α1肾上腺素能阻滞剂用于患有原发性膀胱颈梗阻的年轻男性。

alpha1-Adrenergic blockers in young men with primary bladder neck obstruction.

作者信息

Yang Stephen Shei Dei, Wang Chung Cheng, Hsieh Cheng Hsing, Chen Yung Tai

机构信息

Department of Urology, En Chu Kong Hospital, College of Medicine, National Taiwan University and Taipei Medical University, Taiwan, Republic of China.

出版信息

J Urol. 2002 Aug;168(2):571-4.

PMID:12131312

Abstract

PURPOSE

We assessed the efficacy and safety of the mid term use of alpha1-adrenergic blockers for treating primary bladder neck obstruction in young and middle-aged men.

MATERIALS AND METHODS

Between May 1998 and February 2001 primary bladder neck obstruction was diagnosed by videourodynamic study in 28 men younger than 55 years. The degree of obstruction was graded by the Schafer nomogram. Mean patient age and mean symptom duration were 39.3 years and 18.1 months, respectively. The presenting symptom was frequency in 22 cases (78.6%), urgency in 10 (35.7%), weak stream in 9 (32.1%), nocturia greater than 2 times in 7 (25%) and hesitancy in 7 (25%). A dose of 1 to 2 mg. doxazosin was administered at bedtime for at least 3 months. International Prostate Symptom Score (I-PSS), quality of life, uroflowmetry and post-void residual urine were assessed before and 3 months after medication. Improved urine flow was defined as at least a 2.5 ml. per second increase in the maximum flow rate. Improved symptoms was defined as more than a 50% decrease in I-PSS. Successful treatment was defined as improved urine flow and symptoms.

RESULTS

Followup data were available in 24 patients. The medication period and followup were 7 and 12 months, respectively. Mean I-PSS plus or minus standard deviation decreased from 18.3 +/- 4.6 to 11.6 +/- 5.2 (p <0.01) and mean quality of life decreased from 4.1 +/- 1.1 to 2.6 +/- 1.0 (p <0.01). Mean maximum flow increased from 11.8 +/- 3.2 to 15.9 +/- 3.9 ml. per second (p <0.01). Mean post-void residual urine decreased from 80.2 +/- 17.1 to 48.5 +/- 10.3 ml. (p <0.01). Treatment was successful in 13 patients (54.2%) and 3 (12.5%) were free of medication for at least 6 months. More successful outcomes were noted in patients with high grades III to IV obstruction than in those with low grades 0 to II obstruction (80% versus 35.7%, p = 0.03). Before treatment higher detrusor pressure at maximum flow (70.1 versus 47.8 cm. water, p = 0.01) and lower maximum flow (10.6 versus 13.3 ml. per second, p = 0.02) were observed in patients with successful versus unsuccessful treatment, respectively. Differences in patient age, I-PSS, quality of life, prostate size and post-void residual urine were not statistically significant. No significant adverse effects were noted.

CONCLUSIONS

alpha1-Blockers were effective and safe for treating young men with primary bladder neck obstruction.

摘要

目的

我们评估了α1-肾上腺素能阻滞剂中期治疗中青年男性原发性膀胱颈梗阻的疗效和安全性。

材料与方法

1998年5月至2001年2月，通过影像尿动力学研究对28名年龄小于55岁的男性诊断为原发性膀胱颈梗阻。梗阻程度采用谢弗列线图分级。患者平均年龄和平均症状持续时间分别为39.3岁和18.1个月。主要症状为尿频22例（78.6%）、尿急10例（35.7%）、尿流无力9例（32.1%）、夜尿大于2次7例（25%）、排尿犹豫7例（25%）。睡前给予1至2毫克多沙唑嗪，至少服用3个月。在用药前和用药3个月后评估国际前列腺症状评分（I-PSS）、生活质量、尿流率和排尿后残余尿量。尿流改善定义为最大尿流率至少每秒增加2.5毫升。症状改善定义为I-PSS降低超过50%。成功治疗定义为尿流和症状改善。

结果

24例患者有随访数据。用药期和随访期分别为7个月和12个月。平均I-PSS加减标准差从18.3±4.6降至11.6±5.2（p<0.01），平均生活质量从4.1±1.1降至2.6±1.0（p<0.01）。平均最大尿流率从11.8±3.2增至15.9±3.9毫升/秒（p<0.01）。平均排尿后残余尿量从80.2±17.1降至48.5±10.3毫升（p<0.01）。13例患者（54.2%）治疗成功，3例（12.5%）至少6个月未用药。III至IV级高梗阻患者的成功结局比0至II级低梗阻患者更多（80%对35.7%，p=0.03）。治疗前，成功治疗与未成功治疗的患者相比，最大尿流时逼尿肌压力更高（70.1对47.8厘米水柱，p=0.01），最大尿流率更低（10.6对13.3毫升/秒，p=0.02）。患者年龄、I-PSS、生活质量、前列腺大小和排尿后残余尿量的差异无统计学意义。未观察到明显不良反应。