Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Urology. 2014 Mar;83(3):556-62. doi: 10.1016/j.urology.2013.10.034. Epub 2013 Dec 19.
To assess the clinical efficiency and safety of combination pharmacotherapy of antimuscarinics and α-blockers vs α-blockers monotherapy on patients with moderate to severe lower urinary tract symptoms (LUTS).
We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, the Cochrane Database of Systematic Review, and Web of Science from their inception until June 2013 to identify all eligible studies that compare the 2 pharmacotherapy strategies on LUTS. The Cochrane Collaboration's RevMan 5.2 software was used for data analysis, and the fixed or the random effect model was selected depending on the proportion of heterogeneity.
Eighteen eligible randomized controlled trials were included in this systematic review, including 2106 (51.57%) in cotherapy group and 1978 (48.43%) in monotherapy group. Synthetic data showed that there were significant improvements on Storage International Prostate Symptom Score (mean difference [MD] = -1.51; 95% confidence interval [CI] -2.10 to -0.91, P <.00001), quality of life score (MD = -0.53; 95% CI -0.89 to -0.17, P = .004), micturitions per 24 hours (MD = -1.14; 95% CI -1.84 to -0.45, P = .001), and urgency episodes per 24 hours (MD = -0.99; 95% CI -1.46 to -0.51, P <.0001) in the cotherapy group. There were no significant difference regarding maximum flow rate (MD = -0.05; 95% CI -0.27 to 0.17, P = .64), Total International Prostate Symptom Score (TIPSS) (MD = -0.88; 95% CI -1.64 to -0.12, P = .02), and Voiding International Prostate Symptom Score (VIPSS) (MD = 0.40; 95% CI -0.34 to 1.15, P = .29). As to postvoid residual volume, however, a worse condition was showed in the cotherapy group (MD = -6.53; 95% CI 3.06-10.00, P <.0002).
Antimuscarinics could and should be added to the drug regimen for patients with LUTS attributed to benign prostatic hyperplasia/bladder outlet obstruction, particularly are dominated by storage symptoms. For patients with increased acute urinary retention risk, they should be carefully monitored.
评估抗毒蕈碱药物与α-受体阻滞剂联合治疗与单独使用α-受体阻滞剂治疗中重度下尿路症状（LUTS）患者的临床疗效和安全性。
我们检索了 Cochrane 对照试验中心注册库、PubMed、EMBASE、Cochrane 系统评价数据库和 Web of Science，从建库开始到 2013 年 6 月，以确定所有比较这两种药物治疗策略的合格研究。使用 Cochrane 协作网的 RevMan 5.2 软件进行数据分析，根据异质性比例选择固定或随机效应模型。
本系统评价共纳入 18 项随机对照试验，其中联合治疗组 2106 例（51.57%），单独治疗组 1978 例（48.43%）。综合数据显示，在储尿期国际前列腺症状评分（平均差值 [MD] = -1.51；95%置信区间 [CI] = -2.10 至 -0.91，P <.00001）、生活质量评分（MD = -0.53；95% CI = -0.89 至 -0.17，P =.004）、24 小时排尿次数（MD = -1.14；95% CI = -1.84 至 -0.45，P =.001）和 24 小时急迫发作次数（MD = -0.99；95% CI = -1.46 至 -0.51，P <.0001）方面，联合治疗组有显著改善。最大尿流率（MD = -0.05；95% CI = -0.27 至 0.17，P =.64）、总国际前列腺症状评分（TIPSS）（MD = -0.88；95% CI = -1.64 至 -0.12，P =.02）和排尿期国际前列腺症状评分（VIPSS）（MD = 0.40；95% CI = -0.34 至 1.15，P =.29）无显著差异。然而，就残余尿量而言，联合治疗组的情况更差（MD = -6.53；95% CI 3.06 至 10.00，P <.0002）。
抗毒蕈碱药物可用于治疗伴有良性前列腺增生/膀胱出口梗阻的中重度下尿路症状（LUTS）患者，且应该联合应用，特别是以储尿症状为主的患者。对于有急性尿潴留风险增加的患者，应密切监测。
