180例离退休干部下尿路症状与尿流率的相关性探讨

Objective To explore the correlation between lower urinary tract symptoms (LUTS) with prostate volume and peak flow rate in aging staff men with benign prostatic hyperplasia (BPH). Methods A total of 180 elderly patients were randomly enrolled. They were diagnosed with BPH by rectal touch and transected ultrasound from April 2008 to December 2008. The international prostate symptom score (IPSS), prostate volume (PV) as well as peak flow rate (QMAX)were analyzed respectively. Results IPSS were ( 9. 1 ± 0. 7 ) scores, ( 12. 1 ± 0. 7 ) scores and (14.0±1.3) scores in 60-69 years old group, 70-79 years old group and more than 80 years old group. PV were (40. 6±1.9) ml, (42. 4±1.9) ml and (48. 7±2.8) ml in corresponding groups, and PV was elevated along with aging (F= 5. 705, 2. 983, P＜0. 05). QMAX were ( 14.7 ± 0. 6) ml/s,(14.0±0. 5) ml/s and (12.6±0.9) ml/s, and QMAX was decreased along with aging (F=2. 131, P＞0. 05). Along with aggravation of LUTS, PV (ml) increased (39. 2±18. 1 vs. 45.7±16.9 vs. 47. 9± 16. 5) and QMAX (ml/s) decreased ( 15.0 ± 4.8 vs. 13. 5 ± 5.06 vs. 11.5 ± 4. 7, F= 3. 427, 4. 742, P ＜0.05). Conclusions The LUTS of patients with BPH is aggravated with aging, at the same time, the degree of LUTS increases with PV and decreases with QMAX. If get active treatment of drugs if available, they may improve their quality of life.     

Increasing dietary fiber intake in terms of kiwifruit improves constipation in Chinese patients

AIM To investigate if increased dietary fiber, in terms of kiwifruit, is effective in Chinese constipated patients.METHODS 33 constipated patients and 20 healthy volunteers were recruited for a 4-wk treatment of kiwi fruit twice daily. Response during wk 1-4 was defined as an increase in complete spontaneous bowl, motion (CSBM)≥ 1/wk. Secondary efficacy included response during wk 1-4, individual symptoms and scores of bowel habits and constipation. Responses were compared with the baseline run-in period. Colonic transit time and anorectal manometry were performed before and after treatment.RESULTS Responder rate was 54.5% in the constipated group. The mean CSBM increased after treatment (2.2 ± 2.6 vs 4.4 ± 4.6, P = 0.013). There was also improvement in the scores for bothersomeness of constipation (P = 0.02), and satisfaction of bowel habit (P = 0.001), and decreased in days of laxative used (P =0.003). There was also improvement in transit time (P =0.003) and rectal sensation (P ＜ 0.05). However, there was no change in the bowel symptoms or anorectal physiology in the healthy subjects.CONCLUSION Increasing dietary fiber intake is effective in relieving chronic constipation in Chinese population.     

老年人良性前列腺增生症与胰岛素抵抗

Objective To explore the relationship between insulin resistance (IR) and benign prostatic hyperplasia (BPH) in elderly men. Methods All BPH outpatients in Geriatric department of the second Xiang Ya Hospital in Feb 2008 were recruited in this study. Bioche assays including insulin (FINS), prostate specific antigen (PSA), HbAlc, fasting plasma glucose, 2 hours postprandial blood glucose were performed and HOMA-IR were calculated. The blood pressure, body weight, height and waist circumference were measured, and the body mass index (BMI) was calculated. Prostate volume (PV) was measured by abdominal ultrasound, lower urinary tract symptoms (LUTS) was evaluated by International Prostate Symptom Score (IPSS) and inquired about the history of LUTS in detail. Results (1) HOMA-IR＞ 2.8 was diagnosed as insulin resistance (IR). The patients were divided into two groups: insulin sensitivity (IS) group (n=48) and IR group (n=20). The PV level was higher in IR group than in IS group [(61.1-32. 9) ml vs. (40.4±16.5)ml, P＜0. 05], there were no statistical differences in PSA [(3.3±2.3) μg/L vs. (2.91±1.3) μg/L, P＞0.05], the history of LUTS [(13.4±6.6)years vs. (8.7±6.0)years, P＞0.05], IPSS [(16.42±6.67)scores vs. (13. 29±7.09)scores, P＞0. 05] between the two groups. (2)According to BPH progressivity evaluation provided by MTOPS study (age≥62 years, PSA≥1. 6 μg/L, PV≥31 ml), the patients were divided into two groups: low progressive risk group (n= 30) and high progressive risk group (n= 38). The FINS and HOMA-IR levels were significantly higher in highprogressive risk group than in low progressive risk group (all P＜0. 01). (3)The PV was positively correlated with HOMA-IR level and FINS level (r= 0. 431, 0. 492, P＜0. 01). Conclusions IR exists in majority of elderly BPH patients, the degree of IR and relative high level of FINS are related to the enlargement of PV and the development of BPH.     

