Yassin A, Saad F, Hoesl C E, Traish A M, Hammadeh M, Shabsigh R
Clinic of Urology and Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany.
Andrologia. 2006 Feb;38(1):1-12. doi: 10.1111/j.1439-0272.2006.00709.x.
A literature search of PubMed documented publications and abstracts from proceedings of scientific meetings was made to review the available data on benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) and erectile dysfunction (ED) with a special focus on the role of alpha-adrenoceptors as critical mediators of pathophysiology. The reader is introduced to clinical results on the therapeutic potential of alpha-blockers alone and in combination with phosphodiesterase type 5 (PDE-5) inhibitors in the treatment of ED associated with LUTS/BPH. Epidemiological studies clearly show that an association exists between ED and LUTS/BPH. The severity of LUTS is correlated with the risk for ED. A significant number of LUTS/BPH patients are nonresponsive to the common ED treatment with PDE-5 inhibitors. As smooth muscle contractility is regulated by adrenoceptors in the corpus cavernosum, prostate and detrusor, the alpha-adrenoceptor system may be considered a common pathophysiological mediator in the development of ED and LUTS/BPH. Blockade of alpha-adrenoceptors for the treatment of BPH/LUTS may have the potential of improving sexual function. Conversely, PDE-5 inhibitors may exhibit positive effects in LUTS patients. Pilot studies on combination regimens of alpha-adrenoceptor antagonists and PDE-5 inhibitors have yielded encouraging results in LUTS patients with persistent ED. On the basis of pharmacological and clinical evidence, it is established that the alpha-adrenoceptor system plays an important role in the pathophysiology of ED and LUTS secondary to BPH. Larger trials on the combination of alpha-adrenoceptor antagonists with PDE-5 inhibitors are necessary to develop an integrated treatment approach for BPH/LUTS patients with comorbid ED.
我们在PubMed上进行了文献检索，记录了科学会议论文集里的出版物和摘要，以回顾有关良性前列腺增生/下尿路症状（BPH/LUTS）和勃起功能障碍（ED）的现有数据，特别关注α-肾上腺素能受体作为病理生理学关键介质的作用。向读者介绍了仅使用α受体阻滞剂以及α受体阻滞剂与5型磷酸二酯酶（PDE-5）抑制剂联合使用在治疗与LUTS/BPH相关的ED方面的治疗潜力的临床结果。流行病学研究清楚地表明，ED与LUTS/BPH之间存在关联。LUTS的严重程度与ED的风险相关。大量LUTS/BPH患者对PDE-5抑制剂这种常见的ED治疗方法无反应。由于海绵体、前列腺和逼尿肌中的肾上腺素能受体调节平滑肌收缩，α-肾上腺素能受体系统可能被认为是ED和LUTS/BPH发生过程中的常见病理生理介质。阻断α-肾上腺素能受体治疗BPH/LUTS可能具有改善性功能的潜力。相反，PDE-5抑制剂可能对LUTS患者有积极作用。关于α-肾上腺素能受体拮抗剂与PDE-5抑制剂联合治疗方案的初步研究在持续性ED的LUTS患者中取得了令人鼓舞的结果。基于药理学和临床证据，已确定α-肾上腺素能受体系统在继发于BPH的ED和LUTS的病理生理学中起重要作用。有必要对α-肾上腺素能受体拮抗剂与PDE-5抑制剂的联合使用进行更大规模的试验，以开发针对合并ED的BPH/LUTS患者的综合治疗方法。
