Comparative Effectiveness and Safety of Monodrug Therapies for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: A Network Meta-analysis

A wide array of drugs are available for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH), but the evidence for the comparative effectiveness is controversial.The objective of this study is to evaluate the comparative effectiveness and safety of monodrug therapies for BPH.Data sources are MEDLINE, EMBASE, and the Cochrane Library.We included randomized controlled trials that compared α-blockers, 5-alpha reductase inhibitors (5ARIs), muscarinic receptor antagonists (MRAs), phosphodiesterase-5 inhibitor (PDE5-Is), or placebo for the treatment of BPH.Comparative effectiveness and safety were pooled by both traditional meta-analysis and network meta-analysis. Summary effect size was calculated as mean difference (MD) and relative risk (RR), together with the 95% confidence intervals (CIs).This study included 58,548 participants from 124 trials in total. When compared with placebo, α-blockers, 5ARIs, and PDE5-Is reduced International Prostate Symptom Score (IPSS) by −1.35 to −3.67 points and increased peak urinary flow rate (PUF) by −0.02 to 1.95 mL/s, with doxazosin (IPSS: MD, −3.67[−4.33 to −3.02]; PUF: MD, 1.95[1.61 to 2.30]) and terazosin (IPSS: MD, −3.37 [−4.24 to −2.50]; PUF: MD, 1.21[0.74 to 1.66]) showing the greatest improvement. The improvement in the IPSS was comparable among tamsulosin, alfuzosin, naftopidil, silodosin, dutasteride, sildenafil, vardenafil, and tadalafil. The incidence of total adverse events and withdraws due to adverse events were generally comparable among various agents.In conclusion, α-blockers, 5ARIs, and PDE5-Is are effective for BPH, with doxazosin and terazosin appearing to be the most effective agents. Drug therapies for BPH are generally safe and well-tolerated, with no major difference regarding the overall safety profile.     

Tadalafil Administered Once Daily for Treatment of Lower Urinary Tract Symptoms in Korean men with Benign Prostatic Hyperplasia: Results from a Placebo‐Controlled Pilot Study Using Tamsulosin as an Active Control

Objectives: Assess the efficacy and safety of once‐daily tadalafil or tamsulosin versus placebo during 12 weeks on lower urinary tract symptoms (LUTS) in Korean men with benign prostatic hyperplasia (BPH). Methods: Following a 4‐week placebo run‐in period, 151 Korean men were randomly assigned to receive once‐daily tadalafil 5 mg, tamsulosin 0.2 mg, or placebo for 12 weeks. Results: The International Prostate Symptom Score (IPSS) least squares mean changes from baseline to endpoint were numerically but not significantly improved in the tadalafil (?5.8) and tamsulosin (?5.4) groups compared with placebo (?4.2, P > 0.05). Decreases in IPSS obstructive and irritative subscores, IPSS Quality of Life score, and BPH Impact Index from baseline to endpoint were largest in the tadalafil group followed by tamsulosin, though none separated significantly from placebo. Increases in maximum urinary flow rate were small and not significantly different than placebo; the increase was largest in the tadalafil group (2.5 mL/sec), followed by the placebo (2.3 mL/sec) and tamsulosin (2.1 mL/sec) groups. The percentage of subjects reporting at least one treatment‐emergent adverse event was 26.5, 13.7 and 3.9% in the tamsulosin, tadalafil and placebo groups, respectively. Conclusions: In this pilot study in Korean men, those with BPH and treated with tadalafil 5 mg or tamsulosin 0.2 mg once daily experienced a reduction in LUTS, which was numerically (but not statistically) significant compared with the placebo. Tadalafil was well tolerated and few subjects discontinued the study due to treatment‐emergent adverse events. Larger studies in Asian men with BPH and LUTS treated with phosphodiesterase type 5 inhibitors are needed.     

