坦索罗辛联合托特罗定改善老年男性帕金森病患者下尿路症状效果观察

目的观察坦索罗辛联合托特罗定对老年男性帕金森病(PD)患者下尿路症状(LUTS)的改善效果。方法选择伴发LUTS的老年男性PD患者84例,随机分为单用坦索罗辛组(对照组)、坦索罗辛联合托特罗定组(联合用药组),每组42例。对照组单用坦索罗辛,观察组联合应用坦索罗辛、托特罗定,4周为1个疗程。治疗2个疗程后,比较两组治疗前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率评分(Qmax)以及日均排尿次数、尿急发作次数、尿失禁次数、夜尿次数,观察两组治疗期间出现的不良反应情况。结果联合用药组治疗后IPSS、QOL、Qmax及日均夜尿次数、日均尿失禁次数、日均尿急发作次数、日均排尿次数较治疗前均明显改善(P均<0.05),而对照组各指标变化多不明显。两组治疗期间出现的不良反应症状轻微,治疗结束后皆缓解。结论坦索罗辛联合托特罗定改善PD伴发的LUTS效果较好,值得临床借鉴。     

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。     

坦索罗辛联合索利那新在治疗前列腺增生不同症状阶段伴膀胱过度活动症的疗效

目的探讨坦索罗辛联合索利那新在治疗良性前列腺增生(BPH)不同症状阶段伴膀胱过度活动症(OAB)的有效性及安全性。方法选取BPH患者168例;分为储尿期症状组(89例,试验组48例及对照组41例)和排尿期症状组(79例,试验组37例及对照组42例)。两组临床指标比较差异无统计学意义(P0.05)。两组中试验组均口服坦索罗辛0.2 mg,每日1次,索利那新5 mg。每日1次,共12 w。两组中对照组均服用坦索罗辛0.2 mg,每日1次。比较两组患者治疗前后国际前列腺症状评分(IPSS)、排尿期症状评分、储尿期症状评分、最大尿流率(Qmax)、残余尿量、膀胱过度活动症评分(OABSS)、尿常规检查、不良事件登记等。结果在储尿期症状组中,试验组治疗后在IPSS、储尿期症状评分、Qmax、OABSS等方面明显优于对照组(P0.05);残余尿量、尿常规检查、不良事件登记两组无明显差异(P0.05);但是,在排尿期症状组中,对照组治疗后IPSS、排尿期症状评分、Qmax、残余尿量优于试验组(P0.05)。试验组治疗后OABSS优于对照组(P0.05);尿常规检查及不良事件登记两组无明显差异(P0.05)。试验组治疗储尿期症状明显优于排尿期症状(P0.05)结论坦索罗辛联合索利那新治疗BPH储尿期症状较排尿期症状更安全、有效,且疗效优于单用坦索罗辛,而副作用无明显增加。     

坦索罗辛治疗良性前列腺增生疗效及安全性的Meta分析

目的:探讨坦索罗辛治疗良性前列腺增生的疗效以及安全性。方法:搜集2009~2014年世界范围内运用坦索罗辛治疗BPH的英文及中文文献,并追查已纳入文献的参考文献。使用计算机检索、手工检索等方式,参考《中华泌尿外科杂志》《中国男科学杂志》等权威杂志,由系统评价员对文献做独立的筛选和抽取。设坦索罗辛治疗为观察组,设特拉唑嗪治疗为对照组,收集数据采用相关软件进行Meta分析,计算其安全系数。结果:经筛选,有5篇文献符合相关标准,均是探讨坦索罗辛治疗良性前列腺增生的疗效以及安全性,并以特拉唑嗪作对照。此次5篇文献共囊括的患者936例,均为中老年良性前列腺增生患者,对其治疗结果进行Meta分析。通过比较用药前后国际前列腺症状评分(IPSS)、最大尿流率(MFR)和Boyarsky症状评分来比较治疗结果。发现坦索罗辛较特拉唑嗪的效果好,两者的对比具有统计学意义。其不良反应与安慰剂相比差异具有统计学意义(P<0.05)。结论:坦索罗辛在改善患者前列腺增生引起的相关症状和前列腺功能上效果较为显著,不良反应率低,是一种较为安全的治疗良性前列腺增生方法,可以进行临床推广。     