广州地区老年科良性前列腺增生的诊断治疗现状

Objective To evaluate the diagnostic and therapeutic status of lower urinary tract symptoms (LUTS) in the elderly outpatients with benign prostatic hyperplasia (BPH) in Guangzhou.Methods The investigation was conducted in outpatient departments for elderly patients in 3 hospitals of Guangzhou. The eligible male patients with LUTS/BPH were chosen from patients who came to the clinic in the process of investigation. Results The 29.7% (1824/6140) of them had history of LUTS/BPH previously or presently. In 134 patients received medical questionnaire, the proportion of LUTS/BPH patients with mild, middle and severe degree based on international prostate symptom score (IPSS) was 24.5%, 72.5% and 3.0% respectively. The abnormal percentage of PSA was 37. 3 %. The most common examinations that patients received were directeral rectun examination (96.8%), PSA (88. 7%) and transabdominal ultrasonography (84.8%). The 44.7% of cases were given the treatment of 5α-reductase inhibitor, and 24.7% of cases received a combination therapy of 5α-reductase inhibitor plus α receptor blocker. The 16.7% of cases were given a combination treatment of 5α-reductase inhibitor plus herbs. The proportion of therapy with α receptor blocker and herbs was similar (6.8% and 7.1% respectively). Conclusions LUTS/BPH is one of the most common diseases in elderly male patients. The examinations conducted by doctors are unreasonable.The doctors are easy to ignore inquirement of patient's history and IPSS. The drugs conducted by doctors are reasonable basically.     

Salvage irrigation-suction in gracilis muscle repair of complex rectovaginal and rectourethral fistulas

AIM:To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas(RVFs)and rectourethral fistulas(RUFs).METHODS:Between May 2009 and March 2012,11female patients with complex RVFs and 8 male patients with RUFs were prospectively enrolled.Gracilis muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early leakage.Efficacy was assessed in terms of the success rate and surgical complications.SF-36 quality of life(QOL)scores and Wexner fecal incontinence scores were compared before and after surgery.RESULTS:The fistulas healed in 14 patients after gracilis muscle transposition;the initial healing rate was73.7%.Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5patients:4 healed and 1 failed,and postoperative fecal diversions were performed for the patient whose treatment failed.At a median follow-up of 17 mo,the overall healing rate was 94.7%.Postoperative complications occurred in 4 cases.Significant improvement was observed in the quality outcomes framework scores(P<0.001)and Wexner fecal incontinence scores(P=0.002)after the successful healing of complex RVFs or RUFs.There was no significant difference in SF-36 QOL scores between the initial healing group and irrigationsuction-assisted healing group.CONCLUSION:Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and RUFs.QOL and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.     

