锯叶棕果实提取物软胶囊治疗良性前列腺增生的有效性和安全性分析

目的:探讨锯叶棕果实提取物软胶囊治疗良性前列腺增生(BPH)的有效性和安全性。方法:采用多中心、开放性临床研究,对临床和实验室确诊的165例BPH患者给予锯叶棕果实提取物软胶囊口服1粒/次(160 mg),1次/d,6周后及12周试验结束时比较患者治疗前后的疗效。主要疗效指标:IPSS评分、前列腺体积、残余尿量;次要疗效指标:尿流率、生活质量评分(QOL)。结果:治疗6周后,患者的国际前列腺症状评分(IPSS)和QOL较前有所改善,治疗12周后,患者的IPSS评分、QOL评分、尿流率、残余尿较治疗前均有明显改善。研究过程中有1例不良事件发生。结论:锯叶棕果实提取物软胶囊治疗BPH是有效和安全的。     

锯叶棕果实提取物联合α受体阻滞剂治疗良性前列腺增生的有效性及安全性meta分析

目的:评价锯叶棕果实提取物联合α受体阻滞剂治疗良性前列腺增生(BPH)的有效性及安全性。方法:搜集锯叶棕果实提取物联合α受体阻滞剂与α受体阻滞剂单药对比治疗BPH有效性及安全性的随机对照研究(RCT),以meta分析法系统比较锯叶棕果实提取物联合α受体阻滞剂治疗BPH的有效性及安全性。结果:7个RCT研究1 009例患者纳入分析,研究基线具有可比性。与α受体阻滞剂单药治疗相比,锯叶棕果实提取物联合α受体阻滞剂更能有效降低IPSS总评分、储尿期IPSS、排尿期IPSS、生活质量评分(QOL)及前列腺特异性抗原(PSA)水平(P0.05),增加最大尿流率(Qmax)(P=0.04),而前列腺体积(PV)及残余尿量(PVR)两组间无明显差异(P0.05)。安全性方面,两组间的不良反应发生率均无显著性差异(P0.05)。结论:锯叶棕果实提取物联合α受体阻滞剂治疗BPH安全、有效,联合用药较α受体阻滞剂单药治疗患者获益更多。     

柏诺特胶囊治疗良性前列腺增生的临床疗效

目的：观察柏诺特胶囊治疗前列腺增生的临床疗效。方法：对60例良性前列腺增生(BPH)患者口服柏诺特胶囊，每次160mg.bid，治疗前及治疗8周后进行国际前列腺症状评分(IPSS)、前列腺体积、最大尿流率和剩余尿等检测，观察有无副作用。结果：用药8周后，患者的IPSS、最大尿流率和剩余尿量有明显改善，前列腺体积明显减小，总有效率为87．6％，PSA无明显变化，未见有明显副作用。结论：柏诺特胶囊治疗BPH安全有效。     

α受体阻滞剂对良性前列腺增生患者症状的影响作用

目的　分析α受体阻滞剂对良性前列腺增生 (BPH)患者症状的影响。　方法　对 14 8例BPH患者进行 4周α受体阻滞剂治疗 ,记录并分析治疗前后患者症状、IPSS评分、最大尿流率、平均尿流率及剩余尿量情况。　结果　治疗 4周后 ,患者平均IPSS评分、最大尿流率、平均尿流率及剩余尿量均有显著改善。各项症状中 ,夜尿次数的改善显著低于其它症状的改善。 35例 (2 3.6 % )患者治疗后生活质量评分没有改善 (主观不满意组 ) ,IPSS改善程度明显低于生活质量评分有提高的患者(主观满意组 ) ,但两组间最大尿流率及平均尿流率的改善差别无显著性意义。　结论　α受体阻滞剂治疗BPH患者症状的改善与尿流率的提高可能存在不同机制     