Combination medical therapy for symptomatic benign prostatic hyperplasia

PURPOSE: The purpose of this study was to evaluate treatment response to terazosin, finasteride, or a combination of both in men with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Patients with BPH were consecutively enrolled from a clinical urology practice. International Prostate Symptom Score (IPSS), peak urinary flow rate, and prostate volume were assessed at baseline and every 2 months for 12 months. Detrusor pressure at maximum flow was assessed at baseline, 4 and 12 months. Patients were randomized into 1 of 3 treatment groups - terazosin alone, finasteride alone, or combination therapy. RESULTS: At 12 months, symptom scores had decreased significantly in all 3 treatment groups (p<0.05). Combination therapy resulted in significantly greater reductions in IPSS than terazosin or finasteride (6.4, 4.9, 4.1 points, respectively, p<0.05) There were significant increases in peak urinary flow rate within each treatment group, although there were no significant changes between groups. Detrusor pressure also significantly decreased from baseline within each treatment group. Patients treated with combination therapy had a significantly greater mean decrease in detrusor pressure after 12 months when compared with finasteride-treated patients (16.7 versus 10.5 cm H20, p<0.03). There were no significant differences between terazosin and combination therapy or between terazosin and finasteride despite the relatively greater decrease in detrusor pressure seen in the terazosin group when compared with the finasteride group. CONCLUSIONS: Combination medical therapy with finasteride and terazosin provides greater symptom relief than monotherapy in men with BPH.     

Tadalafil for the Treatment of Lower Urinary Tract Symptoms in Japanese Men with Benign Prostatic Hyperplasia: Results from a 12‐week Placebo‐controlled Dose‐finding Study with a 42‐week Open‐label Extension

Objectives: To examine the efficacy, safety, and dose response of tadalafil once daily in Japanese men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH‐LUTS). Methods: Men ≥45 years with moderate‐to‐severe BPH‐LUTS were randomized to once‐daily placebo (N = 140), tadalafil 2.5 mg (N = 142), or tadalafil 5.0 mg (N = 140), in a 12‐week double‐blind phase, followed by a 42‐week, tadalafil 5.0 mg open‐label extension (OLE) phase (N = 394). The primary outcome was total International Prostate Symptom Score (IPSS) change from baseline to last available observation in the double‐blind phase. Results: The least squares (LS) mean difference between placebo and tadalafil in total IPSS change from baseline was ?0.7 (P = 0.201) and ?1.1 (P = 0.062) for tadalafil 2.5 and 5 mg, respectively (ANCOVA; a dose‐dependent improvement in placebo‐adjusted total IPSS for tadalafil 5 mg versus 2.5 mg of 57%). Repeated‐measures analyses identified a significant total IPSS change for tadalafil 5 mg (LS mean difference between placebo and tadalafil 5 mg: ?1.2; P = 0.035), but not tadalafil 2.5 mg, at week 12. Significant improvements for tadalafil 5 mg were demonstrated (ANCOVA) for IPSS obstructive subscore (P = 0.033) and IPSS quality of life index (P = 0.022). Numerical improvements in IPSS scores were maintained over the OLE phase. Tadalafil was well tolerated with no unexpected adverse events. Conclusion: Tadalafil (5.0 mg) had a favorable benefit‐to‐risk profile, supporting further investigation of tadalafil (5.0 mg) in Japanese men with BPH‐LUTS.     

Efficacy and safety of the doxazosin gastrointestinal therapeutic system for the treatment of benign prostate hyperplasia

This study was carried out to obtain information on the efficacy and safety of the controlled release formulation of the doxazosin Gastrointestinal Therapeutic System (GITS) in Taiwanese subjects with benign prostatic hyperplasia (BPH). Studies of doxazosin in Asian populations for this indication have lacked data particularly from Taiwan. This was an 8-week, post-marketing, open-label, non-comparative study. Eighty male subjects (mean age=64 years) with BPH received doxazosin GITS 4 mg once daily. At week 4, subjects who achieved an increase in maximum urinary flow rate (Qmax) of ≥3mL/s and a ≥30% reduction in the total International Prostate Symptom Score (IPSS) continued on doxazosin GITS 4 mg for the remaining 4 weeks; all other subjects were up-titrated to 8 mg once daily. Change from baseline at weeks 4 and 8 (primary endpoint) in IPSS and Qmax was evaluated using two-sided paired t tests for the intent-to-treat population. Safety was assessed throughout the study. A total of 53 (66.3%) subjects completed the study. Baseline Qmax and IPSS were 10.7+3.4 mL/s and 20.6+5.4, respectively. At week 8, a significant increase from baseline in Qmax of 3.3+4.6 mL/s (95% confidence interval = 2.2-4.4, p< 0.001) and a significant decrease in total IPSS of -8.9 + 7.0 (95% confidence interval=-10.5 to -7.3, p< 0.001) was observed. The most common treatment-related adverse event was dizziness. Doxazosin GITS 4 mg per day (with an 8-mg titration step) effectively improved symptoms of BPH. The results from this study provide further information for clinicians on the use of doxazosin GITS for the treatment of BPH, particularly in Taiwanese patients.     