坦索罗辛治疗前列腺体积小于40 ml的前列腺增生合并膀胱过度活动症患者有效性的相关因素分析

目的观察坦索罗辛单药治疗前列腺体积(PV)<40 ml的前列腺增生(BPH)合并膀胱过度活动症(OAB)患者的有效性, 并分析影响疗效的相关因素。方法入组PV<40 ml的BPH合并OAB患者300例, 平均(66.9±7.7)岁, 调查吸烟、饮酒等生活习惯, 口服坦索罗辛0.2 mg, 每晚1次, 治疗4周, 采集治疗前后OAB症状评分(OABSS)评分、国际前列腺症状评分(IPSS)及生活质量(QOL)评分, 最大尿流率(Qmax)、膀胱残余尿量(PVR)。以OBASS作为主要观察指标, 分析年龄、生活习惯、治疗前症状评分、PV、Qmax、PVR等因素与治疗效果的相关性。结果完成研究257例, 治疗有效169例, 总体治疗有效率65.8%, 轻、中、重度OAB组治疗有效率分别为83.6%、62.4%、38.5%, 三组有效率比较差异有统计学意义(χ2=13.037, P=0.001);3例患者出现药物不良反应, 其中2例以轻度头晕为主, 1例出现恶心的症状。OAB治疗有效组基线OABSS评分、吸烟患者比例、饮酒患者比例均明显低于无效组, 多因素分析结果显示基线OABSS...     

溴吡斯的明联合坦索罗辛治疗良性前列腺增生伴急性脑梗死后尿潴留患者的疗效观察

目的观察溴吡斯的明联合坦索罗辛治疗良性前列腺增生伴急性脑梗死后尿潴留患者的临床疗效。方法选取2016年1月-2018年5月西安市第四医院泌尿外科收治的良性前列腺伴急性脑梗死后尿潴留患者58例,根据治疗方法分为对照组(n=30)和观察组(n=28)。在常规治疗基础上,对照组患者给予坦索罗辛治疗,观察组患者给予溴比斯的明联合坦索罗辛治疗;两组患者均连续治疗14 d。比较两组患者入院第7天、第14天留置尿管拔管率、残余尿量(RUV)、最大尿流率(Qmax)及治疗前后国际前列腺症状评分(IPSS)、生活质量(QOL)评分,并观察两组患者治疗期间不良反应发生情况。结果(1)观察组患者入院第7天、第14天留置尿管拔管率高于对照组(P<0.05)。(2)两组患者治疗前IPSS、QOL评分比较,差异无统计学意义(P>0.05);观察组患者治疗后IPSS、QOL评分低于对照组(P<0.05)。(3)观察组患者入院第14天拔管RUV低于对照组,入院第7天、第14天Qmax均高于对照组(P<0.05);两组患者入院第7天RUV比较,差异无统计学意义(P>0.05)。(4)两组患者治疗期间均未发生明显不良反应。结论溴吡斯的明联合坦索罗辛可有效提高良性前列腺增生伴急性脑梗死后尿潴留患者留置尿管拔除率、生活质量及尿流量,改善患者临床症状,降低患者膀胱RUV,且安全性较高。     

TUR-BT联合TUPKP治疗表浅性膀胱癌合并良性前列腺增生的疗效及安全性

目的 探讨同期行经尿道等离子双极膀胱肿瘤电切术(TUR-BT)联合经尿道前列腺等离子双极电切术(TUPKP)治疗表浅性膀胱癌(SBC)合并良性前列腺增生(BPH)的疗效及安全性.方法 选择SBC合并BPH患者39例,随机分为TUR-BT联合TUPKP组20例(A组)、单纯TUR-BT组19例(B组).观察两组术前、术后最大尿流率(MFR)、平均尿流率(AFR)、国际前列腺症状评分(IPSS)、残余尿量(RU)、生活质量评分(QOL)以及术后肿瘤复发率.结果 术后随访9～54个月,A组术后1例发生非原手术区域膀胱肿瘤复发,其MFR、AFR较术前明显升高(P均＜0.05),IPSS、RU、QOL明显降低(P均＜0.05).B组术后6例发生非原手术区域膀胱肿瘤复发,其MFR、AFR、IPSS、RU、QOL手术前后比较P均＞0.05.两组术后肿瘤复发率比较差异有统计学意义(P＜0.05).结论 TUR-BT联合TUPKP治疗SBC合并BPH能有效解除下尿路梗阻,减少肿瘤术后复发,疗效确切,安全可行.     