厄贝沙坦与美托洛尔的联合方案对男性高血压患者性功能的影响

目的 探讨非洛地平联合厄贝沙坦或美托洛尔两种降压方案对男性高血压病患者性功能的影响.方法 123例高血压病患者随机分为两组:非洛地平(5 mg/d)+厄贝沙坦(150 mg/d)组(F+I组,64例);非洛地平(5 mg/d)+琥珀酸美托洛尔(47.5 mg/d)组(F+M组,59例).监测患者血压变化;治疗第0、24周用国际男性性功能问卷(IIEF)评价患者的性功能,同时用放射性免疫法测血清睾酮和性激素结合蛋白、硫代巴比妥酸法测丙二醛、ELISA 法测8-羟基脱氧鸟苷和4-羟基壬烯酸.结果 F+I组治疗后性欲积分值增高(P<0.05),轻度勃起功能障碍患者的勃起功能评分增加;勃起功能障碍患者8-羟基脱氧鸟苷治疗前、后分别为(146.02±60.54)ng/L比 (139.89±62.03)ng/L,丙二醛治疗前、后分别为(6.59±1.75)μmol/L比(6.01±1.65)μmol/L,治疗前后比较差异有统计学意义(P<0.05).两组治疗前后血压达标率、有效率、勃起功能障碍的发生率、睾酮、性激素结合蛋白、4-羟基壬烯酸差异均无统计学意义(P>0.05).结论 相对于F+M组,F+I组可能更有益于男性高血压病患者性功能,但这种获益是否与该组治疗后患者氧化应激状态的改变有关,尚待进一步的研究.

Abstract：

Objective To compare the effects of felodipine combined irbesartan regimen with that of felodipine combined metoprolol regimen on the sexual function in male hypertensive patients. Method One handred and twenty-three male hypertensive paitients (age 25 to 60) were randomly assigned to felodipine (5 mg/d) plus irbesartan ( 150 mg/d, n=64) group and felodipine (5 mg/d) plus metoprolol (47.5 mg/d, n=59) group. Dosage of felodipine were doubled after 4 weeks if the blood pressure were ≥140/ 90 mm Hg (1 mm Hg=0.133 kPa). At the baseline and post 24th week treatment, sexual function of patients was assessed by the International Index of Erectile Function (IIEF) Questionaire. Serum testosterone (T), sex hormone binding globulin (SHBG), 4-hydroxynonenal (HNE), 8-hydroxy-2′-deoxyguanosine (8-OHdG) and Malonaldehyde (MDA) were measured by Radioimmunoassay (RIA), ELISA and TBA respectively. Results Total prevalence of erectile dysfunction (ED),T, SHBG and HNE were similar between pre- and post-treatment in two groups (P>0.05). On the other hand, the scores of the mild ED and sexual desire (SD) were improved and both serum 8-OHdG and MDA in patients with ED decreased [(146.02±60.54)ng/L vs. (139.89±62.03)ng/L, P=0.048 and (6.59±1.75)μmol/L vs. (5.51±1.65)μmol/L,P=0.039] in Felodipine plus Irbesartan group. Conclusion The results suggested that Felodipine + Irbesartan regimen may be superior to Felodipine + metoprolol regimen for male hypertensive patients with mild ED.     

阿仑磷酸钠治疗早期成年非创伤性股骨头坏死的临床观察

目的 探讨阿仑磷酸钠治疗早期成年非创伤性股骨头坏死的临床效果.方法 选择非创伤性股骨头坏死患者83例,给予阿仑磷酸钠70 mg口服,采用髋关节Harrjs评分标准进行治疗前和治疗后的评价.结果 ARCOⅠ型患者治疗前后比较,疼痛评分分别为(38.48±5.55)分对(41.45±3.55)分(t=3.70),功能评分分别为(43.97±2.31)分对(45.06±1.50)分(t=3.76),差异均有统计学意义(均P=0.001);ARCOⅡ型患者治疗前后疼痛[(37.32±6.65)分对(40.40±4.31)分,t=4.06,P=0.00]、功能[(41.66±3.35)对(42.90±2.70),t=3.15,P=0.003]及活动度[(4.42±0.70)分对(4.76±0.47)分,t=3.35,P=0.002]评分比较,治疗后均明显优于治疗前,差异有统计学意义.结论 阿仑膦酸钠能有效治疗早期非创伤性股骨头坏死,特别是ARCOⅡ型,但对其远期效果有待进一步研究.

