Chapple Christopher R
Department of Urology, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK.
BJU Int. 2004 Sep;94(5):738-44. doi: 10.1111/j.1464-410X.2004.05022.x.
Less than 10 years ago surgery and watchful-waiting were the only widely accepted management options for lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and benign prostatic obstruction (BPO). There has been an enormous decline in the popularity of surgery and it is now apparent that medication is the most frequently used treatment for BPH/LUTS; this has arguably therefore been the most major change in urological clinical practice in the last decade. Currently alpha(1)-adrenoceptor antagonists are the commonest medical therapy, and are thought to act by relaxing prostatic smooth muscle, the neural or so-called 'dynamic' component of BPO. 5alpha-reductase inhibitors (finasteride, dutasteride) are another option for BPH/LUTS, which reduce prostatic mass and therefore the mechanical or 'static' component of BPO. In the last 10 years there have been four direct comparative studies between alpha(1)-adrenoceptor antagonists and finasteride, including their combination, the results of which, and their implications for therapy, are discussed. Another group of agents are the phytotherapeutic extracts, which act via various mechanisms, many as yet poorly defined. This review critically assesses existing publications relating to the medical management of BPH/LUTS.
不到10年前，手术和观察等待是唯一被广泛接受的针对提示良性前列腺增生（BPH）和良性前列腺梗阻（BPO）的下尿路症状（LUTS）的治疗选择。手术的受欢迎程度大幅下降，现在很明显药物是治疗BPH/LUTS最常用的方法；因此，这可以说是过去十年泌尿外科临床实践中最重大的变化。目前，α1肾上腺素能受体拮抗剂是最常见的药物治疗方法，被认为是通过松弛前列腺平滑肌起作用，这是BPO的神经或所谓“动态”成分。5α还原酶抑制剂（非那雄胺、度他雄胺）是治疗BPH/LUTS的另一种选择，可减少前列腺体积，从而减少BPO的机械或“静态”成分。在过去10年里，有四项关于α1肾上腺素能受体拮抗剂和非那雄胺之间的直接对比研究，包括它们的联合使用，本文将讨论这些研究的结果及其对治疗的意义。另一类药物是植物提取物，它们通过多种机制起作用，其中许多机制尚未明确。本综述对与BPH/LUTS药物治疗相关的现有文献进行了批判性评估。