天津地区中老年男性原发性高血压与良性前列腺增生和下尿路症状的相关性

目的探讨天津地区普通居民中50岁以上男性人群中原发性高血压与良性前列腺增生(BPH)以及下尿路症状(LUTS)之间的关系。方法 2011年2月开始于天津医科大学总医院进行健康体检的天津地区老年男性中剔除其他相关因素后筛选出413名受试者,采用单因素和多因素分析法研究其一般人口学特征、国际前列腺评分(IPSS)、生活质量评分(QOL)、最大尿流率(MFR)、膀胱壁厚度、残余尿、前列腺特异性抗原(PSA)、前列腺体积8个方面与收缩压和舒张压之间的相关性。结果天津地区普通人群中老年男性BPH患病率为56.17%,患病年龄50～81岁,平均年龄59.7岁。统计分析显示BPH合并原发性高血压者122例,高血压组BPH患病率(69.3%)明显高于非高血压组(46.6%),BPH合并高血压组患病年龄明显高于单纯BPH组(P<0.05);BPH合并高血压组中,收缩压与患者发病年龄提前显著相关。下尿路症状方面,IPSS评分、最大尿流率、残余尿及膀胱壁厚度与高血压无明显相关性。结论天津地区普通中老年男性人群原发性高血压尤其是高收缩压可能促进BPH的发生。     

选择性环氧合酶抑制剂联合用药控制老年前列腺增生下尿路症状的疗效

目的 比较环氧合酶抑制剂联合α受体阻滞剂以及单独应用α受体阻滞剂治疗前列腺增生症(BPH)下尿路症状的疗效及安全性.方法 共计69例患者入选.试验组治疗方式为多沙唑嗪4 mg/d+塞来昔布200 mg/d,对照组为单独服用多沙唑嗪4 mg/d,治疗周期6 w.评价指标包括尿流率,残余尿,国际前列腺症状评分(IPSS),国际勃起功能评分(IIEF).膀胱过度活动症状评分(OABSS)等.结果 与基线水平相比,两组IPSS、OABSS均显著降低,最大尿流率、平均尿流率均显著改善,但联合治疗组改善的程度明显好于单药治疗组(P＜0.01).结论 环氧合酶抑制剂与α受体阻滞剂联合用药在老年患者中安全性高,可以更好地改善BPH下尿路症状.     

后尿道形态改变在诊断良性前列腺增生致下尿路症状中的应用

目的探讨经直肠超声观察良性前列腺增生(BPH)致下尿路症状(LUTS)时后尿道形态的改变。方法 BPH患者65例,应用经直肠超声检查,测量前列腺体积和膀胱残余尿量,观察后尿道走行及尿道内口,采用国际前列腺症状评分(IPSS)评价LUTS,根据超声测量结果将患者分为后尿道形态正常组30例和后尿道形态改变组35例,对比两组患者LUTS、前列腺增生程度及膀胱残余尿量分级所占比例,采用Pearson相关性分析后尿道形态及尿道内口的改变与IPSS评分、膀胱残余尿量、前列腺体积的关系。结果两组患者LUTS、膀胱残余尿量分级所占的比例比较差异均有统计学意义(P<0.05),两组前列腺增生程度比较差异无统计学意义(P>0.05)。后尿道形态及尿道内口的改变与IPSS评分、膀胱残余尿量呈正相关性(P<0.05),与前列腺体积无相关(P>0.05)。结论经直肠超声观察后尿道走行及尿道内口形态改变可作为BPH致LUTS的直接证据。     

Correlations among Lower Urinary Tract Symptoms,Bother, and Quality of Life in Patients with Benign Prostatic Hyperplasia and Associated Fluctuations with Tamsulosin Administration

