Li Man-Kay, Garcia Lester, Patron Nelson, Moh Lei Chang, Sundram Murali, Leungwattanakij Somboon, Pripatnanont Choosak, Cheng Christopher, Chi-Wai Man, Loi-Cheong Ngai
Gleneagles Medical Center, Singapore.
BJU Int. 2008 Jan;101(2):197-202. doi: 10.1111/j.1464-410X.2007.07320.x. Epub 2007 Nov 13.
To examine the characteristics, management practices and outcomes of patients presenting with symptoms of benign prostatic hyperplasia (BPH) in Asia, with a focus on comorbidities and sexuality.
In this multinational prospective observational registry, eligible patients with BPH attending a urology clinic for the first time were enrolled. Details of comorbidities, sexuality and symptoms of BPH were collected through the International Prostate Symptom Score (IPSS), International Index of Erectile Dysfunction-5 (IIEF-5) and the Danish Prostate Symptom Score (DAN-PSS-1) questionnaires. The follow-up was scheduled at 1-3 or 3-6 months, depending on the treatment.
In 994 men aged 40-88 years the most common comorbidities were hypertension (38%) and obesity (36%). Nocturia was the most common symptom for consultation. A previous episode of acute urinary retention (AUR) was recorded in 12%. About 90% of the men had moderate-to-severe lower urinary tract symptoms (LUTS), and the severity increased with age. Sexual dysfunction was reported by 82%, and it correlated with the severity of LUTS. Of 918 sexually active men, only 20% had normal erectile function; 36%, 19% and 25% reported severe, moderate and mild erectile dysfunction (ED), respectively. BPH medication was started in 78%, 9% had surgery, and in 13% an approach of watchful waiting was adopted. In all, 89% of patients completed the follow-up. The symptoms of BPH resolved in 93% after surgery, in 83% on BPH medication and in 34% of those on 'watchful waiting'. Surgery, which led to a mean reduction of 17.0 IPSS points, was the most effective in improving LUTS. Improvement on the DAN-PSS-1 items of reduced erection and reduced ejaculation was higher with medication, while surgery led to better outcomes on the DAN-PSS-1 item of pain/discomfort on ejaculation. For ED, from baseline to after treatment, the mean IIEF-5 scores changed from 19.1 to 18, from 14.2 to 14.8, and from 4.5 to 5.5 for those with mild, moderate and severe ED at baseline, respectively. Only 2.3% of patients had an episode of AUR while on treatment. About 5.5% of patients on BPH medication and 6% of surgical patients reported adverse events.
Asian patients with BPH usually present with LUTS; sexual dysfunction is also very common. BPH medication is the most frequent treatment approach, followed by watchful waiting and surgery. Medication and surgery resulted in a greater reduction of LUTS and improvement in sexual dysfunction than watchful waiting. As Asian men remain sexually active even at advanced ages, sexual function should be assessed and discussed with the patient before deciding the management strategy for LUTS associated with BPH.
研究亚洲良性前列腺增生（BPH）症状患者的特征、管理措施及治疗结果，重点关注合并症和性功能。
在这个跨国前瞻性观察性登记研究中，纳入首次到泌尿外科门诊就诊的符合条件的BPH患者。通过国际前列腺症状评分（IPSS）、国际勃起功能障碍指数-5（IIEF-5）和丹麦前列腺症状评分（DAN-PSS-1）问卷收集合并症、性功能及BPH症状的详细信息。根据治疗情况，随访安排在1 - 3个月或3 - 6个月。
994名年龄在40 - 88岁的男性中，最常见的合并症是高血压（38%）和肥胖（36%）。夜尿是最常见的就诊症状。12%的患者有急性尿潴留（AUR）病史。约90%的男性有中重度下尿路症状（LUTS），且严重程度随年龄增加。82%的患者报告有性功能障碍，且与LUTS严重程度相关。在918名有性生活的男性中，只有20%勃起功能正常；分别有36%、19%和25%报告有重度、中度和轻度勃起功能障碍（ED）。78%的患者开始使用BPH药物治疗，9%接受手术，13%采取观察等待的方法。总体而言，89%的患者完成了随访。手术后93%的BPH症状得到缓解，使用BPH药物治疗的患者中这一比例为83%，观察等待的患者中为34%。手术平均使IPSS评分降低17.0分，是改善LUTS最有效的方法。药物治疗对DAN-PSS-1中勃起减弱和射精减弱项目的改善更高，而手术对DAN-PSS-1中射精时疼痛/不适项目的改善更好。对于ED，从基线到治疗后，基线时轻度、中度和重度ED患者的平均IIEF-5评分分别从19.1变为18、从14.2变为14.8和从4.5变为5.5。治疗期间只有2.3%的患者发生AUR。使用BPH药物治疗的患者中约5.5%和手术患者中6%报告有不良事件。
亚洲BPH患者通常表现为LUTS；性功能障碍也很常见。BPH药物治疗是最常用的治疗方法，其次是观察等待和手术。与观察等待相比，药物治疗和手术在减轻LUTS和改善性功能方面效果更显著。由于亚洲男性即使到高龄仍有性生活，在决定BPH相关LUTS的管理策略之前，应评估患者的性功能并与患者进行讨论。