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.     

Medical therapy options for aging men with benign prostatic hyperplasia: focus on alfuzosin 10 mg once daily

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) are common in aging men and can significantly affect quality of life. Men with bothersome LUTS/BPH often present with various other age-related conditions, including sexual dysfunction, heart disease, hypertension, diabetes, and the metabolic syndrome, which can complicate management decisions. Therefore, healthcare providers should be familiar with first-line treatment options for LUTS/BPH and their differing safety profiles, particularly with respect to cardiovascular and sexual function side effects. This article presents a review of first-line medical therapy options for managing aging men with LUTS/BPH and patient considerations when evaluating and selecting these therapies, with a focus on the clinical efficacy and cardiovascular and sexual function safety profiles of the uroselective α₁-adrenergic receptor antagonist alfuzosin 10 mg once daily. Alfuzosin improves LUTS, peak urinary flow rates, and disease-specific quality of life, reduces the long-term risk of overall BPH progression, and is well tolerated in aging men, with minimal vasodilatory and sexual function side effects, even in those with comorbidities. Alfuzosin is well tolerated when used in combination with antihypertensive medications and phosphodiesterase type 5 inhibitors for the treatment of erectile dysfunction. The long-term clinical efficacy and good cardiovascular and sexual function safety profile of alfuzosin can contribute to an improved quality of life for aging men with LUTS/BPH.     

甲磺酸多沙唑嗪控释片治疗良性前列腺增生及改善勃起功能的研究

目的 研究甲磺酸多沙唑嗪控释片对良性前列腺增生(BPH)患者下尿路症状(LUTS)及性功能的影响.方法 101例典型的伴有LUTS的BPH患者治疗前进行国际前列腺症状评分(IPSS)、勃起功能障碍国际问卷5(IIEF2-5)调查,给甲磺酸多沙唑嗪控释片4 mg,1次/d,疗程8周.分析治疗后LUTS及性功能改善情况.结果 治疗前IPSS评分(19.9±6.5)分,治疗后(14.3±4.0)分(t=7.534,P＜0.001);治疗前IIEF-5评分(9.5±8.5)分,治疗后(14.9±8.8)分(t=5.335,P＜0.001),治疗后各项指标较治疗前有明显改善.IPSS和IIEF2-5呈负相关(r=-0.33,P＜0.001).结论 LUTS是性功能障碍的危险因素,LUTS的严重程度与性功能障碍的发展密切相关.甲磺酸多沙唑嗪控释片在改善LUTS的同时可明显改善患者的性功能状况.

Abstract：

Objective To study the therapeutic effect of cardura on lower urinary tract symptoms (LUTS) and ejectile dystunction(ED) in men with benign prostatic hyperplasia (BPH).Methods One hundred and one cases with BPH and typical LUTS were investigated using the International Prostate Symptom Score (IPSS) and International Index of Erectile Function 5 (IIEF-5)before and after treatment. The patients were given cardura 4 mg, once a day for 8 weeks. The LUTS and ED were was analyzed after treatment. Results The IPSS was scores ( 14.3 ± 4.0) after treatment, and it was lower than before (mean scores: 19.9±6.5, t= 7.534, P＜0.001). The IIEF2-5 was(14.9±8.8)scores after treatment, and it was higher than before (mean scores: 9.5±8. 5, t = 5. 335, P＜ 0. 001 ), respectively. There was statistically significant correlation between IIEF2-5 and IPSS score (r= -0. 327, P＜0. 001 ). Various indexes were significantly improved after cardura treatment as compared with pretreatment (P＜0.001). Conclusions LUTS is dangerous factor for sexual dysdysfunction, and the severity of LUTS is closely related to the development of sexual dysfunction. Cardura can at once improve the sexual function and LUTS of BPH patients.     

Anticholinergics in men: Does the evidence support combination therapy?