Abstract：

Objective To evaluate the influence of the alendronate treatment in early-stage adult nontraumatic avascular necrosis of femoral head. Methods The 83 patients with nontraumatic avascular necrosis of femoral head were enrolled in this study. They were given oral alendronate 70 mg weekly, and evaluated with Harris criteria before and after treatment. Results In the patients with ARCO Ⅰ necrosis, the scores of pain and function were higher after treatment than before [(41.45±3.55) scores vs. (38. 48± 5.55) scores, t = 3. 70, P = 0. 001; (45.06 ± 1.50) scores vs. (43.97 ±2.31) scores, t= 3.76, P= 0. 001]. In the patients with ARCO Ⅱ necrosis, the scores of pain,function and activity were also higher after treatment than before [(40. 40±4.31 ) scores vs. (37.32±6. 65) scores, t=4.06, P=0.00; (42.90±2.70) scores vs. (41.66±3.35) scores, t=3.15, P=0.003; (4.76±0.47) scores vs. (4.42±0.70) scores, t=3.35, P=0.002]. Conclusions Alendronate is effective in treatment of early-stage adult nontraumatic avascular necrosis of femoral head, in particular for ARCO Ⅱ patients. But its long-term effect is worth researching in future.     

Irsogladine maleate and rabeprazole in non-erosive reflux disease: A double-blind,placebo-controlled study

AIM:To evaluate the efficacy of adding irsogladine maleate(IM) to proton-pump inhibitor(PPI) therapy in non-erosive reflux disease(NERD) treatment.METHODS:One hundred patients with NERD were recruited and randomized to receive rabeprazole plus IM(group I) or rabeprazole plus placebo(group P).The efficacy of the treatment was assessed using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease(FSSG) and the short form(SF)-36 quality of life questionnaires after four weeks of treatment.We also assessed whether patients with NERD with minimal changes(grade M) had different responses to the therapies compared with patients who did not have minimal changes(grade N).RESULTS:Group I and group P showed significant improvements in their FSSG scores after the treatment(from 17.9 ± 7.9 to 9.0 ± 7.6, and from 17.7 ± 7.3 to 11.2 ± 7.9, respectively, P = 0.0001), but there was no statistically significant difference between the FSSG scores in group I and those in group P.Subgroup analysis showed that significant improvements in the FSSG scores occurred in the patients in group I who had NERD grade N(modified Los Angeles classification)(7.8 ± 7.4 vs 12.5 ± 9.8, P = 0.041).The SF-36 scores for patients with NERD grade N who had received IM and rabeprazole were significantly improved in relation to their vitality and mental health scores.CONCLUSION:The addition of IM to rabeprazole significantly improves gastroesophageal reflux diseasesymptoms and the quality of the lives of patients with NERD grade N.     

动脉溶栓辅助支架置入术治疗急性脑梗死

Objective To investigate the efficacy of intra-arterial thrombolysis with stenting for acute cerebral infarction. Methods Using a prospective case-control design, 24 patients with acute cerebral infarction who remained angiostegnosis ( ＞ 50%) after intra-arterial thrombolysis were randomly divided into stent treatment group and drug treatment group. They were treated with stenting + drug treatment and conventional drug treatment. The rates of vascular complete revascularization and residual stenosis, and the modified Rankin scale scores at 3 months in both groups were evaluated. Results The rate of complete revascularization in the stent treatment group was significantly higher than that in the drug treatment group (54. 5% vs.0%,χ2 =6.382, P ＜0. 001), and the rate of residual stenosis was significantly lower than that in the drug treatment group ([4.5 ±5.2]% vs. [82. 5 ±10. 5]%, t =7.464, P＜0.001). The rate of favorable clinical outcome in the stent treatment group was significantly higher than that in the drug treatment group (100% vs. 76. 9%,χ2 = 14. 263, P = 0.038). Conclusion The efficacy of intra-arterial thrombolysis with stenting in the treatment of acute cerebral infarction is superior to that in the drug treatment group, and it is safer.     

