多沙唑嗪控释片治疗前列腺增生症的对照研究

目的评价多沙唑嗪控释片、特拉唑嗪片和坦索罗辛片等3种α1受体阻滞剂治疗良性前列腺增生症(BPH)的临床有效性和安全性。方法对入选的183例BPH患者进行了一个前瞻性的随机、双盲和平行对照试验,过程分3个阶段:第一阶段为2周的清洗期,第二阶段为2周的单盲安慰剂导入期,第三阶段为12周的双盲药物治疗期。多沙唑嗪控释片、特拉唑嗪片和坦索罗辛片的起始剂量分别为4 mg/d、1 mg/d和0.4 mg/d,如果治疗4周后最大尿流率(Qmax)增加<3 mL/s,国际前列腺症状评分(IPSS)下降<30%,则将3种药物分别加量为8 mg/d、8 mg/d和0.8 mg/d。主要评价指标为从基线到最后1次随访的IPSS和Qmax的变化值,以及治疗中常见不良事件的发生率。统计方法采用方差分析和χ2检验。结果多沙唑嗪控释片、特拉唑嗪片和坦索罗辛片均能显著减轻BPH的下尿路梗阻症状,增加Qmax(P<0.01),但是前两种药物对IPSS的降低显著优于坦索罗辛片(P<0.05)。多沙唑嗪控释片组没有因为与治疗相关的不良事件而退出试验的患者,并且在头晕、恶心、体位性低血压等主要不良事件的发生率与特拉唑嗪片组和坦索罗辛片组比较,差异有统计学意义(P<0.05)。结论α1受体阻滞剂均能有效缓解BPH的下尿路症状。多沙唑嗪控释片作用全面,有效性和安全性显著提高,是这类药物的首选。     

国产盐酸特拉唑嗪治疗前列腺增生症的临床研究

目的:对盐酸特拉唑嗪治疗前列腺增生症患者的疗效与安全性进行临床评价.方法:采用随机平行对照试验方法,对比研究受试药盐酸特拉唑嗪和高特灵对102例前列腺增生症(BPH)患者的疗效及药物不良反应.特拉唑嗪和对照药高特灵分别每日1次口服2mg,疗程4周.结果:治疗后患者国际前列腺症状评分(I-PSS)、生活质量评分(QOL)、最大尿流率(MFR)及残尿量(RU)与用药前比较,均有明显改善(均P<0.01),两药无显著差异(P>0.05).两药综合疗效评价的有效率分别为66%及68%.两药使患者的收缩压(SBP)和舒张压(DBP)均有统计意义的降低,但对基础血压正常(BP<140/90 mmHg)的患者SBP和DBP无明显影响,而对基础血压异常(SBP>140 mmHg或(和) DBP>90 mmHg)的患者血压降低幅度显著,两者均有显著差异(分别P<0.01;P<0.05).两组各有1例因头昏而退出试验.药物不良反应发生率分别为15.7 %和19.6 %,主要症状为轻微头昏、口干等,勿需任何处理,于2～3d内逐渐减轻和消失.结论:特拉唑嗪片治疗前列腺增生症疗效确切,药物不良反应轻,耐受性好,对伴有高血压的前列腺增生症患者更为有益.     

Combination of finasteride and doxazosin for the treatment of benign prostatic hyperplasia

Finasteride, which inhibits the enzyme 5 alpha-reductase, reduces prostate size and relieves the symptoms of benign prostatic hyperplasia (BPH) in men with enlarged prostates. alpha 1 -Adrenoceptor antagonists, such as doxazosin and terazosin, are also effective in the treatment of BPH. Previous clinical studies in which finasteride had little or no effect alone, have shown little or no additive effect with alpha 1 -adrenoceptor antagonists. The Medical Therapy of Prostatic Symptoms study showed a considerable benefit with finasteride alone and an additive effect when administered with doxazosin. One interpretation of these results is that if finasteride is effective alone in BPH, the combination with an alpha 1 -adrenoceptor antagonist will give an additive effect.     