Benign prostatic hyperplasia (BPH) is common in men older than age 50, and the symptoms occurring from bladder outlet obstruction (BOO) commonly overlap with lower urinary tract symptoms (LUTS) experienced in overactive bladder (OAB). Anticholinergics are often withheld from men with BOO. This article reviews seven randomized controlled trials (RCTs) and a meta-analysis study examining anticholinergic use in men with LUTS associated with OAB and BPH. There is growing evidence that anticholinergics are a suitable, safe treatment in men with persistent LUTS associated with BOO, refractory to α-blockers. Only four of 750 men treated with anticholinergics in the seven RCTs reviewed had acute urinary retention. Further well-designed, placebo-controlled RCTs are required to assess the efficacy and long-term safety outcomes of combination therapy. However, it appears feasible to effectively use adjunctive anticholinergic therapy in men with LUTS/BPH and no significant increase in postvoid residual volume.     

老年良性前列腺增生症单药治疗无效的危险因素

目的通过分析α-受体阻滞剂治疗老年良性前列腺增生症(BPH)无效的危险因素,明确初诊老年BPH的药物选择。方法回顾研究96例老年BPH患者,其中单用α-受体阻滞剂坦索罗新治疗组42例,与5α-还原酶抑制剂非那雄胺联合治疗组54例,比较两组国际前列腺症状评分(IPSS)、生活质量指数(QOL)、最大尿流速(Qmax)、残余尿量(PVR)、前列腺体积及血清前列腺特异性抗原(PSA)。结果联合用药与单药治疗组比较,前列腺体积、Qmax和IPSS具有统计学差异;多元回归分析显示IPSS(P<0.001)及前列腺体积(P<0.05)与老年BPH单药治疗无效密切相关。结论老年BPH患者单药及联合治疗均能改善病情,对于初诊时具有较高的IPSS评分及严重的前列腺体积增大者应给予药物联合治疗。     

Early Efficacy of an α1 Adrenoceptor Antagonist,Naftopidil, against Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

Objectives: The present study investigated the early efficacy of naftopidil against lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Methods: Subjects comprised patients with LUTS suggestive of BPH who were followed prospectively for 8 weeks. Inclusion criteria were: (i) international prostate symptom score (IPSS) ≥8; (ii) no previous treatment for BPH; and (iii) eligibility for naftopidil monotherapy. IPSS and quality of life index were evaluated, and uroflowmetry and residual urine volume were determined optionally. In the previous study, patients who demonstrated a decrease in total American Urological Association symptom score of 25% or more from baseline were considered responders. The ratio of onset of efficacy of naftopidil was calculated by the ratio of the number of responder in each group with the starting dose. Results: Naftopidil efficacy was analyzed for 243 patients. Significant improvement of IPSS was achieved within 1–3 days after medication. Starting dosage and average dosage were identified as factors associated with the period until onset of naftopidil efficacy. Onset of efficacy was significantly quicker with a starting dosage of 50 mg/day as compared with 25 mg/day (P = 0.0047). However, ratios of onset of efficacy with starting dosages of 25, 50 and 75 mg/day were 77.9, 76.7 and 85.7%, respectively, showing no significant difference between groups (P = 0.7463). Duration to onset of efficacy with naftopidil dosage ≥50 mg/day was 11.2 days, significantly early compared to dosage <50 mg/day. Incidence of adverse effect was 3.8%. Conclusion: Naftopidil showed early effects against LUTS suggestive of BPH within a few days.     

Statin Medications and Development and Progression of Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms

Benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are common among aging men and impact quality of life. Recently, there has been an interest in alternative mechanisms of BPH and LUTS, specifically the role of chronic prostatic inflammation. Statin medications, known for their cholesterol-lowering properties, also possess certain anti-inflammatory effects, which may be of interest in the treatment and/or prevention of BPH and LUTS. Prior studies of statins have yielded conflicting results. These were limited by cross-sectional designs or limited follow-up, small sample sizes, and inability to control for confounding. One prior randomized control trial found no difference between atorvastatin vs. placebo in the treatment of BPH and LUTS after 6 months. Additional randomized trials with longer follow-up time evaluating the impact of statins on incident BPH and LUTS are required to assess the therapeutic potential of statins and develop a better understanding of alternative mechanisms for BPH and LUTS.     

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.     