Inhibition of gastric perception of mild distention by omeprazole in volunteers

AIM:To evaluate the effects of omeprazole on gastric mechanosensitivity in humans. METHODS:A double lumen polyvinyl tube with a plastic bag was introduced into the stomach of healthy volunteers under fluorography and connected to a barostat device. Subjects were then positioned so they were sitting comfortably, and the minimal distending pressure (MDP) was determined after a 30-min adaptation period. Isobaric distensions were performed in stepwise increments of 2 mmHg (2 min each) starting from the MDP. Subjects were instructed to score feel-ings at the end of every step using a graphic rating scale:0, no perception; 1, weak/vague; 2, weak but significant; 3, moderate/vague; 4, moderate but signifi-cant; 5, severe discomfort; and 6, unbearable pain. After this first test, subjects received omeprazole (20 mg, after dinner) once daily for 1 wk. A second test was performed on the last day of treatment. RESULTS:No adverse effects were observed. Mean MDP before and after treatment was 6.3 ± 0.3 mmHg and 6.2 ± 0.5 mmHg, respectively. One subject before and 2 after treatment did not reach a score of 6 at the maximum bag volume of 750 mL. After omeprazole, there was a significant increase in the distension pres-sure required to reach scores of 1 (P = 0.019) and 2 (P = 0.017) as compared to baseline. There were no changes in pressure required to reach the other scores after treatment. Two subjects before and one after omeprazole rated their abdominal feeling 1 at MDP, and mean (± SE) abdominal discomfort scores at MDP were 0.13 ± 0.09 and 0.04 ± 0.04, respectively. Mean scores induced by each MDP + 2, 4, 6, 8, 10, 12, 14, 16, 18 and 20 (mmHg) were 1.1 ± 0.3, 2.0 ± 0.4, 2.9 ± 0.5, 3.3 ± 0.4, 4.6 ± 0.3, 5.2 ± 0.3, 5.5 ± 0.2, 5.5 ± 0.3, 5.7 ± 0.3, and 5.4, respectively. After omepra-zole, abdominal feeling scores for the same incremental pressures over MDP were 0.3 ± 0.1, 0.8 ± 0.1, 2.0 ± 0.4, 2.8 ± 0.4, 3.8 ± 0.4, 4.6 ± 0.4, 4.9 ± 0.3, 5.4 ± 0.4, 5.2 ± 0.6, and 5.0 ± 1.0, respectively. A signif- icant decrease in feeling score was observed at intrabag pressures of MDP + 2 mmHg (P = 0.028) and + 4 mmHg (P = 0.013), respectively, after omeprazole. No significant score changes were observed at pres-sures ≥ MDP + 6 mmHg. CONCLUSION:Although the precise mechanisms are undetermined, the present study demonstrated that omeprazole decreases mechanosensitivity to mild gastric distension.     

辛伐他汀对代谢综合征并良性前列腺增生患者下尿路症状的影响

目的 观察辛伐他汀对代谢综合征(MS)并存良性前列腺增生症(BPH)患者的下尿路症状(LUTS)影响.方法 2011年2-6月我科门诊和住院患者中MS并存BPH继发LUTS患者共30例,检查并记录国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(MFR)、前列腺体积、肝肾功能、尿常规后,随机分为两组:联合用药组给予辛伐他汀40 mg和坦索罗辛0.2 mg口服,每晚1次;单药组给予坦索罗辛0.2 mg口服,每晚1次,治疗8周后复诊,复查上述指标,对治疗的有效性和安全性进行评价.结果 联合用药组和单药组IPSS、QOL、和MFR与治疗前比较,差异均有统计学意义,前列腺体积差异无统计学意义.联合用药组治疗后IPSS评分变化值为(6.4±4.4)分,单药组为(4.2±3.3)分,两组比较差异有统计学意义(P＜0.05),联合用药组症状改善优于单药组.两组均无不良事件发生.结论 辛伐他汀对MS并存BPH患者的LUTS有改善作用,联合用药组耐受性良好,未出现明显不良事件.     

The Effect of Tamsulosin Treatment on Erectile Functions in Patients with Lower Urinary Tract Symptoms (LUTS) due to Benign Prostate Hyperplasia: Correlation between Improvement of LUTS and Erectile Function

