Department of Urology, CHU de Bordeaux, Bordeaux-2 Victor Segalen University, Bordeaux, France.
Curr Opin Urol. 2011 Jan;21(1):42-8. doi: 10.1097/MOU.0b013e32834100b3.
This review aims at giving a critical overview of the most recent publications on the diagnosis and treatment of high-risk patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.
New risk factors such as dynamic variables, metabolic syndrome, or chronic prostatic inflammation have been recently investigated. Large prospective interventional studies have consistently provided new evidences of a benefit of the 5-α reductase inhibitors in reducing the risk of complication.
Despite the large number of risk factors that have been described, predicting the evolution and complication of lower urinary tract symptoms suggestive of benign prostatic hyperplasia remains challenging. Dynamic variables such as a previous acute urinary retention, a poor response to a medical therapy, a worsening of the symptom score, and a worsening of the postvoid residual are of additional value to the baseline variables. The metabolic syndrome and the chronic prostatic inflammation are also new fields of research providing new explanations on the physiopathology of lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Treatment of high-risk patients should reduce the risk of complications. The 5-α reductase inhibitors and their combination with alpha-blockers have achieved this goal, but surgery should be considered as a first-line treatment in high-risk patients.
本文旨在对最近关于有下尿路症状（LUTS）的高危患者的诊断和治疗的出版物进行批判性综述，这些患者的 LUTS 提示良性前列腺增生（BPH）。
新的风险因素，如动态变量、代谢综合征或慢性前列腺炎症，最近已被研究。大型前瞻性干预研究一致提供了 5-α 还原酶抑制剂在降低并发症风险方面有益的新证据。
尽管已经描述了大量的风险因素，但预测有 LUTS 提示 BPH 的患者的病情演变和并发症仍然具有挑战性。动态变量，如既往急性尿潴留、药物治疗反应不佳、症状评分恶化和残余尿量恶化，对基线变量具有额外的价值。代谢综合征和慢性前列腺炎症也是研究的新领域，为 BPH 的 LUTS 的病理生理学提供了新的解释。治疗高危患者应降低并发症的风险。5-α 还原酶抑制剂及其与 α 受体阻滞剂的联合应用已实现了这一目标，但手术应被视为高危患者的一线治疗方法。