Efficacy of Additional Dutasteride on Lower Urinary Tract Symptoms in Patients with Alpha‐1 Blocker‐Resistant Benign Prostatic Hyperplasia

Objective: We investigated the effects of dutasteride on urination and quality of life (QOL) in patients diagnosed with benign prostatic hyperplasia (BPH) who showed poor improvement in lower urinary tract symptoms (LUTS) with alpha‐1 blockers. Methods: We retrospectively analyzed 108 patients with BPH who took dutasteride for more than 3 months from October 2009 to October 2011. The patients showed poor improvement in LUTS despite administration of alpha‐1 blockers for more than 3 months; all had an International Prostate Symptom Score (IPSS) of eight or greater. We investigated changes in prostate‐specific antigen and prostate volume and performed uroflowmetry and medical interviews to assess IPSS‐QOL score and BPH impact index (BII). Results: Mean prostate volume was 52.8 ± 22.2 mL, and the mean period of dutasteride administration was 284 ± 118 days. Prostate volume decreased 24.1% from baseline to 6 months after administration. Voiding symptoms and storage symptoms showed improvements with longer administration periods, but only nocturia showed no clear improvement. There was a 0.9‐point decrease in BII after 6 months. There was no statistically significant association between the rate of prostate volume reduction and improvement in voiding and storage symptoms. Conclusion: Additional administration of dutasteride to patients with alpha‐1 blocker‐resistant BPH led to improvements in all voiding and storage symptoms except nocturia, and showed no correlation between the prostate volume reduction rates and improvement in LUTS.     

The use of baseline clinical measures to predict those at risk for progression of benign prostatic hyperplasia

Although histologic changes of benign prostatic hyperplasia (BPH) begin in men when they are in their thirties, symptomatic BPH characterized by lower urinary tract symptoms (LUTS) typically do not develop for several decades. Progression of BPH may lead to significant voiding symptoms, acute urinary retention, and the need for prostate surgery. However, developing LUTS is not inevitable for men with histologic evidence of BPH. The ability to predict those men who are risk for BPH progression is increasingly important because of recent evidence provided by the Medical Therapy of Prostate Symptoms study. This landmark study demonstrated that 5α-reductase inhibitors, alone or in combination with selective α-blockers, can delay or prevent the progression of BPH. In addition, the most important and consistent predictive factors for BPH progression are baseline prostatespecific antigen and prostate volume. Integration of these clinical parameters into clinical practice is influencing the decision regarding which men should observe or initiate treatment. This article highlights recent studies regarding the use of baseline clinical parameters on predicting BPH progression.     

Impact of Androgen Deprivation Therapy on Volume Reduction and Lower Urinary Tract Symptoms in Patients with Prostate Cancer

Objective

To evaluate the impact of androgen deprivation therapy (ADT ) on prostate volume, lower urinary tract symptoms (LUTS ), and LUTS ‐related quality of life (QOL ) in patients with prostate cancer.

Methods

Patients with prostate cancer (PCa ) were treated with goserelin and bicalutamide for 24 weeks. Changes in the total prostate volume (TPV ), International Prostate Symptom Score (IPSS ), and QOL score for urinary symptoms were assessed every 12 weeks. Of the 42 patients enrolled, 8 patients withdrew and 2 were excluded, so 32 patients were analyzed.

Results

The median age, PSA levels, and TPV were 77.5 years, 22.0 ng/mL, and 29.5 cm³, respectively. TPV showed a significant decrease from baseline in weeks 12 and 24, with the mean percent decreases being ?37.5 ± 4.25 and ?7.5 ± 3.84%, respectively. The IPSS decreased from baseline to weeks 12 and 24 (from 11.7 ± 1.6 to 9.3 ± 1.0 and 9.3 ± 1.0; P = 0.15 and 0.2, respectively). The IPSS voiding score showed a significant decrease from baseline to weeks 12 and 24 whereas the IPSS storage score did not. In patients with moderate to severe LUTS , the IPSS and the QOL score showed a significant decrease in weeks 12 and 24. In patients with mild LUTS , nocturia increased significantly from baseline and there was approximately one additional episode of nocturia at 24 weeks.

Conclusions

In this study, we observed that ADT significantly reduced TPV and improved LUTS in patients with PCa and moderate to severe LUTS , but increased nocturia in patients with mild LUTS .