盐酸坦索罗辛联合非那雄胺对延缓和预防BPH临床进展的疗效观察

目的：探讨坦索罗辛联合非那雄胺对延缓和预防良性前列腺增生临床进展性的疗效。方法：对具有前列腺增生临床进展高危因素的患者给予坦索罗辛联合非那雄胺治疗,观察治疗前后各项相关指标的变化,并进行统计学处理。结果：全部患者症状显著改善,临床进展的风险显著降低。结论：坦索罗辛联合非那雄胺能显著降低良性前列腺增生临床进展,显著减少急性尿潴留的发生和外科干预的风险。     

Combination of finasteride and doxazosin for the treatment of benign prostatic hyperplasia

Finasteride, which inhibits the enzyme 5α-reductase, reduces prostate size and relieves the symptoms of benign prostatic hyperplasia (BPH) in men with enlarged prostates. α₁-Adrenoceptor antagonists, such as doxazosin and terazosin, are also effective in the treatment of BPH. Previous clinical studies in which finasteride had little or no effect alone, have shown little or no additive effect with α₁-adrenoceptor antagonists. The Medical Therapy of Prostatic Symptoms study showed a considerable benefit with finasteride alone and an additive effect when administered with doxazosin. One interpretation of these results is that if finasteride is effective alone in BPH, the combination with an α₁-adrenoceptor antagonist will give an additive effect.     

西地那非治疗良性前列腺增生症所致下尿路症状的疗效

目的 观察西地那非治疗前列腺增生症（BPH）所致下尿路症状（LUTS）的临床疗效及安全性.方法 将经导入期后符合本试验研究的90例BPH所致LUTS并伴有勃起功能障碍（ED）的患者完全随机分成治疗组45例、对照组45例.治疗组口服西地那非100 mg/次,1次/d;对照组服用外型相同的安慰剂1片/次,1次/d,2组均用药8周.观察2组患者IPSS、最大尿流率（Qmax）、残余尿量等的改变,对LUTS进行评估;采用国际勃起功能评分（IIEF-5）对勃起功能进行评估,采用生活质量（QoL）评分评价BPH患者生活质量.结果 2组各有3例患者失访,末获任何评估结果,故实际试验患者数为84例.治疗8周后,对照组各项指标及治疗组的Qmax、残余尿量均有所改善,但差异无统计学意义（P＞0.05）;治疗组治疗后与治疗前比较IPSS、IIEF-5、QoL评分均明显改善（13.3分比17.5分,23.2分比15.2分,2.0分比4.9分,P＜0.05）.试验中,不良反应发生率治疗组为3例（7.1%）,对照组为2例（4.7%）,治疗组患者对西地那非耐受良好,不良反应轻微.结论 西地那非对治疗BPH所致LUTS有效、安全,尤其对BPH伴发ED患者具有较好的疗效.     

