Schulman Claude C
Department of Urology, Erasme Hospital, University Clinics of Brussels, Brussels, Belgium.
Urology. 2003 Sep;62(3 Suppl 1):24-33. doi: 10.1016/s0090-4295(03)00471-0.
The beneficial effects of treatment for lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), or LUTS/BPH, have to be balanced against the morbidity associated with treatment. Invasive surgery, such as transurethral resection of the prostate, has been associated with irreversible complications (eg, impotence and retrograde ejaculation). Alpha(1)-adrenoceptor antagonists provide effective and fast relief of LUTS/BPH. In contrast to finasteride, they are not associated with sexual dysfunction (eg, decreased libido or impotence). Alpha(1)-adrenoceptor antagonists induce adverse events associated with interference with blood pressure regulation. The alpha(1A)/alpha(1D)-adrenoceptor antagonist tamsulosin has the lowest potential to interfere with blood pressure regulation and induce related adverse events. In addition, tamsulosin seems to be as well tolerated as phytotherapy, except for a higher incidence of abnormal ejaculation. Abnormal ejaculation occurs in 4% to 11% of patients receiving a alpha(1)-adrenoceptor antagonist, which is, however, well tolerated; <1% of patients discontinue because of this adverse event. In placebo-controlled trials, abnormal ejaculation has been predominantly reported for tamsulosin, but in most direct comparative studies, the incidence was comparable to that of other alpha(1)-adrenoceptor antagonists. Men with LUTS/BPH have an increased risk of impaired sexual function. However, alpha(1)-adrenoceptor antagonists, such as tamsulosin, may slightly improve sexual dysfunction together with LUTS problems. Combination therapy of an alpha(1)-adrenoceptor antagonist and finasteride has a similar adverse-event profile as each monotherapy, except for an increased risk of abnormal ejaculation. The discontinuation rate because of adverse events does not seem to be higher than with monotherapy. Medical therapies, and particularly alpha(1)-adrenoceptor antagonists such as tamsulosin, can be considered a first-line treatment option for LUTS/BPH because they provide effective relief of bothersome LUTS with excellent tolerability.
对于提示良性前列腺增生（BPH）的下尿路症状（LUTS），即LUTS/BPH的治疗效果，必须与治疗相关的发病率相权衡。侵入性手术，如经尿道前列腺切除术，与不可逆的并发症（如阳痿和逆行射精）相关。α1肾上腺素能受体拮抗剂能有效快速缓解LUTS/BPH。与非那雄胺不同，它们与性功能障碍（如性欲减退或阳痿）无关。α1肾上腺素能受体拮抗剂会引发与干扰血压调节相关的不良事件。α1A/α1D肾上腺素能受体拮抗剂坦索罗辛干扰血压调节并引发相关不良事件的可能性最低。此外，除了异常射精发生率较高外，坦索罗辛的耐受性似乎与植物疗法相当。接受α1肾上腺素能受体拮抗剂治疗的患者中，4%至11%会出现异常射精，不过这种情况耐受性良好；因该不良事件停药的患者不到1%。在安慰剂对照试验中，主要报告坦索罗辛会出现异常射精，但在大多数直接比较研究中，其发生率与其他α1肾上腺素能受体拮抗剂相当。患有LUTS/BPH的男性性功能受损风险增加。然而，α1肾上腺素能受体拮抗剂，如坦索罗辛，在改善LUTS问题的同时可能会轻微改善性功能障碍。α1肾上腺素能受体拮抗剂与非那雄胺的联合治疗与每种单一疗法的不良事件谱相似，只是异常射精的风险增加。因不良事件导致的停药率似乎并不高于单一疗法。药物治疗，尤其是α1肾上腺素能受体拮抗剂如坦索罗辛，可被视为LUTS/BPH的一线治疗选择，因为它们能有效缓解令人困扰的LUTS，且耐受性极佳。