Objectives: To evaluate the impact of tamsulosin treatment on erectile function in patients with lower urinary tract symptoms (LUTS). Methods: Seventy‐five patients with LUTS received tamsulosin 0.2 mg once daily for 3 months. Subjective efficacy was assessed by International Prostatic Symptom Score (IPSS) for LUTS and International Index for Erectile Function 5 (IIEF5) for erectile dysfunction (ED). Objective efficacy was assessed by prostate volume and urine flow rate. All measurements were performed at baseline and month 3. On the basis of IPSS ratio (month 3/baseline), the patients were classified into good responders (≤0.75) and poor responders (>0.75). Good responders to ED were defined as the patients who improved IIEF5 score 3 or more. Results: Seventy‐four subjects completed the study. IPSS score showed significant improvement, but IIEF5 score showed no significant change. Forty‐three patients (58%) were classified into good responders to LUTS. The baseline score of IIEF5 in the good responders was significantly higher than that in the poor responders. Negative correlation was recognized between IPSS ratio and baseline score of IIEF5. Nine patients (13%) were able to classify into good responders to ED, who had significantly smaller prostate volume and showed significantly lower IPSS ratio. Conclusions: The tamsulosin therapy for LUTS patients showed a significant improvement of LUTS, but no significant change of erectile functions. The better response to LUTS was seen in the milder ED patient. Tamsulosin therapy may be effective not only on LUTS but also on ED in the patients who have small prostate.     

180例离退休干部下尿路症状与尿流率的相关性探讨

目的 探讨离退休干部良性前列腺增生(BPH)患者下尿路症状(LUTS)与前列腺体积(PV)、最大尿流率(QMAX)的关系. 方法 随机选取180例经直肠指诊及经直肠前列腺超声(TRUS)确诊的离退休干部BPH患者,计算其国际前列腺症状评分(IPSS),记录PV及QMAX值,分析其相关性. 结果 (1)60～69岁、70～79岁、≥80岁3组离退休干部BPH患者IPSS评分分别为(9.1±0.7)分、(12.1±0.7)分、(14.0±1.3)分,PV分别为(40.6±1.9)ml、(42.4±1.9)ml、(48.7±2.8)ml,随年龄增加而增加(F值分别为5.705,2.983,P＜0.05).QMAX分别为(14.7±0.6)ml/s、(14.0±0.5)ml/s、(12.6±0.9)ml/s,随年龄增加而降低,但差异无统计学意义(F=2.131,P＞0.05),组间分析,60～69岁组与≥80岁组间差异有统计学意义(P=0.048).(2)随着LUTS加重,在IPSS评分＜7分、8～17分、＞20分组中,PV增加[分别为(39.2±18.1)ml、(45.7±16.9)ml、(47.9±16.5)ml],QMAX下降[(15.0±4.8)ml/s、(13.5±5.0)ml/s、(11.5±4.7)ml/s](F值分别为3.427,4.742,P＜0.05). 结论 离退休干部BPH患者LUTS不仅随年龄增加而加重,而且其严重程度随PV增加,随QMAX下降.对于PV增大的老年患者积极给予缩小体积的药物治疗有可能改善LUTS.     

Nocturia Potentially Influences Maintenance of Sexual Function in Elderly Men with Benign Prostatic Hyperplasia

Objective: This study examined the relationship between bothersome symptoms of nocturia and erectile function. Methods: Subjects comprised patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Patients were prospectively followed on treatment with the alpha‐1 blocker naftopidil for 8 weeks. Patient backgrounds and efficacy of naftopidil associated with LUTS and sexual activity were evaluated. Results: The percentage of patients who identified nocturia as the most bothersome symptom was 30.2% (n = 135), representing the highest percentage among International Prostate Symptom Score (IPSS) items. The number of patients with nocturia as the most bothersome symptom plateaued at an IPSS for nocturia of two or three points. In contrast, the number of patients with slow stream as the most bothersome symptom increased with symptom severity according to IPSS for slow stream. Logistic regression analysis on association between nocturia and erectile function confirmed that the odds ratio was 1.41 (P < 0.05). Naftopidil showed excellent efficacy related to male LUTS, but International Index of Erectile Function 5 (IIEF5) total score was almost unchanged. Among patients with nocturia improved by naftopidil, IIEF5 total score was significantly changed in the group with IPSS nocturia score ≤1 as compared to the group with IPSS nocturia score ≥2 per night (P = 0.038). Conclusion: Nocturia the most bothersome symptom correlated with aging. Nocturia could associate erectile dysfunction, and keeping the frequency of nocturia at ≤1 episode might be meaningful for maintaining quality of life in elderly men.     