通尿灵对BPH患者影像尿动力学的影响

目的：评价生长因子抑制剂非洲臀果木提取物－通尿灵治疗良性前列腺增生症（BPH） 的临床疗效。方法;选择经临床确诊的BPH患者48例,口服通尿灵50mg,2次／d,共8周。分别于用药前及治疗后8周行国际前列腺症状评分（IPSS）、尿流率、剩余尿量、前列腺休影像尿动力学等指标测定,同时对出现的副作用进行记录。结果：用药8周后IPSS平均降低6.67分,尿流率平均升高4.2mg/s ,剩余尿量平均减少25.5ml,前列腺体积无明显变化,影像尿动力学指标有明显改善。结果：通尿灵对改善BPH患者主观症状、客观体征和提高生活质量有明显效果,副作用及不良反应少。评价通尿灵对BPH疗效时,影像尿力学检查能了解逼尿肌的功能状况,并能准确判断下尿路梗阻的解剖水平变化情况。     

福施乐治疗良性前列腺增生的临床研究

目的:观察福施乐治疗BPH的有效性和安全性。方法:采用多中心、开放性、自身前后对照的临床研究方法,对60例BPH患者采用福施乐治疗12周。以国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、膀胱残余尿(PVR)和前列腺体积为主要疗效指标,以生活质量评分(QOL)和平均尿流率(Qave)为次要疗效指标,来评价福施乐治疗BPH的效果。结果:治疗12周后,患者IPSS评分、Qmax、PVR、QOL评分、Qave均比治疗前明显改善(P<0.01),而前列腺体积治疗前后无显著性差异(P>0.05)。结论:福施乐可明显改善BPH患者的排尿症状,增加尿流率,减少残余尿,无明显不良反应,治疗BPH安全、有效。     

癃闭舒胶囊联合非那雄胺治疗良性前列腺增生观察

目的:研究非那雄胺联合癃闭舒胶囊治疗良性前列腺增生(BPH)的疗效。方法:将前列腺体积>30mL、国际前列腺症状评分(IPSS)>15分的良性前列腺增生69例随机分为两组,治疗组给予非那雄胺及癃闭舒胶囊联合治疗,对照组单独予非那雄胺治疗。治疗3月后,观察两组治疗前后最大尿流率、IPSS、超声测量残余尿。结果:两组患者IPSS评分、残余尿量和最大尿流率在治疗3月后与治疗前对比均有显著性差异(P<0.05),治疗组优于对照组,两组比较在治疗各时段IPSS、残余尿量和最大尿流率对比无显著性差异(P>0.05)。结论:对前列腺体积中度增大并合并下尿路症状(LUTS)的BPH患者,予非那雄胺和癃闭舒胶囊联合治疗,可获得满意疗效。     

坦索罗辛对有下尿路症状的BPH人群临床症状参数的改变

目的：探讨有下尿路症状的BPH人群服用坦索罗辛后剩余尿量、IPSS评分、最大尿流率的变化。方法：选择有下尿路症状的BPH人群,测定其剩余尿量、最大尿流率、IPSS评分、生活质量评分。应用坦索罗辛后前3个月每月随访1次,后3个月随访1次,连续2次,比较服药前后临床症状参数的变化。结果：服药后前3个月临床症状参数改善较明显,3个月后变化不再明显,维持在平稳水平。结论：坦索罗辛对有下尿路症状的BPH人群的临床症状参数有明显改善作用,尤其对IPSS评分、生活质量评分的减少较为明显。     

前列腺增生电切术后下尿路症状发生因素分析

目的 分析经尿道前列腺增生电切术后下尿路症状发生情况及影响因素。方法 收集2020年2月至2023年2月于湖州市第三人民医院、湖州市第一人民医院治疗的前列腺增生患者92例，均给予经尿道前列腺增生电切术治疗，根据术后是否合并下尿路症状分为对照组60例（未合并）及观察组（合并）32例，比较两组患者病程、国际前列腺症状评分（IPSS）评分、前列腺体积、残余尿量、最大尿流率、前列腺特异抗原（PSA）水平手术时间及术后导尿管留置时间，多因素logistic回归分析经尿道前列腺增生电切术后下尿路症状发生的影响因素。结果经尿道前列腺增生电切术后患者IPSS评分、前列腺体积、残余尿量明显低于术前，最大尿流率明显高于术前（P<0.01）。观察组患者病程、术前IPSS评分、前列腺体积、残余尿量及术后导尿管留置时间明显高于对照组（P<0.01），最大尿流率明显低于对照组（P<0.01）。病程、术前IPSS评分、术前前列腺体积、术后导尿管留置时间为影响前列腺增生患者下尿路症状发生的独立危险因素，最大尿流率为独立保护因素（P<0.05）。结论 经尿道前列腺增生电切术后仍有部分患者下尿路症...     

