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Eturauhasen hyvänlaatuinen liikakasvu
Käypä hoito -suositus |  Julkaistu: 2012-03-22   | Tila: päivityksessä  |  Aihepiiri(t): Kirurgia, Työterveyshuolto, Urologia, Yleislääketiede
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Suomalaisen Lääkäriseuran Duodecimin ja Suomen Urologiyhdistyksen asettama työryhmä
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Eturauhasen hyvänlaatuinen liikakasvu

Käypä hoito
22.3.2012
Suomalaisen Lääkäriseuran Duodecimin ja Suomen Urologiyhdistyksen asettama työryhmä

Koosteet

Potilaalle

Miten viitata Käypä hoito -suositukseen? «»1

Keskeinen sisältö

  • Useimmat potilaat voidaan tutkia ja hoitaa perusterveydenhuollossa.
  • Usein pelkkä seuranta riittää.
  • Useimmiten potilaita hoidetaan lääkkeillä: alfasalpaajilla, 5-alfareduktaasin estäjillä ja niiden yhdistelmällä.
  • Alfasalpaajat lievittävät nopeasti oireita mutteivät vaikuta liikakasvun luonnolliseen kulkuun. 5-alfareduktaasin estäjät pienentävät vähitellen eturauhasen kokoa. Lääkkeitä yhdistettäessä hoidon tulokset paranevat.
  • Jos lääkehoito ei auta tai tapaus komplisoituu, potilas lähetetään erikoissairaanhoitoon.
  • Operatiivinen hoito on tarpeen, jos lääkehoidolla ei saada riittävää hoitovastetta tai sairaus on aiheuttanut komplikaation.
  • Tavanmukainen höyläysleikkaus on vaikeiden tapausten hoidossa säilyttänyt tärkeän asemansa, mutta sen rinnalle on tullut monia vähän kajoavia hoitomenetelmiä.

Suosituksessa on linkkejä Lääkärin tietokantojen artikkeleihin. Tietokanta on maksullinen ja vaatii erilliset käyttöoikeudet.

Tavoitteet

  • Suosituksella pyritään parantamaan eturauhasen hyvänlaatuisen liikakasvun diagnostiikkaa ja luomaan yhtenäinen hoitokäytäntö.

Kohderyhmä

  • Hoitosuositus on tarkoitettu sekä perusterveydenhuoltoon että erikoissairaanhoitoon.

Epidemiologia

Diagnostiikka

Tavoitteet

  • Tavoitteena on todeta
    • tapaukset, joissa virtsaamisoireet johtuvat eturauhasen hyvänlaatuisesta liikakasvusta ja jotka voidaan hoitaa suoraan perusterveydenhoidossa
    • tapaukset, joissa potilas tarvitsee erikoissairaanhoidon tutkimuksia ja hoitoja.
  • Erikoissairaanhoidon tutkimusten tulee johtaa tarkkaan virtsaamishäiriön diagnoosiin ja oikeaan hoitoon.

Oireet

Taulukko 1. DAN-PSS-1- ja IPSS-oirepisteiden rajat vaikeusasteen määrittämisessä.
Pistemäärä Vaikeusaste
0–7 Lievä
8–19 Keskivaikea
20– Vaikea

Perustutkimukset

Täydentävät tutkimukset

Erotusdiagnostiikka

Taulukko 2. Eturauhasen hyvänlaatuisen liikakasvun erotusdiagnostiikka
Sairaus Esitieto tai löydös
Eturauhassyöpä Tuseerauslöydös, seerumin suurentunut PSA-pitoisuus
Rakkosyöpä Hematuria, poikkeava sytologinen löydös
Rakkokivet Hematuria, kaikututkimuslöydös
Virtsaputken arpiahtauma Laatikkomainen virtaamakäyrä
Rakon kaulan ahtauma Aikaisempi toimenpide
Sulkijan dyssynergia Pieni eturauhanen, haittaavat virtsaamisoireet
Eturauhastulehdus Aristava eturauhanen
Yliaktiivinen virtsarakko Virtsauspakko, johon voi liittyä pakkoinkontinenssia

Hoidon aiheet

Hoidon valinta

Konservatiivinen hoito

Seuranta

Lääkehoito

Lääkkeen valinta

Kajoava hoito

Eturauhasen sisäiset laajentimet

Lämpöhoidot

Muut hoidot

Laserhoidot

Leikkaushoidot

Katetrihoito

Seuranta ja hoidon porrastus

Laadun mittarit

  • Väestötason mittareita ovat perustutkimusten, täydentävien tutkimusten ja eri menetelmin hoidettujen potilaiden määrät, painevirtaustutkimusten ja leikkauksella hoidettujen suhde, ehdottomien aiheiden vuoksi hoidettavien osuus leikkauksella hoidettavista, odotusaika toimenpiteeseen sekä uusintatoimenpiteiden ja komplikaatioiden määrät.
  • Yksilötason mittarit: Potilas arvioi hoidon tehoa täyttämällä oirekyselylomakkeen, minkä lisäksi mitataan virtsasuihkun virtaama ja jäännösvirtsa. Edelleen seurataan virtsatulehdusten määrää, seerumin kreatiniinipitoisuutta ja komplikaatioiden kehittymistä.