Terazosin. A pharmacoeconomic evaluation of its use in benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a common disorder in elderly men which carries a substantial economic burden. Urinary symptoms associated with moderate to severe disease can significantly interfere with daily activities and reduce quality of life. Obstruction of urine flow in men with BPH can result from nonmalignant enlargement of the prostate gland (static component of BPH) and from alpha 1 receptor-mediated increased smooth muscle tone of the bladder neck and prostate (dynamic component of BPH). Transurethral resection of the prostate (TURP) is generally very effective and has traditionally been the standard treatment for men with moderate to severe BPH. However, response to therapy with TURP is not universal and the procedure is associated with a number of potential complications. Moreover, many men prefer to avoid or are not suitable candidates for this invasive procedure. Thus, there is an increasing role for less invasive treatment, including drug therapy, in men with moderate to severe BPH. Terazosin is an alpha 1 receptor antagonist which has been shown in placebo-controlled trials to significantly improve American Urology Association (AUA) symptom and quality-of-life scores and symptom problem index ('bother' score), as well as increase peak urinary flow rate, in men with BPH. In a recent large randomised US trial, treatment for 1 year with terazosin titrated to 10 mg/day improved mean AUA symptom score and peak urinary flow rate to a significantly greater extent than finasteride 5 mg/day in men with moderate to severe BPH. The most frequently reported adverse events associated with terazosin include dizziness, asthenia, postural hypotension, somnolence, headache, peripheral oedema, nasal congestion/rhinitis and syncope. Approximately 5% of men with BPH discontinue terazosin because of adverse events. Results of an economic evaluation of terazosin, in which both clinical and economic data were collected prospectively in a randomised placebo-controlled study design, showed similar total direct treatment costs per 1000 patients associated with 1 year of therapy with terazosin ($US3.57 million) and placebo ($US3.78 million) in men with moderate to severe BPH (1992 dollars). The analysis, which was conducted from the perspective of a managed care organisation in the US, demonstrated that the lower medication costs in the placebo group relative to the terazosin group were offset by increased inpatient care costs. Thus, terazosin (titrated to response up to a maximum of 10 mg/day) was significantly more effective than placebo in improving disease-specific symptoms and quality of life, but at a similar overall cost to placebo. Another economic analysis, also conducted from a third-party payer perspective in the US, modelled direct treatment costs associated with terazosin, finasteride and TURP during the first 2 years after initiating therapy in men with moderate to severe BPH. Results of the study favoured terazosin; the private insurance cost per patient undergoing primary treatment with TURP was $US6411, compared with $US2860 with finasteride (45% of the cost of TURP) and $US2422 with terazosin (38% of the cost of TURP). Medicare costs were lower for all 3 treatment groups but the relative comparisons were similar; corresponding costs per patient were $US3874, $US2161 and $US1820 (1992 dollars). A companion break-even cost analysis used a hypothetical cohort of men with BPH starting treatment at age 67 years. Private insurance costs associated with terazosin remained lower then those associated with TURP for approximately 15 years (the corresponding break-even point was 10 years for finasteride vs TRUP). Medicare costs associated with terazosin would not exceed those of TURP for approximately 7 years (5.5 years for finasteride vs TURP). In conclusion, a limited number of detailed pharmacoeconomic analysis of terazosin have been conducted to date, although it has not been compared with other a1 receptor antagonists.     

Effects of alpha(1)-adrenoceptor antagonists on male sexual function

alpha(1)-Adrenoceptor antagonists such as alfuzosin, doxazosin, tamsulosin and terazosin are first-line agents for the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH), but are only second-line agents (doxazosin and terazosin only) for the treatment of arterial hypertension. Sexual function is complex and includes multiple domains such as sexual desire (libido), erectile function and ejaculatory function. Erectile and ejaculatory functions are frequently reduced in patients with BPH and can impact on their quality of life. Therefore, the treatment of BPH should aim to maintain or even restore sexual function.alpha(1)-Adrenoceptor antagonists lack major effects on sexual desire in placebo-controlled studies. Reports on erectile function are inconsistent, with both beneficial and adverse effects being reported, but impotence can occur in some patients without clear differences between drugs. Ejaculatory dysfunction during treatment may represent (relative) an ejaculation. It occurs more frequently with tamsulosin than with other drugs of this class, but the differences are not big enough to be consistently detectable in directly comparative studies. We propose that such differences between drugs should be weighed against differences in cardiovascular tolerability when choosing the optimal treatment for each patient.     

经尿道电气化切除术治疗前列腺增生症

目的 评价经尿道前列腺电气化切除术(TUVP)治疗良性前列腺增生症(BPH)。方法 回顾性分析62例进行TUVP的BPH病人的临床资料。结果 所有病人排尿梗阻症状均明显改善,术后最大尿流率明显提高、国际前列腺症状评分显著降低。并发症主要有继发性出血(3.2％)和尿道狭窄(6.4％)。结论 TUVP术是治疗BPH一种安全有效的方法。     

经尿道前列腺剜除术与电切术治疗前列腺增生对患者疗效与并发症影响

目的:探讨前列腺增生患者采用经尿道前列腺剜除术与电切术治疗的临床效果。方法:随机选取于2015年1月~2018年1月治疗前列腺增生的88例患者,A组采用经尿道等离子前列腺电切术(TUPKRP)治疗,B组采用经尿道等离子前列腺剜除术(TUPKEP)治疗,比较两组的手术疗效。结果:B组手术时间、出血量、住院时间、术后半年IPSS指标及并发症发生率明显少于A组,腺体切除量、术后半年Qmax指标明显多于A组,差异有统计学意义(P<0.05)。结论:TUPKEP术治疗前列腺增生,能有效改善患者临床症状,减少其出血量与并发症发生率,促进患者早日康复。     

