International Prostate Symptom Score
over the age of 50 is an enlarged prostate.
(IPSS) or AUA Symptom Index — a short
this problem. By age 85, the number climbs or enlarged prostate and how often theyoccur. Due to the prostate’s location, benignenlargement may result in obstruction of • Urinalysis — a laboratory test of your
urine performed to rule out the presence prostate is to produce fluid that aids in semen. While its growth is thought to be an abnormal part of aging, the exact cause • Prostate-Specific Antigen (PSA) Blood
Test— used to help rule out prostate
cancer as the cause of your symptoms.
Risk Factors
PSA is a protein produced by cells in theprostate, and the level of this protein is • Heredity — A family history of BPH If the results of these tests suggest that you examinations to help confirm the diagnosisand determine the severity of the condition.
Urinary flow study — This measures the
Imaging tests — Ultrasound may be
• A feeling of incomplete bladder emptying for prostate stones, kidney stones orobstructions or a tumor. • Cystoscopy — A cystoscope (a thin tube
containing a lens with a light system) is • Getting up frequently at night to urinate inserted into the urethra so the doctor can detect problems, including prostate • A urinary stream that starts and stops enlargement or the development of stonesin your bladder. • Urodynamic studies — Your doctor may
• Acute urinary retention (inability to suspects your symptoms might be relatedto a bladder problem or a neurological Post-void residual volume test — Ultrasound
Detection and Diagnosis
imaging is used to determine whether youcan empty your bladder. Your doctor may perform some or all of the following tests to confirm or rule out the presence of BPH or enlarged prostate. • Digital Rectal Examination (DRE)
Usually, this is the first test performed.
During the examination, the doctor insertsa gloved and lubricated finger into the rec-tum to feel the prostate. This examinationallows the doctor to get a general idea ofthe size and condition of your prostate. Treatment Options
Minimally Invasive Office Procedures
Surgery — For most men with very enlarged
When medications don't solve the problem, prostates, surgery can relieve symptoms, but there are both risks and benefits with each Medications — Several drugs are FDA-
doctor's office. These procedures use various types of heat energy to shrink a portion of • TURP (transurethral resection of the
the prostate and are very effective.
prostate): This is the most common
blockers and 5-alpha reductase inhibitors.
Each works differently. They either shrink • Interstitial Laser Therapy (ILT): Causes
considered to bring the greatest reduction the enlarged prostate or stop the prostate a coagulative necrosis below the urethral surface that allows for less obstruction is pressing against the urethra is removed to allow urine to flow easily. The procedure receptors. Men are given local anesthesia involves an electrical loop that cuts tissue for the procedure. This procedure involves • Alpha Blockers: These drugs don't reduce
passing a cystoscope through which a laser the size of the prostate, but they can relieve fiber is inserted and used to puncture the as it is less traumatic than open surgery prostate. Once in the prostate, laser energy muscles around the bladder neck, so urine destroy the tissue to shrink the gland.
to have retrograde ejaculation afterwards.
There is very little bleeding or recovery This is a condition in which a man ejaculates treatment is the rule, and may last for a through the urethra. Retrograde ejaculation generally isn't painful. It shouldn't be an Flomax (tamsulosin), Uroxatral (alfuzosin), issue unless fertility is a concern. Other Hytrin (terazosin), and Cardura (doxazosin).
TUMT (transurethral microwave ther-
possible side effects: blood loss requiring Alpha blockers were originally created to motherapy): This therapy reduces urinary
transfusion, painful urination, recurring treat high blood pressure; dizziness is the frequency, urgency, straining and intermit- urinary tract infections, bladder narrowing most common side effect; other side effects tent flow, but does not correct any bladder- generally are mild and controllable.
and frequent urinary tract infections.
TUIP (transurethral incision of the
doctor's office and requires only topical prostate): This procedure involves making
5-Alpha Reductase Inhibitors: These
anesthesia and pain medications. Possible side effects: painful urination for several prostate tissue. These cuts reduce pressure by reducing levels of the male hormone — on the urethra, making urination easier.
of urination also are possible. There may take longer to work than alpha blockers.
relief is slower with TUIP, compared with with their symptom relief from this. Also, reduce risk of acute retention (inability to retrograde ejaculation is less common and urinate) — and also reduce the need for • TUNA (transurethral radio frequency
less severe than after TURP. Risk of erectile needle ablation): This procedure also
destroys prostate tissue to improve urine • Greenlight Laser Surgery: This procedure
(finasteride) and Avodart (dutasteride).
Possible side effects: erection problems, radiowaves transmitted by needles inserted destroy prostate tissue. It is done under directly into the prostate (local anesthesia is used). The procedure does not require stay at the hospital. It provides immediate side effects are generally mild and may go painful, urgent or frequent urination for or after the first year of taking the drugs.
In general, this procedure causes lessblood loss, and side effects can includeretrograde ejaculation.
Open Prostate Surgery (Simple
Prostatectomy): When a transurethral
(which requires an incision in the abdomen) insurance plan, in advance, to make sure.
remove tissue in the prostate. Open prosta-tectomy typically is done when the prostate Schedule an Appointment
gland is greatly enlarged, when there isbladder damage, if there are bladder stones To schedule a consultation with a urologist at GW Hospital and determine if you suffer from an enlarge prostate, please call 1-888- anesthesia, and recovery can take a fewweeks to several months. Side effects aresimilar to TURP, including blood lossrequiring a transfusion, urinary inconti-nence, erection problems and retrogradeejaculation.
Although you cannot prevent the prostate
from enlarging over the course of time, you
can take measures to reduce your symptoms:
• Limit your intake of liquids in the evening, especially drinks containing alcohol andcaffeine. Cutting back helps to minimizethe number of times you have to urinateduring the night. (Also, drinking too muchalcohol may irritate the bladder or prostate.
Most experts recommend that men avoidmore than two alcoholic drinks a day.) • Ask your doctor whether you can change or eliminate medications that may beaggravating the problem. These medica-tions include antihistamines, diuretics,decongestants, antispasmodics, tranquilizersand certain types of antidepressants. Thesecan weaken the bladder muscle or narrowthe opening of the prostate. time to empty your bladder completely.
900 23rd St., NW Washington, DC 20037 (202) 715-4000www.gwhospital.com

Source: http://www.gwhospital.com/sites/gwhospital.com/files/070830_GWUH_prostate_factsheet.pdf


Pharmacy and Therapeutics Committee Decisions March 19, 2010 Drug/Therapeutic Class P&T Decision Bepreve® (bepotastine besilate ophthalmic solution) • Non-formulary Medications – Treatment of Allergic Conjunctivitis Effient® (prasugrel) – Platelet Aggregation Inhibitor • Formulary Multaq® (dronedarone) – Treatment of Arrhythmias • Non-formulary

Microsoft word - 04 declaraciÓn de lima - terrorismo, 26 abril 1996.doc

DECLARACIÓN DE LIMA PARA PREVENIR, COMBATIR Y ELIMINAR EL TERRORISMO Los Ministros de Estado y los Jefes de Delegación de los Estados miembros de la Organi-zación de los Estados Americanos (OEA), reunidos en Lima, Perú, del 23 al 26 de abril de 1996, en ocasión de la Conferencia Especializada Interamericana sobre Terrorismo, CON FUNDAMENTO en los principios y propósitos consagrados

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