Park Hyun Jun, Won Ji Eon Joanne, Sorsaburu Sebastian, Rivera Paul David, Lee Seung Wook
Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.
Eli Lilly and Company, Indianapolis, IN, USA.
World J Mens Health. 2013 Dec;31(3):193-207. doi: 10.5534/wjmh.2013.31.3.193. Epub 2013 Dec 24.
This review assesses lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with or without erectile dysfunction (ED) and related therapies focusing on tadalafil. A literature search was obtained and reviewed for the epidemiology, treatment therapies, pathophysiology, and efficacy and safety of phosphodiesterase type 5 inhibitor (PDE5i) tadalafil in patients with LUTS/BPH. Approximately 42% of men aged 51 to 60 years have BPH. Approximately 90% of men aged 45 to 80 years have LUTS. Occurrence of LUTS increases with age for almost all racial/ethnic groups (range, 32% to 56%) with prevalence of LUTS highest among Hispanic men, then Blacks, Caucasians, and Asians. There is an independent relationship with LUTS/BPH and ED, with approximately 70% of men with LUTS/BPH having ED with severity of one disease often correlating with the other. The European Urological Association guidelines include the use of the PDE5i tadalafil. Tadalafil is the only therapy recommended for treatment of co-existing BPH and ED, while other therapies have unwanted ED side effects. The mode of action of tadalafil may involve different areas of the lower urinary tract such as smooth muscle cell relaxation in the bladder neck, prostate, and urethra, but there may also be resulting modulation of the afferent nerve activity. Tadalafil (5 mg) in Asian men with LUTS/BPH, similar to global studies, is efficacious and safe. Tadalafil (5 mg) improves co-existing LUTS/BPH and ED, independently. Men with LUTS/BPH likely also have ED. Asian men with LUTS/BPH have similar incidence rates, co-existing ED, comorbid diseases, and risks as non-Asian men. Tadalafil can improve co-existing LUTS/BPH and ED.
本综述评估了伴有或不伴有勃起功能障碍（ED）的良性前列腺增生（BPH）所致下尿路症状（LUTS）以及以他达拉非为重点的相关治疗方法。检索并回顾了有关5型磷酸二酯酶抑制剂（PDE5i）他达拉非在LUTS/BPH患者中的流行病学、治疗方法、病理生理学、疗效和安全性的文献。51至60岁的男性中约42%患有BPH。45至80岁的男性中约90%有LUTS。几乎所有种族/族裔群体中LUTS的发生率都随年龄增长而增加（范围为32%至56%），其中西班牙裔男性中LUTS的患病率最高，其次是黑人、白人和亚洲人。LUTS/BPH与ED之间存在独立关系，约70%的LUTS/BPH男性患有ED，一种疾病的严重程度通常与另一种疾病相关。欧洲泌尿外科学会指南包括使用PDE5i他达拉非。他达拉非是唯一推荐用于治疗并存BPH和ED的疗法，而其他疗法有不良的ED副作用。他达拉非的作用方式可能涉及下尿路的不同区域，如膀胱颈、前列腺和尿道的平滑肌细胞松弛，但也可能导致传入神经活动的调节。在患有LUTS/BPH的亚洲男性中，他达拉非（5毫克）与全球研究相似，是有效且安全的。他达拉非（5毫克）独立改善并存的LUTS/BPH和ED。患有LUTS/BPH的男性可能也有ED。患有LUTS/BPH的亚洲男性与非亚洲男性在发病率、并存的ED、合并疾病和风险方面相似。他达拉非可以改善并存的LUTS/BPH和ED。
