Han Euna, Black Libby K, Lavelle John P
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Am J Geriatr Pharmacother. 2007 Dec;5(4):324-34. doi: 10.1016/j.amjopharm.2007.12.003.
The prevalence of incontinence ranges from 11% to 34% among community-dwelling men aged > or =65 years.
The objective of this analysis was to determine the nature of incontinence diagnosed in men with benign prostatic hypertrophy (BPH), focusing on its incidence, prevalence, diagnostic workup, and management.
A cohort of patients with BPH was identified in the Integrated Healthcare Information Services National Managed Care Benchmark Database (1997-2003). Age and duration in the database after the first diagnosis of BPH were used as matching strata. Therapeutic subgroups consisted of watchful waiting, alpha-blockers, 5-alpha-reductase inhibitors (5ARIs), and BPH-related surgery.
A total of 411,658 males with BPH were identified from 12,298,027 males (3.3%). Of the BPH cohort, 2.7% (n = 11,172) were identified as having incontinence; of these, 57.8% of patients were > or =65 years of age. Alter applying inclusion/exclusion criteria, the final matched case-control sample included 6346 men as case subjects and 229,154 men as control subjects. The overall incidence of incontinence in this BPH sample was 1835/100,000/year, and the prevalence was 2713/100,000 men. In 48.5% of the incontinent men, the type of incontinence was not specified. Diagnostic testing was performed in 2.9% of men with incontinence. Conditional logistic regression analyses found that BPH-related surgery and alpha-blocker use increased the adjusted odds ratio for the risk of incontinence 3.1-fold, and 1.1- to 1.7-fold, respectively. The odds ratio of the risk of incontinence was not significantly increased with long-term 5ARI use.
Use of alpha-blockers, 5ARIs for the short term (<1 year), and BPH-related surgery were independently, significantly associated with BPH-related incontinence; 5ARI use for >1 year and watchful waiting were not. BPH-related incontinence may be related to progression of BPH or as a postsurgical complication. Patients with BPH should be asked specifically about incontinence, especially after BPH-related surgery, and undergo a full diagnostic workup for the diagnosis of urinary incontinence.
在年龄≥65岁的社区男性居民中，尿失禁患病率在11%至34%之间。
本分析的目的是确定诊断为良性前列腺增生（BPH）的男性尿失禁的性质，重点关注其发病率、患病率、诊断检查及管理。
在综合医疗信息服务国家管理医疗基准数据库（1997 - 2003年）中确定一组BPH患者。首次诊断BPH后的年龄及在数据库中的时长用作匹配分层。治疗亚组包括观察等待、α受体阻滞剂、5α还原酶抑制剂（5ARIs）及与BPH相关的手术。
从12,298,027名男性中确定了411,658名患有BPH的男性（3.3%）。在BPH队列中，2.7%（n = 11,172）被确定患有尿失禁；其中，57.8%的患者年龄≥65岁。应用纳入/排除标准后，最终匹配的病例对照样本包括6346名男性作为病例组，229,154名男性作为对照组。该BPH样本中尿失禁的总体发病率为1835/100,000/年，患病率为2713/100,000男性。在48.5%的尿失禁男性中，未明确尿失禁类型。2.9%的尿失禁男性进行了诊断性检查。条件逻辑回归分析发现，与BPH相关的手术及使用α受体阻滞剂分别使尿失禁风险的调整比值比增加3.1倍和1.1至1.7倍。长期使用5ARIs并未显著增加尿失禁风险的比值比。
使用α受体阻滞剂、短期（<1年）使用5ARIs及与BPH相关的手术与BPH相关的尿失禁独立且显著相关；使用5ARIs超过1年及观察等待则不然。BPH相关的尿失禁可能与BPH进展或术后并发症有关。对于BPH患者，应特别询问其尿失禁情况，尤其是在与BPH相关的手术后，并进行全面的诊断检查以诊断尿失禁。