Impact of alfuzosin on sexual function in Taiwanese men with benign prostatic hyperplasia

To assess the effect of alfuzosin (XATRAL) 10 mg once daily on sexual function in men with moderate to severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), patients with suggestive symptomatic BPH, an International Prostate Symptom Score (IPSS) >8 (range of scores, 0-35), and sexual attempts at least once per month were enrolled. All patients received alfuzosin 10 mg once daily for 24 weeks and were asked to complete the IPSS test and Male Sexual Health Questionnaire at weeks 0 (baseline), 1, 4, 12, and 24. Other assessments included the International Index of Erectile Function-five-item version (range of scores: 5-25), as well as onset of action and peak urinary flow rate (Q(max)). From September 2006 to May 2008, 279 patients were enrolled from nine centers in Taiwan. At 24 weeks, alfuzosin effectively improved LUTS and quality of life, as demonstrated by a reduction in the IPSS total score (17.3 vs. 9.9, p < 0.001) and the IPSS bother score (3.8 vs. 2.5, p < 0.001). The majority (85%) of patients perceived an improvement of urinary symptoms within 1 month of administration. In patients with an International Index of Erectile Function-five-item version score of ≤16, alfuzosin significantly improved erectile disorder and satisfaction subscores at each time point (p ≤ 0.02). Prolonged-release alfuzosin effectively improved LUTS, quality of life, erectile function, and sexual satisfaction in men with BPH and mild to severe erectile dysfunction. Alfuzosin is an effective treatment option for the management of patients with BPH/LUTS and concomitant sexual dysfunction.     

老年人良性前列腺增生症与胰岛素抵抗

目的 观察胰岛素抵抗和空腹胰岛素(FINS)水平与老年良性前列腺增生(BPH)的关系. 方法 以2008年2月在湘雅二医院老年病科门诊就诊的BPH患者68例为观察对象,分析FINS、血清前列腺特异性抗原(PSA)、糖化血红蛋白、空腹血糖、餐后2 h血糖,计算胰岛素抵抗指数(HOMA-IR).测量血压、体质量、身高、腹围,计算体质指数.测定前列腺体积,评估下尿路症状(LUTS),并询问LUTS出现的时间. 结果 (1)按照HOMA-IR＞2.8为胰岛素抵抗,将患者分为敏感组48例和抗组20例,结果显示抵抗组患者的前列腺体积高于敏感组,分别为(61.1±32.9)ml和(40.4±16.5)ml,差异有统计学意义(P＜0.05);两组PSA分别为(3.3±2.3)μg/L与(2.9±1.3)μg/L,差异无统计学意义(P＞0.05);LUTS出现时间(13.4±6.6)年和(8.7±6.0)年,差异无统计学意义(P＞0.05);国际前列腺症状评分(IPSS)分别为(16.4±6.7)分和(13.3±7.1)分,差异无统计学意义(P＞0.05).(2)以前列腺症状药物治疗(MTOPS)研究的进展性评价指标为标准,将患者分为低进展组与高进展组,分别为30例和38例,两组FINS、HOMA-IR比较,差异有统计学意义(均P＜0.01).(3)前列腺体积与HOMA-IR、FINS呈正相关(r值分别为0.431和0.492,均P＜0.01).结论老年BPH患者存在胰岛素抵抗,胰岛素抵抗程度、高FINS水平与前列腺体积的增大及疾病进展有关.     

长期应用非那雄胺治疗良性前列腺增生临床疗效分析

目的 探讨长期应用非那雄胺治疗良性前列腺增生(BPH)的临床疗效及安全性.方法 观察患有BPH并坚持服用非那雄胺5 mg/d治疗7年以上的患者并分析其临床资料.结果 患者治疗前后前列腺体积分别为(48.0±12.5)ml和(41.0±8.4) ml,治疗后前列腺体积明显缩小(t=2.04,P＜0.05).血清前列腺特异抗原(PSA)治疗前后分别为(3.8±1.5)μg/L和(1.5±1.1)μg/L,差异有统计学意义(t=5.30,P＜0.05),治疗后2倍PSA值为(2.9±2.2)μg/L,较治疗前差异无统计学意义(t=1.38,P＞0.05).国际前列腺症状评分(IPSS)治疗后有显著改善[(21.1±7.0)分与(17.1±4.5)分,t=2.09,P＜0.05].治疗期间1例患者发生急性尿潴留,1例患者出现肉眼血尿,未见其他不良反应.结论 长期应用非那雄胺治疗良性BPH疗效好,不良反应小,值得临床推广.     