非那雄安联合特拉唑嗪对前列腺增生症围手术期腺体微血管密度的影响

目的通过对CD34和第Ⅷ因子相关抗原（FⅧ-Rag）在非那雄安联合特拉唑嗪治疗前列腺增生症围手术期中的表达及腺体微血管密度（MVD）的检测,探讨前列腺增生症围手术期非那雄安联合特拉唑嗪治疗后FⅧ-Rag、CD34与MVD的关系及其对手术的影响。方法设在围手术期联合应用非那雄安、特拉唑嗪为实验组,单独服用非那雄安治疗为对照组,采用免疫组化方法检测两组患者术后前列腺组织中CD34、FⅧ-Rag的表达,并检测其微血管密度。结果实验组与对照组CD34的表达值分别为（19.4±3.6）和（21.5±4.7）,FⅧ-Rag的表达值分别为（14.8±2.1）和（18.3±3.5）,差异均有统计学意义（P均〈0.05）。结论在前列腺增生症围手术期应用非那雄安联合特拉唑嗪治疗,可以降低前列腺腺体的微血管密度,有效减少手术中和手术后的出血。     

经尿道等离子体电切术治疗高龄高危前列腺增生症的体会

目的：探讨经尿道等离子体双极电极汽化电切术（TUPKVP）治疗高龄高危前列腺增生症（BPH）的安全性及疗效。方法：采用TUPKVP治疗高龄高危BPH患者61例。结果：手术切除前列腺重量（14．1～90．0）g,平均53g,出血量30～100ml,未出现TURS、真性尿失禁,术中、术后无输血,所有患者术后均排尿通畅,随访3～12个月,IPSS评分由术前（22．4±4．2）分,降至术后（7.2±3．3）分。结论：TUPKVP是高龄高危BPH的安全有效的治疗方法,TUPKVP的汽化止血效果更好．更能减少TURS的发生,对高龄高危的BPH患者安全性更高。     

经尿道前列腺电切和气化治疗高龄重度前列腺增生

目的：探讨经尿道前列腺电切和气化治疗高龄重度前列腺增生的临床效果。方法：回顾性分析本院近年来收治的60例高龄重度前列腺增生患者的临床资料。结果：60例高龄重度前列腺增生患者手术均顺利完成,无中转开放手术病例,患者围术期生命体征平稳,无意外事件发生。术后随访3个月均排尿通畅,无膀胱颈部挛缩发生。患者的前列腺症状评分（IPSS）、生活质量评分（QOL）、残余尿量（RUV）与术前比较,均有改善,差异有统计学意义（P〈0.01）。结论：经尿道前列腺电切和气化治疗高龄重度前列腺增生,不仅具有创伤小、出血量少、临床症状改善明显的特点,还无明显并发症发生,值得临床推广应用。     

录流动力学检查在前列腺增生手术适应证选择中的临床价值

目的：评价尿流动力学检查在前列腺增生（BPH）手术适应证选择中的临床价值。方法：对110例BPH患者分别进行术前、术后的残余尿测定、国际前列腺症状评分（IPSS）以及尿流动力学检查。结果：110例BPH患者中均存在膀胱出口梗阻（BOO）,术后BPH患者症状明显改善,各项尿流动力学指标都得到改善,梗阻得到解除,膀胱功能也得到相应的改善。结论：尿流动力学检测可以判断BPH患者是否存在BOO以及了解逼尿肌及评价膀胱功能,选择合理的治疗方案及判断预后具有重要的临床意义。     

Treatment of Benign Prostatic Hyperplasia

Drugs & Aging - Men with moderate symptoms of benign prostatic hyperplasia (BPH) are the best candidates for medical treatment, while surgery is usually indicated for patients with severe...     

