MacDonald Donald, McNicholas Thomas A
Wolfson Institute for Biomedical Research, University College London, London, UK.
Drugs. 2003;63(18):1947-62. doi: 10.2165/00003495-200363180-00004.
Benign prostatic hyperplasia (BPH), now referred to as lower urinary tract symptoms suggestive of bladder outflow obstruction (LUTS/BOO), is a significant cause of morbidity in ageing men. Surgery has virtually eliminated BPH-related mortality, and so the focus for men and their urologist is improvement in urinary symptoms and quality of life. Numerous tools have been developed to quantify symptoms and impact on quality of life--the most commonly used is the International Prostate Symptom Score. Sexual function and the avoidance of BPH-related complications such as acute urinary retention and surgery are also important to men--tools are available to assess sexual function but the benefits of complication avoidance are difficult to quantify. Approximately one million men in the UK have brought their symptoms to the attention of their doctor and been given a diagnosis of BPH, but extrapolation from community based studies suggests that many more (up to 2.5 million men) may have significant symptoms without seeking attention. Histopathological BPH, diminishing peak urinary flow rate, worsening lower urinary tract symptoms and increasing impact on quality of life all become more common as men age. Two groups of drugs are commonly used to treat LUTS/BOO--alpha-adrenoreceptor antagonists and 5alpha-reductase inhibitors. Both groups have been shown to improve quality of life measures in randomised, placebo-controlled trials--usually by approximately twice as much as placebo.
良性前列腺增生（BPH），现在称为提示膀胱出口梗阻的下尿路症状（LUTS/BOO），是老年男性发病的一个重要原因。手术实际上已消除了与BPH相关的死亡率，因此男性及其泌尿科医生关注的焦点是改善尿路症状和生活质量。已经开发了许多工具来量化症状及其对生活质量的影响——最常用的是国际前列腺症状评分。性功能以及避免与BPH相关的并发症（如急性尿潴留和手术）对男性也很重要——有评估性功能的工具，但避免并发症的益处难以量化。在英国，约有100万男性已向医生提及他们的症状并被诊断为BPH，但基于社区研究的推断表明，更多（多达250万男性）可能有明显症状却未就医。随着男性年龄增长，组织病理学BPH、尿流率峰值降低、下尿路症状恶化以及对生活质量影响增加都变得更为常见。通常使用两组药物来治疗LUTS/BOO——α-肾上腺素能受体拮抗剂和5α-还原酶抑制剂。在随机、安慰剂对照试验中，这两组药物均已显示可改善生活质量指标——通常比安慰剂高出约一倍。
