伴有下尿路症状的良性前列腺增生症治疗选择的探讨

目的 探讨伴有下尿路症状(LUTS)的良性前列腺增生症(BPH)的科学治疗选择.方法 将2006年1月至2007年12月伴有LUTS的BPH患者209例,根据患者意愿分为两组,分别采用经尿道手术(A组,115例)和盐酸坦索罗辛治疗(B组,94例).治疗前后采用问卷形式,比较两组患者国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Q_(max))及国际勃起功能评分5(IIEF-5)和治疗总体满意率.结果 两组患者均获得随访,平均随访15个月(10-22个月).治疗后两组IPSS、QOL评分和总体满意率比较差异无统计学意义,但A组的Q_(max)高于B组[(20.6±2.8)ml/s比(17.1±3.2)ml/s,P＜0.05],而B组的IIEF-5低于A组[(16.5±4.7)分比(19.3±3.4)分,P＜0.05].结论 对伴有LUTS的BPH患者,治疗前应重视患者性功能要求和评估,科学选择治疗措施.盐酸坦索罗辛在改善LUTS的同时可明显改善患者性功能,经尿道手术虽可有效解除膀胱出口 梗阻,但可导致勃起功能下降.

Therapeutic selection of benign prostatic hyperplasia with lower urinary tract symptoms

Objective To improve therapeutic selection of benign prostatic hyperplasia ( BPH) with lower urinary tract symptoms (LUTS). Methods Two hundred and nine BPH patients with LUTS were divided into transurethral resection (group A,115 patients) and tamsulosin (group B,94 patients). The international prostate symptoms score (IPSS),quality of life (QOL),maximal flow rate (Qmax),international index of erectile function 5 (ITEF-5) and satisfactory degree were used for investigating safety and efficacy before and after the treatments. Results Mean follow-up periods were 15 months (ranged 10 to 22 months),all patients were followed up. IPSS,QOL and satisfactory degree between the two groups were no statistically significance after treatment. Qmax of group A was superior to group B [ (20.6 ± 2.8) ml/s vs (17.1 ±3.2) ml/s,P＜0.05],while IIEF-5 of group A was superior to group B [(19.3 ±3.4) scores vs (16.5 ±4.7) scores,P＜ 0.05]. Conclusions Therapeutic selections should be based on complete evaluations of patients symptoms and sexual status. Tamsulosin can improve both of the LUTS and sexual function,while transurethral resection of the prostate can relieve bladder outlet obstruction markedly but decrease patients' erectile function.