Cost-effectiveness of tamsulosin, doxazosin, and terazosin in the treatment of benign prostatic hyperplasia

OBJECTIVE: To evaluate the cost-effectiveness of tamsulosin, doxazosin, or terazosin as initial treatments for moderate benign prostatic hyperplasia (BPH) over a 3-year time horizon from a health-system-payer perspective. METHODS: A decision-analytic model is used to project the course of treatment at 6-month intervals over 3 years following initiation of therapy with tamsulosin, doxazosin, or terazosin. Treatment failure is defined as failure to attain and maintain a 25% improvement in the American Urological Association (AUA) symptom score from baseline. In the model, finasteride is added for patients who fail on their initial therapy and, in the event of finasteride treatment failure, patients progress to transurethral resection of the prostate (TURP) and, if needed, a second TURP. The ranges of values for treatment failure rates and clinical event cost parameters used in the decision model are derived from the literature. Only direct medical costs related to BPH and its treatment are included. Since 2 comparators are available generically (doxazosin and terazosin) drug acquisition costs are defined by the list prices at Drugstore.com. All costs are discounted by 3% per year. Effectiveness is measured as successful medical treatment without surgery over 3 years. RESULTS: For base-case model parameters, discounted BPH-related total direct medical costs over 3 years are 4084 dollars, 4323 dollars, and 4695 dollars for generic terazosin, generic doxazosin, and tamsulosin, respectively. The model estimates a medical treatment success rate (no TURP) at 3 years of 72.3% for tamsulosin, compared with 68.2% for both terazosin and doxazosin. The incremental cost for tamsulosin versus terazosin is 610 dollars over 3 years, which yields an incremental cost-effectiveness ratio of 14,609 dollars per success. Generic doxazosin is dominated (higher cost but equal effectiveness compared with terazosin). Higher rates of twice-daily (or 2 units per day) dosing are associated with higher incremental cost-effectiveness ratios. The decision-model results also are sensitive to the estimated costs of TURP and hypotensive adverse events. CONCLUSION: As an initial medical therapy for moderate BPH, tamsulosin is more effective than generic terazosin or doxazosin, with an incremental cost of about 203 dollars per year (or about 17 dollars per month) over 3 years.     

良性前列腺增生症并急性尿潴留逼尿肌功能改变的临床探讨

目的：探讨前列腺增生症（BPH）出现急性尿潴留（AUR）后逼尿肌功能情况。方法：对76例BPH并急性尿潴留患者（AUR组）进行尿动力学检查,并与88例单纯BPH患者（非AUR组）作比较。结果：AUR组中逼尿肌功能不稳定、逼尿肌低顺应性以及合并二种以上逼尿肌异常的发生率明显高于非AUR组。结论：BPH出现急性尿潴留时逼尿肌功能严重受损,应及时解除膀胱出口梗阻。     

急诊手术治疗前列腺增生症并出血临床分析

目的 探讨前列腺增生症（BPH）并出血急诊行前列腺电汽化术（TVP）的疗效。方法 对我院6年来34例前列腺增生症并出血急诊行前列腺电汽化术患者的临床资料进行回顾分析。结果 平均手术时间56．3min，切除前列腺组织平均重量28．2g。术后随访3—6个月，国际前列腺症状评分（IPSS）、生活质量评分（QOL）均有改善。结论 急诊行前列腺电汽化术治疗前列腺增生症并出血安全、有效，并发症少。     

高危前列腺增生症经尿道前列腺电汽化切除的围手术期处理

目的总结高危前列腺增生症(BPH)围手术期处理体会,提高手术治疗的疗效和安全性。方法进行全面详细的临床检查,客观评价重要脏器功能,有效治疗内科原有疾病,然后采用经尿道前列腺电汽化切除术(TUVP)治疗高危患者96例。结果平均随访6.8个月,前列腺症状评分、生活质量评分、最大尿流率和残余尿量均较术前明显改善。结论TUVP治疗BPH期间,加强围术期处理措施,不仅其疗效显著,且可做到创伤小、安全性高和并发症少。