锯叶棕果实提取物对以LUTS为主要症状的ⅢA型前列腺炎治疗的疗效观察

目的:探讨锯叶棕果实提取物对以下尿路症状(LUTS)为主要症状的ⅢA型前列腺炎治疗的临床疗效。方法:对2015年1月至12月就诊的54例ⅢA型前列腺炎患者予以锯叶棕果实提取物软胶囊口服320 mg/次,1次/d,12周后评价疗效。使用慢性前列腺炎症状指数(NIH-CPSI)评分、排尿日记及国际前列腺症状(IPSS)评分评估治疗前后症状,并行尿动力学检查,比较患者治疗前后变化。结果:治疗12周后,患者的NIH-CPSI评分(18.6±5.34)较治疗前(27.61±3.76)明显下降(P0.01)、IPSS评分(10.96±4.62)较治疗前(20.44±4.51)有明显下降(P0.01)。尿动力学检查指标反应治疗前平均尿流率[AFR(8.05±1.42)ml/s]、最大尿流率[MFR(14.22±1.74)ml/s]、残余尿[RU(46.15±16.57)ml]、尿道最大闭合压[MCP(76.52±3.53)cm H2O],治疗后指标[AFR(12.05±2.60)ml/s、MFR(21.32±4.51)ml/s、RU(14.55±10.21)ml、MCP(65.32±4.75)cm H2O]均明显改善(P0.01)。排尿日记显示治疗后平均排尿量[(285.93±58.68)ml]、排尿次数(8.96±2.50)及夜尿次数(3.15±1.90)次均较治疗前[(124.63±40.55)ml、16.96±4.17、8.94±3.23]明显改善(P0.01)。治疗期间所有患者均未诉不良反应。结论:锯叶棕果实提取物可有效地改善ⅢA型前列腺炎患者出现的LUTS,提高患者生活质量,且安全性高,可作为临床治疗方案之一。     

联合应用坦索罗辛和托特罗定治疗男性顽固性下尿路症状的临床研究

目的:探讨及对比联合应用高选择性α受体阻滞剂(坦索罗辛)和M受体阻滞剂(托特罗定)及单用高选择性α受体阻滞剂治疗男性顽固性下尿路症状的临床疗效及安全性。方法:2009年4月至2009年12月期间收集我院184例顽固性下尿路症状(LUTS)的男性前列腺增生患者,病程4周至2年。所有患者均为应用高选择性α受体阻滞剂(坦索罗辛)0.2 mg,1次/d,治疗1周后LUTS症状无改善。入选病例随机分成2组,其中坦索罗辛组89例继续应用坦索罗辛0.2 mg,1次/d,治疗4周;联合治疗组95例联合应用高选择性α受体阻滞剂(坦索罗辛)和M受体阻滞剂(托特罗定),给予坦索罗辛0.2 mg 1次/d+托特罗定2 mg 2次/d,治疗4周。分组治疗前后分别进行国际前列腺症状储尿期症状评分(储尿期IPSS)、生活质量评分(QOL)和最大尿流率(Qmax)检测,评估治疗后LUTS症状的改善情况。结果:坦索罗辛组储尿期IPSS、QOL总体评分分别由治疗前的(13.23±4.39)、(4.23±1.27)分下降到治疗后的(12.21±4.07)、(3.53±0.9)分,Qmax由治疗前的(12.31±8.39)ml/s上升到治疗后的(14.12±8.62)ml/s,与治疗前相比差异均无显著性(P>0.05)。联合治疗组储尿期IPSS、QOL总体评分分别由治疗前的(14.45±5.31)、(4.45±0.79)分降到治疗后的(6.56±2.03)、(2.34±0.73)分,Qmax由治疗前的(11.41±9.21)ml/s上升到治疗后的(15.52±8.35)ml/s,与联合治疗前相比差异均有显著性(P<0.01)。184例患者均无严重并发症出现。结论:联合应用坦索罗辛和托特罗定能明显缓解男性顽固性下尿路症状,改善患者的生活质量。未见严重不良反应和急性尿潴留发生。     

