended based on strong evidence.4 STATEMENT THIRTEEN: Clinicians may offer select non-invasive therapies to all patients with OAB. (Clinical Principle) Non-invasive therapies, such as pelvic floor muscle therapy (PFMT), transcutaneous tibial nerve stimulation, transvaginal electrical stimulation, and yoga are conservative therapies for OAB that are Figure. OAB algorithm. 14 AUA/SUFU GUIDELINE: DIAGNOSIS AND TREATMENT OF IDIOPATHIC OVERACTIVE BLADDER Copyright © 2024 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. Obr. 2. AUA/SUFU algoritmus léčby OAB (Cameron AP, et al. J Urol. 2024;212(1):11-20) Obr. 3. Fenotypy OAB a jejich cílená léčba (Peyronnet B, et al. Eur Urol. 2019;75(6):988-1000) ZAZNĚLO NA KONGRESE PACIENTI S LUTS V CENTRU ZÁJMU ANEB CO ZAZNĚLO NA SATELITNÍM SYMPOZIU SPOLEČNOSTI ASTELLAS V RÁMCI 70. VÝROČNÍ KONFERENCE ČUS V BRNĚ A MĚLI BYSTE TO VĚDĚT
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