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Cost Effectiveness / Yield / Medical Economics
 
Try Non Pharmacological Treatment in all Prostate (BPH) Patients Before Starting Drugs
O P Kapoor
 

Remember, most symptoms of enlarged prostate i.e. lower urinary tract symptoms, are due to BOO (bladder outlet obstruction). Thus these are functional symptoms and can be looked after by training the bladder and pelvic floor. A patient of BPH can be given the following advice:

  1. Patient must contract the pelvic floor as often as possible during the day. This is done by putting pressure and contracting and elevating the perineum.
  2. Urine should be passed at regular intervals.
  3. Double evacuation of the bladder must be done i.e. after finishing to pass urine, the patient must wait for a few seconds, upto a minute and once again pass urine.
  4. Milking of the urethra (penis) must be done at the end of the procedure to remove left over urine in the long male urethra.
 

POST-THROMBOLYSIS ROUTINE ANGIOPLASTY

Early post-thrombolysis routine angioplasty is discouraged in patients with ST-segment elevated myocardial infarction (STEMI) because of a high incidence of events. The GRACIA-1 trial was designed to reassess the benefits of this approach in the era of stents and new antiplatelet agents. Francisco Fernandez-Aviles and colleagues did a randomised controlled trial in 500 patients with thrombolysed STEMI who were randomly assigned to angiography and intervention, or to an ischaemia-guided conservative approach. Early post-thrombolysis catheterisation and intervention was safe and reduced the combined rate of death, reinfarction, and revascularisation at 1 year. In a comment paper, Freek WA Verheugt suggests that an approach such as lyse now, stent later might be more helpful in reducing longterm mortality than an immediate approach.

BMJ, 2004: 1014, 1045.