伴有下尿路症状的良性前列腺增生患者勃起功能状况及坦索罗辛的干预研究

目的:研究伴有下尿路症状(LUTS)的良性前列腺增生(BPH)对患者性功能的影响及坦索罗辛干预的效果。方法:192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)、生活质量评分(QOL)、勃起功能障碍国际问卷5(IIEF-5)调查,同时检测最大尿流率(Qm ax)。然后随机分两组,治疗组(103例)给予坦索罗辛0.2 mg,对照组(89例)应用安慰剂,1次/d,疗程8周。分析治疗前不同因素对性功能的影响和治疗后LUTS及性功能改善情况。结果:192例患者治疗前IPSS评分3~32(20.20±6.81)分,QOL评分0~6(4.51±0.76)分,Qm ax 8~30(9.6±8.79)m l/s,IIEF-5评分1~24(9.80±8.62)分。勃起功能障碍(ED)发生率75%(144/192)。统计学显示:IPSS和IIEF-5有明显的相关性(r=-0.312,P<0.001)。年龄与IPSS和IIEF-5均有明显的相关性(r=0.203,P<0.005和r=-0.571,P<0.001)。对照组治疗后各项指标变化差异无显著性,治疗组治疗后各项指标较治疗前有明显改善(P<0.001),好于对照组(P<0.001)。结论:年龄和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。坦索罗辛在改善LUTS的同时可明显改善患者的性功能状况。     

Seasonal changes in symptom score and uroflowmetry in patients with lower urinary tract symptoms

OBJECTIVE: To determine whether subjective or objective seasonal changes occur in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: A total of 31 patients with LUTS were observed for >5 years. Their International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), voided volume (VV) a nd post-void residual (PVR) we re measured every month. RESULTS: Total IPSS, QOL, VV or PVR did not show any seasonal changes between the three seasons: summer (hot season: June to September); winter (cold season: December to March); and spring and fall (comfortable season: April, May, October and November). Furthermore, when the IPSS was examined by dividing it into storage symptoms (frequency, urgency and nocturia) and voiding symptoms (incomplete emptying, intermittency, weak stream and straining), no significant seasonal changes were detected. Only Qmax showed a significant seasonal change, being higher in both the cold season (median 10.4 ml/s) and the comfortable season (median 10.1 ml/s) than in the hot season (median 9.4 ml/s). CONCLUSIONS: It has generally been thought that LUTS worsen in winter. Our results indicate that the IPSS and the QOL score remain nearly constant if they are determined regularly over an extended period of time. Qmax may however be influenced by seasonal changes in temperature.     

A randomised, placebo-controlled study to assess the efficacy of twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

INTRODUCTION: Benign prostatic hyperplasia (BPH) is associated with bothersome lower urinary tract symptoms (LUTS) and reduced patient quality of life (QoL). Phosphodiesterase (type) 5 (PDE5) inhibitors such as vardenafil are commonly used for the treatment of erectile dysfunction (ED), but have also been shown to improve the symptoms of BPH. This randomised, double-blind, placebo-controlled study investigated the effects of vardenafil on LUTS and QoL in men with BPH/LUTS, with or without concomitant ED. METHODS: Men aged 45-64 yr with BPH/LUTS and an International Prostate Symptom Score (IPSS) > or =12 were randomised to receive either 10mg vardenafil or placebo twice daily. LUTS were assessed with the use of two primary efficacy parameters, IPSS score and maximum urinary flow rate (Qmax), as well as postvoid residual (PVR) urine volume; ED was measured with the use of the erectile function (EF) domain score of the International Index of Erectile Function (IIEF-EF); and QoL was assessed with the Urolifetrade mark QoL-9 questionnaire. RESULTS: After 8 wk of treatment, there was a significant improvement in the IPSS total score in the vardenafil group compared with placebo (-5.9 and -3.6, respectively; p=0.0013). Nominally significant improvements in irritative and obstructive IPSS subscores (p=0.0017 and p=0.0081, respectively), EF (p=0.0001), and Urolife QoL-9 (p<0.0001) were also associated with vardenafil treatment. Qmax and PVR urine volume did not change significantly with treatment, although baseline values were already considered close to normal. Vardenafil was generally well tolerated, with most adverse events considered mild or moderate in severity. CONCLUSIONS: Vardenafil treatment significantly improved LUTS, EF, and QoL in men with BPH/LUTS. Vardenafil may be considered a promising treatment option for men with symptoms secondary to BPH.     