     

广州地区老年科良性前列腺增生的诊断治疗现状

目的 了解广州地区老年科门诊伴有下尿路症状的良性前列腺增生(LUTS/BPH)患者的基本情况及诊治状况. 方法 对广州地区三家三级甲等医院的老年科门诊进行调查,对诊断为LUTS/BPH的患者进行生活的基本状况的问卷调查,同时对门诊医师开具的检查和治疗药物进行分析统计. 结果 6140例男性门诊患者中1824例拟诊LUTS/BPH,占29.7%.在有效回收的调查问卷的134例患者中,国际前列腺症状评分(IPSS)轻、中及重度者分别占24.5%、72.5%及3.0%.血清前列腺特异性抗原(PSA)异常率为37.3%.患者最常接受的检查是直肠指检(96.8%)、PSA(88.7%)和经腹B超(84.8%).医师开具的药物最常见为单独使用5-α还原酶抑制剂(44.7%);其次为α-受体拮抗剂及5-α还原酶抑制剂联合使用(24.7%)及其他(植物用药)(16.7%).单独使用α-受体拮抗剂和单独使用植物制剂的比例相近(分别为6.8%和7.1%). 结论 LUTS/BPH是老年科男性患者最常见的疾病之一.医师开具的检查不尽合理,对常规的病史询问、IPSS评分等重视不够,医师开具的治疗药物基本合理.     

Comparison of Naftopidil 75 mg with Tamsulosin Hydrochloride 0.2 mg in the Treatment of Lower Urinary Tract Symptoms with Benign Prostatic Hyperplasia

Objective: To compare the efficacy of two α₁‐adrenoceptor antagonists, α_1D‐adrenoceptor‐selective naftopidil (Naf) 75 mg and α_1A‐adrenoceptor‐selective tamsulosin hydrochloride (Tam) 0.2 mg, for the treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Methods: Seventy‐seven patients with LUTS secondary to BPH were enrolled. Data were gathered from patients retrospectively: 41 patients who were prescribed Naf 75 mg for 4 weeks and 36 patients who were prescribed Tam 0.2 mg for 4 weeks, respectively. The efficacy criteria were improvement in LUTS International Prostate Symptom Score (IPSS) and quality of life (QOL) scores after dosing. Results: Naf 75 mg significantly improved symptoms in all 11 categories (overall IPSS, incomplete emptying, voiding symptoms [Intermittency, poor flow and straining], storage symptoms [daytime frequency, urgency and nocturia frequency], QOL index, intermittency, poor flow, straining, daytime frequency, urgency, and nocturia frequency) (P < 0.05). Tam 0.2 mg significantly suppressed 10 of the 11 tested symptom categories except straining (P < 0.05). Comparison data of the two drugs tended to show Naf 75 mg had better efficacy on nocturia frequency than Tam 0.2 mg (P < 0.05). Conclusion: Naf 75 mg might show a better efficacy for LUTS with BPH in nocturia frequency than Tam 0.2 mg.     

非那雄胺对慢性心力衰竭合并良性前列腺增生老年男性患者的疗效

目的探讨非那雄胺对慢性心力衰竭（chronic heart failure,CHF）合并良性前列腺增生（benign prostatic hyperplasia．BPH）的老年男性患者的疗效。方法95例CHF合并BPH老年男性按数字表法随机分为治疗组及对照组,两组均根据患者的心功能情况规范使用抗心力衰竭治疗。治疗组使用非那雄胺,对照组使用安慰剂治疗2年。观察两组前列腺体积、国际前列腺症状评分表（IPSS）评分、BPH患者生活质量（QOL）评分、肌酐、血尿素氮、N末端脑钠肽前体、肌钙蛋白、左心室射血分数（LVEF）、急性尿潴留、需手术干预、心血管事件、心力衰竭再住院率、心功能的变化及主要副作用等指标,并进行比较。结果治疗组心血管事件发生率[23．25％（10／43）／35．47．61％（20／42）,P〈0．05]、心力衰竭再住院率[25．58％（11／43）vs50．00％（21／42）,P〈O．05]、急性尿潴留率[13．95％（6／43）vs42．85％（18／42）,P〈0．05]、需手术干预率[16．27％（7／43）／iS．52．38％（22／42）,P〈0．051,明显低于对照组,差异有统计学意义。治疗组前列腺体积、国际前列腺症状评分表评分及肌酐、N末端脑钠肽前体浓度低于对照组,差异有统计学意义（P〈O．05）。两组治疗2年后在勃起功能障碍、性欲减退、乳腺增大、乳腺疼痛的发生率比较,差异无统计学意义（P〉0．05）。结论对于CHF合并BPH的患者在规范的治疗心力衰竭的基础上应尽早长期使用非那雄胺,可显著降低患者的主要心血管事件发生率、心力衰竭再次住院率、急性尿潴留率、需手术干预率,缩小前列腺体积,改善下尿道症状及患者生活质量,而无明显增加副作用。