O'Leary Michael P
Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
Urology. 2003 Sep;62(3 Suppl 1):15-23. doi: 10.1016/s0090-4295(03)00480-1.
Because the average patient with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), or LUTS/BPH, has a remaining life expectancy of 15 to 20 years, both short-term and long-term outcomes matter in the management of LUTS/BPH. Sustained symptom control and improvement of quality of life (QOL), control of disease progression (ie, prevention or reduction of bladder wall hypertrophy [BWH]/increased bladder mass and reduction of the risk of serious complications), and minimization of the need to switch to other medical therapy or surgery are important. In this respect, alpha(1)-adrenoceptor antagonists, such as tamsulosin, have been shown to provide effective and rapid relief of symptoms and improvement in QOL, which is sustained in the long term (up to 6 years). Obstruction may, in the long term, induce changes in the bladder wall (eg, BWH), which may result in (irreversible) bladder damage and serious complications. Preliminary data suggest that alpha(1)-adrenoceptor antagonists prevent the development of BWH in rabbits and reduce existing BWH in obstructed LUTS/BPH patients. Pooled analyses and indirect comparisons of clinical studies up to 1 year have shown that alpha(1)-adrenoceptor antagonists, such as tamsulosin, reduce the risk of acute urinary retention and the need for surgery to at least the same extent as the 5alpha-reductase inhibitor finasteride. In addition, monotherapy with an alpha(1)-adrenoceptor antagonist reduces the risk of long-term clinical progression; the combination with finasteride may be more beneficial in patients at high risk (patients with large prostate volume, high level of prostate-specific antigen, high International Prostate Symptom Score, high postvoid residual amount, and low maximum flow rate). Therefore, alpha(1)-adrenoceptor antagonists, such as tamsulosin, are first-line therapy, not only in the short term but also in the long-term management of LUTS/BPH.
由于提示良性前列腺增生（BPH）的下尿路症状（LUTS）患者，即LUTS/BPH患者的平均预期寿命为15至20年，因此LUTS/BPH管理中的短期和长期结果都很重要。持续的症状控制和生活质量（QOL）改善、疾病进展控制（即预防或减少膀胱壁肥厚[BWH]/膀胱质量增加以及降低严重并发症风险）以及尽量减少改用其他药物治疗或手术的需求都很重要。在这方面，α（1）-肾上腺素能受体拮抗剂，如坦索罗辛，已被证明能有效、快速缓解症状并改善QOL，且这种改善能长期维持（长达6年）。从长远来看，梗阻可能会引起膀胱壁的变化（如BWH），这可能导致（不可逆的）膀胱损伤和严重并发症。初步数据表明，α（1）-肾上腺素能受体拮抗剂可预防兔子发生BWH，并减少梗阻性LUTS/BPH患者现有的BWH。对长达1年的临床研究进行的汇总分析和间接比较表明，α（1）-肾上腺素能受体拮抗剂，如坦索罗辛，将急性尿潴留风险和手术需求降低到至少与5α-还原酶抑制剂非那雄胺相同的程度。此外，α（1）-肾上腺素能受体拮抗剂单药治疗可降低长期临床进展风险；与非那雄胺联合使用可能对高危患者（前列腺体积大、前列腺特异性抗原水平高、国际前列腺症状评分高、排尿后残余尿量高和最大尿流率低的患者）更有益。因此，α（1）-肾上腺素能受体拮抗剂，如坦索罗辛，不仅是LUTS/BPH短期管理的一线治疗药物，也是长期管理的一线治疗药物。