Efficacy and safety of combination therapy with mirodenafil and α1-blocker for benign prostatic hyperplasia-induced lower urinary tract symptoms accompanied by erectile dysfunction: a multicenter, open-label, prospective study

This study was conducted to determine whether mirodenafil 100 mg, when administered on demand to patients with benign prostatic hyperplasia (BPH) who are receiving α1-blocker therapy, is safe with regard to the cardiovascular system and whether it improves lower urinary tract symptoms (LUTS) and sexual function. The study involved 121 LUTS/BPH patients who had been treated for at least 3 months with α1-blockers before being administered with mirodenafil 100 mg on demand. Before the start of mirodenafil administration, the blood pressure, heart rate, international prostate symptom score (IPSS)/quality of life (QoL), peak urine flow rate (Qmax), post-voiding residual urine volume (PVR), and international index of erectile function-5 (IIEF-5) of each patient were measured. At 4 and 8 weeks after commencing mirodenafil administration, the blood pressure and heart rate were measured again, any adverse effects of mirodenafil were assessed, and sexual function and voiding symptoms were re-evaluated. Of the 121 patients, 73 (60.3%) completed the 8-week clinical trial. Significant changes in blood pressure and heart rate were not observed during the study. Significant improvements in the IIEF-5 and the IPSS/QoL, but not the Qmax or PVR, were observed. The results of this study suggest that the administration of mirodenafil 100 mg on demand may induce few hypotensive interactions and may be acceptably effective with regard to improving LUTS and sexual function.     

The effectiveness of naftopidil in patients with benign prostatic hyperplasia evaluated by QOL index

We examined the effectiveness of naftopidil in 81 patients with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). We examined quality of life (QOL) and determined which symptoms improved as a result of naftopidil administration. The findings indicated that storage symptoms, voiding symptoms, total International Prostate Sympotom Score (IPSS), QOL index, Qmax and residual urine volume were significantly improved after treatment when compared to baseline. Improvement of nocturia and incomplete emptying by naftopidil contributed to improvement in QOL, odds ratio between the good response group and poor response group were 3.6 and 2.3, respectively. During naftopidil treatment, two of the 81 patients complained of adverse events. The results show that naftpidil is effective for LUTS caused by BPH, and that improvement of nocturia and incomplete emptying contributed to the improvement in QOL.     

Can preoperative detrusor underactivity influence surgical outcomes of 120 W HPS vaporization of the prostate (PVP) or holmium laser enucleation of the prostate (HoLEP)? A serial 3‐year follow‐up study

Aims

To determine the influence of preoperative detrusor underactivity (DU) on serial long‐term outcomes of HPS/PVP or HoLEP for LUTS/BPH, and to compare the influence between the two surgeries.

Methods

A total of 382 men, who underwent 120W‐HPS/PVP or HoLEP for LUTS/BPH and for whom 36‐month follow‐up data were available, were classified into four groups: HPS with DU (n = 145), HPS without DU (n = 44), HoLEP with DU (n = 105), and HoLEP without DU (n = 88). DU was defined as bladder contractility index of <100. Surgical outcomes were assessed at postoperative 6, 12, 24, and 36 months using IPSS, uroflowmetry, and serum PSA.