Tadalafil 5 mg Once Daily Improves Lower Urinary Tract Symptoms and Erectile Dysfunction: A Systematic Review and Meta‐analysis

Objectives

We carried out a systematic review and meta‐analysis to assess tadalafil 5 mg once‐daily for the treatment of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED).

Methods

A literature review was performed to identify all published randomized double‐blind, placebo‐controlled trials of tadalafil 5 mg once‐daily for the treatment of LUTS and ED. The search included the following databases: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated.

Results

Thirteen publications involving a total of 3973 patients were used in the analysis, including 13 RCTs that compared tadalafil 5 mg once‐daily with placebo. We found that tadalafil 5 mg once‐daily was effective in improving LUTS suggestive of BPH and treating ED over 12 weeks in our meta‐analysis. Total International Prostate Symptom Score (IPSS) (SMD = ? 2.02, 95% CI = ? 2.52 to ?1.53, P < 0.00001); Benign Prostatic Hyperplasia Impact Index (BPH‐II) (SMD = ?0.58, 95% CI = ?0.84 to ?0.33, P < 0.00001); International Index of Erectile Function‐erectile function (IIEF) domain (standardized mean difference [SMD] = 5.18, 95% confidence interval [CI] = 4.13–6.23, P < 0.00001) indicated that tadalafil 5 mg once‐daily was more effective than the placebo. Safety assessments included discontinuations due to adverse event (odds ratio (OR) = 1.79, 95% CI = 1.12–2.85, P = 0.01) indicated that tadalafil 5 mg once‐daily was well tolerated.

Conclusions

This meta‐analysis indicates that tadalafil 5 mg once‐daily to be an effective treatment for LUTS and ED with a low occurrence of side effects.     

琥珀酸索利那新治疗良性前列腺增生术后膀胱过度活动症的临床疗效观察

目的 探讨琥珀酸索利那新治疗良性前列腺增生(BPH)术后并发膀胱过度活动症(OAB)的临床疗效和安全性.方法 115例接受BPH手术的患者中,治疗组(n=58)术后第4d睡前口服索利那新治疗20 d,对照组(n=57)术后服用莨菪碱片,观察患者在拔出导尿管前后排尿情况,并以尿动力学检查、国际前列腺症状评分(IPSS)和膀胱过度活动症评分(OABSS)评价患者排尿情况.结果 治疗组IPSS评分由28.3分下降到11.3分,OABSS评分由(14.2±1.2)分下降到(2.9±0.7)分(P＜0.01).对照组IPSS评分由27.3分下降到11.8分(P＜0.01),OABSS评分由(14.2±1.6)分下降到(11.3±1.1)分,治疗前后差异无统计学意义(P＞0.05).结论 BPH术后正确地使用索利那新,能缓解膀胱过度活动给患者带来的痛苦症状,有利于患者的术后康复.     

良性前列腺增生患者长期联合药物治疗的临床观察

目的 观察非那雄胺联合特拉唑嗪治疗老年良性前列腺增生(BPH)的疗效.方法 对2002年6月到2010年12月我院53例老年BPH患者,连续服用非那雄胺(5 mg/d)和特拉唑嗪(2 mg/d)治疗进行临床观察,记录治疗前、治疗后2年、5年患者IPSS评分、夜尿次数、前列腺体积、膀胱残余尿量的变化.结果 治疗后患者IPSS评分、夜尿次数、前列腺体积、膀胱残余尿量疗效明显优于治疗前(P＜0.05),治疗5年后患者IPSS评分、夜尿次数、前列腺体积优于治疗2年后(P＜0.05),而治疗5年后患者膀胱残余尿量与患者治疗2年后无差别.结论 长期服用非那雄胺和特拉唑嗪治疗老年BPH患者疗效确切,且未出现明显不良反应.