Suomalaisen Lääkäriseuran Duodecimin ja Suomen Urologiyhdistyksen asettama työryhmä

Eturauhasen hyvänlaatuinen liikakasvu -suosituksen historiatiedot «Eturauhasen hyvänlaatuinen liikakasvu, Käypä hoito -suosituksen historiatiedot»10.

Puheenjohtaja:

Teuvo Tammela, professori, vastuualuejohtaja; Tampereen yliopisto ja Kirurgian vastuualue, TAYS

Jäsenet:

Martti Nurmi, dosentti, ylilääkäri (emer.); TYKS

Anssi Pétas, LT, erikoislääkäri; HYKS:n urologian klinikka

Raija Sipilä, LL, Käypä hoito -toimittaja; Suomalainen Lääkäriseura Duodecim

Kimmo Taari, professori, osastonylilääkäri; HYKS:n urologian klinikka, Helsingin yliopisto, kliininen laitos

Asiantuntija:

Ilkka Kunnamo, dosentti, yleislääketieteen erikoislääkäri; Saarijärven-Karstulan seudun terveyskeskus

Sidonnaisuudet:

Martti Nurmi: Toiminut luennoitsijana ja puheenjohtajana lääkealan yritysten järjestämässä tilaisuudessa (GlaxoSmithKline, Astellas Pharma). Osallistunut lääkealan yrityksen järjestämän koulutustilaisuuden suunnitteluun (GlaxoSmithKline). Osallistunut lääkealan yrityksen tuella ulkomaan kongressimatkoihin (GlaxoSmithKline, Janssen-Cilag). Toiminut lääkealan yrityksen asiantuntijana advisory boardin jäsenenä (GlaxoSmithKline).

Anssi Pétas: Ollut ulkomaan kongressimatkalla lääkealan yritysten rahoittamana (Sanofi-Aventis, GlaxoSmithKline, Astellas).

Raija Sipilä: Ei sidonnaisuuksia.

Kimmo Taari: Pitänyt toistuvasti luentoja lääkealan yrityksen koulutuksissa (GlaxoSmithKline). Osallistunut lääkealan yrityksen koulutusten suunnitteluun (GlaxoSmithKline). Ollut ulkomaan kongressimatkalla lääkealan yritysten rahoittamana (Sanofi-Aventis, Pfizer, Astellas). Saanut apurahan lääkealan yrityksen rahastosta (Amgen). Toiminut lääkealan yritysten asiantuntijana (Astellas, GlaxoSmithKline, Ferring, Amgen, Pfizer).

Teuvo Tammela: Osallistunut lääkealan yritysten koulutustilaisuuksien suunnitteluun (GSK, Janssen, Astellas). Osallistunut ulkomaiseen kongressiin (Amgen). Antanut asiantuntija-apua lääkealan yrityksille (GSK, Amgen, Astellas, Pfizer, Orion).

Kirjallisuusviite

Eturauhasen hyvänlaatuinen liikakasvu (online). Suomalaisen Lääkäriseuran Duodecimin ja Suomen Urologiyhdistyksen asettama työryhmä. Helsinki: Suomalainen Lääkäriseura Duodecim, 2012 (viitattu pp.kk.vvvv). Saatavilla internetissä: www.kaypahoito.fi

Tarkemmat viittausohjeet: «http://www.kaypahoito.fi/web/kh/viittaaminen»1

Vastuun rajaus

Käypä hoito -suositukset ovat parhaiden asiantuntijoiden laatimia yhteenvetoja yksittäisten sairauksien diagnostiikan ja hoidon vaikuttavuudesta. Ne eivät korvaa lääkärin tai muun terveydenhuollon ammattilaisen omaa arviota yksittäisen potilaan parhaasta mahdollisesta diagnostiikasta ja hoidosta hoitopäätöksiä tehtäessä.

Tiedonhakukäytäntö

Systemaattinen kirjallisuushaku on hoitosuosituksen perusta. Lue lisää artikkelista khk00007

Kirjallisuutta

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