Results

All four groups maintained improvements in voiding symptom score (VSS), storage symptom score, total‐IPSS, QOL index, maximum flow rate (Qmax), post‐void residual urine volume (PVR), and bladder voiding efficiency (BVE) compared with baseline up to 3 years postoperatively. There were no significant differences in improvements of postoperative IPSS parameters including QOL index between men with and without DU throughout the follow‐up period after HPS or HoLEP. In men with DU, there were no significant differences in improvements of postoperative QOL index, Qmax, PVR, or BVE between HPS and HoLEP groups throughout the follow‐up period, except for VSS and total IPSS. Serum PSA reductions after HoLEP were greater than after PVP.

Conclusions

Improvements in LUTS, Qmax, and BVE can maintain up to 3 years after HPS or HoLEP for LUTS/BPH, irrespective of the presence or absence of preoperative DU. Although HoLEP may provide more durable improvement of VS in men with DU than HPS, there seems to be no difference in improvement of QOL or Qmax or BVE between HPS and HoLEP.     

膀胱重量与前列腺增生临床参数的相关性研究

目的探讨膀胱重量（Bw）与常用BPH临床参数的相关性。方法81例BPH患者分为尿潴留与非尿潴留组,经腹B超（TAUS）测量其BW,将BW与年龄、国际前列腺症状评分（I—PSS）、生活质量评分（QOL）、前列腺体积（PV）、排尿后残余尿（PVR）、最大尿流率（Qmax）和前列腺特异抗原（PSA）进行相关分析。结果81例患者年龄平均（71．73&#177;5．80）岁,IPSS（15．89&#177;3．44）分,QOL（3．88&#177;0．93）分,PV（61．55&#177;19．67）m1．PVR（71．11&#177;30．83）ml,Qmax（9．93&#177;2．74）ml／s,PSA（3．30&#177;2．63）rig／ml,BW（75．85&#177;18．45）g;两组间年龄、QOL、PV、PRV、Qmax、PSA和BW存在显著性差异,而I—PSS差异无显著性;BW与年龄、IPSS、QOL、PV、PRV、PSA呈显著正相关,相关系数分别为（r=0．587,r=0．481,r=0．816,r=0．911,r=0．784,r=0．864,P〈0．001）,而与Qmax呈显著负相关（r=-0．769,p〈0．001）。结论BW能反映BPH的严重程度,对指导判断BPH严重程度和外科干预时机可能有重要的临床意义。     

Saw Palmetto (Serenoa repens) in Men with Lower Urinary Tract Symptoms: Effects on Urodynamic Parameters and Voiding Symptoms

Objectives. To assess the effects of saw palmetto on voiding symptoms and urodynamic parameters in men with lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH).Methods. Fifty men with previously untreated LUTS and a minimum International Prostate Symptom Score (IPSS) of 10 or greater were treated with a commercially available form of saw palmetto (160 mg twice per day) for 6 months. The initial evaluation included measurement of peak urinary flow rate, postvoid residual urine volume, pressure-flow study, and serum prostate-specific antigen (PSA) level. Patients completed an IPSS, serum PSA was determined, and flow rate was measured every 2 months during the course of the study. A urodynamic evaluation was repeated at the completion of the 6-month trial.Results. The mean IPSS (±SD) improved from 19.5 ± 5.5 to 12.5 ± 7.0 (P <0.001) among the 46 men who completed the study. Significant improvement in the symptom score was noted after treatment with saw palmetto for 2 months. An improvement in symptom score of 50% or greater after treatment with saw palmetto for 2, 4, and 6 months was noted in 21% (10 of 48), 30% (14 of 47), and 46% (21 of 46) of patients, respectively. There was no significant change in peak urinary flow rate, postvoid residual urine volume, or detrusor pressure at peak flow among patients completing the study. No significant change in mean serum PSA level was noted.Conclusions. Saw palmetto is a well-tolerated agent that may significantly improve lower urinary tract symptoms in men with BPH. However, we were unable to demonstrate any significant improvement in objective measures of bladder outlet obstruction. Placebo-controlled trials of saw palmetto are needed to evaluate the true effectiveness of this compound.