Tulosta

Eturauhasen hyvänlaatuinen liikakasvu

Käypä hoito
7.11.2018
Suomalaisen Lääkäriseuran Duodecimin ja Suomen Urologiyhdistyksen asettama työryhmä

Opi ja ota käyttöön

Koosteet

Muut suositukset

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 näiden 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 ovat tulleet myös laserhoidot

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 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
0–9 Lievä
10–19 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

Virtsarakon yliaktiivisuusoireiden lääkehoito

Kajoava hoito

  • Ks. hoitokaavio kajoavista hoitovaihtoehdoista «»2.

Muut hoidot

Laserhoidot

Leikkaushoidot

Katetrihoito

Seuranta ja hoidon porrastus

Laadun mittarit

  • Väestötason mittareita ovat perustutkimusten, täydentävien tutkimusten ja eri menetelmin hoidettujen potilaiden määrät, 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 virtsatietulehdusten 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»12

Puheenjohtaja:

Teuvo Tammela, professori, vastuualuejohtaja; Tampereen yliopisto ja TAYS:n kirurgian vastuualue

Jäsenet:

Pekka Kinnala, LT, apulaisylilääkäri; TYKS:n urologian klinikka

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

Hanna Ronkainen, LT, apulaisylilääkäri; OYS Operatiivinen tulosalue, pehmytkudoskirurgia, urologian yksikkö

Raija Sipilä, LT, Terveydenhuollon erikoislääkäri; Suomalainen Lääkäriseura Duodecim, Käypä hoito -toimittaja

Kimmo Taari, dosentti, osastonylilääkäri; HYKS:n urologian klinikka, Helsingin yliopiston kliininen laitos

Sidonnaisuudet:

Pekka Kinnala: Ei aiheeseen liittyviä sidonnaisuuksia

Anssi Pétas: Ei aiheeseen liittyviä sidonnaisuuksia

Hanna Ronkainen: Tutkimusrahoitus: Medivation Inc, Aragon, Astellas, Bayer, MSD. Korvaukset koulutus- ja kongressikuluista: Sanofi, Astellas, Ferring, Orion. Luento-, koulutus- ja asiantuntijapalkkiot: Janssen, Astellas, Bayer

Raija Sipilä: Ei aiheeseen liittyviä sidonnaisuuksia

Kimmo Taari: Tutkimusrahoitus: Aragon, Astellas, Medivation, Orion, Pfizer. Luottamustoimet: Suomen urologiyhdistyksen varapuheenjohtaja, Urologisen tutkimussäätiön hallituksen jäsen, Potilasvahinkolautakunta varajäsen, Suomen lääkäriliiton palliatiivisen lääketieteen erityispätevyystoimikunnan jäsen

Teuvo Tammela: Sivutoimet: kirurgian vastuualueen johtaja TAYS, urologian ylilääkäri TAYS. Tutkimusrahoitus: Suomen Syöpäsäätiö, Suomen Akatemia, Sigrid Juseliuksen Säätiö ja kilpailutettava VTR (valtion tutkimusrahoitus), Astellas, Janssen-Cilag, Bayer, Orion, Lidds Ab, Ferring. Asiantuntijapalkkiot: Janssen-Cilag, Bayer. Luottamustoimet: Urologisen tutkimussäätiön hallituksen jäsen

Kirjallisuusviite

Eturauhasen hyvänlaatuinen liikakasvu. Käypä hoito -suositus. Suomalaisen Lääkäriseuran Duodecimin ja Suomen Urologiyhdistyksen asettama työryhmä. Helsinki: Suomalainen Lääkäriseura Duodecim, 2018 (viitattu pp.kk.vvvv). Saatavilla internetissä: www.kaypahoito.fi

Tarkemmat viittausohjeet: «http://www.kaypahoito.fi/web/kh/viittaaminen»3

Vastuun rajaus

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

Tiedonhakukäytäntö

Systemaattinen kirjallisuushaku on hoitosuosituksen perusta. Lue lisää artikkelista khk00007

Kirjallisuutta

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