Ingimarsson Johann P, Isaksson Helgi J, Sigbjarnarson Hermann P, Gudmundsson Jens, Geirsson Gudmundur
Departments of 1Urology.
Scand J Urol. 2014 Feb;48(1):73-8. doi: 10.3109/21681805.2013.825878. Epub 2013 Aug 7.
The aim of this study was to determine whether there are correlations between medication use for lower urinary tract symptoms/benign prostate hypertrophy (LUTS/BPH) and alteration in incidence and indications for transurethral resection of the prostate (TURP).
The number of TURP patients between 1984 and 2008 in Iceland was obtained from hospital registries. The number of defined daily doses (DDDs) of 5-alpha-reductase inhibitors (5aRIs) and alpha-blockers (ABs) sold was obtained from the Icelandic Medicines Control Agency. Charts of all surgical BPH patients in Iceland from 1998 to 2008 were retrospectively reviewed. The main outcomes measures were: DDDs sold of 5aRIs and ABs, total numbers of TURP, indications for TURP and complications.
After the introduction of ABs and 5aRIs, sales increased annually at a near linear rate. TURP rates peaked in 1992, then declined. In 2008, 81 and 3.4 of 1000 men over the age of 50 used LUTS/BPH medications or underwent TURP, respectively. There was an inverse correlation between LUTS/BPH medication use and (i) overall TURP (R(2) = 0.85), (ii) TURP done for absolute indications (R(2) = 0.91), and (iii) LUTS with (R(2) = 0.77) and (iv) without previous medical therapy (R(2) = 0.75). As medication use rose, fewer TURPs were performed for previous history of urinary retention, and more for recurrent urinary tract infections.
Increased use of ABs and 5aRIs in the Icelandic population correlated with decreasing incidences of TURP procedures for both LUTS and absolute indications. The sequelae of BPH and indications for TURP are changing as medication use increases, although a clear causative link is hard to establish.
本研究旨在确定下尿路症状/良性前列腺增生（LUTS/BPH）的药物使用与经尿道前列腺切除术（TURP）的发生率及适应证改变之间是否存在相关性。
从医院登记处获取1984年至2008年冰岛TURP患者的数量。从冰岛药品管理局获取5-α还原酶抑制剂（5aRIs）和α受体阻滞剂（ABs）的限定日剂量（DDDs）销售数量。对1998年至2008年冰岛所有接受手术的BPH患者的病历进行回顾性分析。主要观察指标包括：5aRIs和ABs的DDDs销售量、TURP总数、TURP适应证及并发症。
ABs和5aRIs引入后，销售额以近乎线性的速度逐年增加。TURP率在1992年达到峰值，随后下降。2008年，每1000名50岁以上男性中，分别有81人使用LUTS/BPH药物或接受TURP。LUTS/BPH药物使用与（i）总体TURP（R² = 0.85）、（ii）因绝对适应证进行的TURP（R² = 0.91）、（iii）伴有（R² = 0.77）和（iv）无既往药物治疗的LUTS（R² = 0.75）之间呈负相关。随着药物使用量的增加，因既往尿潴留病史而进行的TURP减少，因复发性尿路感染而进行的TURP增多。
冰岛人群中ABs和5aRIs使用的增加与LUTS及绝对适应证的TURP手术发生率降低相关。随着药物使用量的增加，BPH的后遗症及TURP的适应证正在发生变化，尽管难以明确建立因果关系。