Objectives: To estimate correlations among lower urinary tract symptoms (LUTS), bother, and quality of life (QOL) and assess fluctuations in these parameters after α1‐blocker administration in patients with benign prostatic hyperplasia (BPH). Methods: Untreated BPH patients with international prostate symptom scores (IPSS) ≥ 8 and IPSS‐QOL scores ≥ 2 were administered tamsulosin at 0.2 mg/day for 4 weeks in a prospective multicenter study. We subsequently estimated the IPSS, bother score for each IPSS item, BPH impact index (BII), and IPSS‐QOL score before and 4 weeks after tamsulosin administration. We also analyzed the LUTS that might strongly influence QOL by using a path analysis model. Results: Analyzable data were obtained from 198 of the 257 patients enrolled. The IPSS were highest for LUTS such as slow stream, followed by increased daytime frequency and nocturia. The bother score was highest for slow stream, followed by nocturia. We observed dissociations between IPSS and bother scores for both urgency and nocturia. After tamsulosin administration, total and individual IPSS, total and individual bother scores, total and individual BII scores, and IPSS‐QOL score demonstrated significant improvements. Path analysis showed that physical discomfort and bothersomeness were BII items that strongly influenced QOL. Furthermore, feeling of incomplete emptying, urgency, and slow stream were LUTS that strongly influenced QOL. Conclusion: Tamsulosin administration improved patient QOL by possible mechanisms via improvement in subjective symptoms and bother. The LUTS that strongly influenced QOL comprised feeling of incomplete emptying, urgency, and slow stream.     

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.     

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.     

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.     

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.     

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.     

Who Would Benefit from Solifenacin Add‐On Therapy to Tamsulosin for Overactive Bladder Symptoms Associated with Benign Prostatic Hyperplasia?

Objectives: We evaluated the types of patient factors that influence the efficacy and safety of solifenacin add‐on therapy to tamsulosin in men with overactive bladder (OAB) associated with benign prostatic hyperplasia (BPH). Methods: A total of 130 BPH patients with persistent OAB symptoms despite undergoing alpha1‐adrenagic antagonist monotherapy were enrolled in this study. Their OAB symptoms persisted after monotherapy consisting of tamsulosin 0.2 mg once daily for more than 8 weeks, followed by subsequent solifenacin 5 mg once daily. The patient backgrounds were assessed, as were the changes in their International Prostate Symptom score (IPSS), Quality of Life (QOL) index, and Overactive Bladder Symptom Score (OABSS) before and 8 weeks after the administration of solifenacin. Results: Total IPSS, QOL index, and OABSS improved significantly following solifenacin administration. Multivariate analyses revealed prostate volume was the only predictor that contributed to the improvement of total IPSS. In patients with prostate volume <30 mL, the improvement in total IPSS (?3.5) was superior to that for prostate volume >30 mL (?0.5; P = 0.002). The data also demonstrated that diabetes mellitus was an independent factor preventing OABSS improvement. In patients with diabetes mellitus, OABSS was not sufficiently improved (?0.6) compared to patients without diabetes (?2.1; P < 0.001). Conclusion: Solifenacin add‐on therapy to tamsulosin showed efficacy and good tolerability in BPH patients with OAB symptoms. The findings also indicated that patients with a relatively small prostate and without diabetes mellitus would receive more benefit from this therapy.     

老年人良性前列腺增生与心血管疾病的关系

目的 了解老年良性前列腺增生(BPH)患者临床特点及用药情况,探讨BPH与心血管疾病的关系. 方法 搜集本院老年病科100例BPH患者临床资料,采用国际前列腺症状评分表(IPSS)、生活质量量表(QOL)对患者进行评价,所有患者均详细询问心血管病史,并检测前列腺特异性抗原(PSA)水平,采用腹部超声测量前列腺体积(PV). 结果 老年BPH患者PV和PSA随年龄增长而升高;疾病严重程度以中度(IPSS 8～19分)多见;BPH患者高血压、冠心病和糖尿病患病率高,冠心病者PV显著高于非冠心病者(P＜0.05);我院BPH患者服用5-α还原酶抑制剂和α-受体阻滞剂者多见,治疗依从性好. 结论 老年BPH患者严重程度与年龄、冠心病发病相关;药物干预治疗以5-α还原酶抑制剂使用率最高.