Andersson Karl-Erik
aInstitute for Regenerative Medicine, Wake Forest University School of Medicine, Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA bAarhus Institute for Advanced Sciences, Aarhus University, Aarhus, Denmark.
Curr Opin Urol. 2014 Nov;24(6):571-7. doi: 10.1097/MOU.0000000000000106.
To summarize recent data on the medical treatment of men with incontinence due to overactive bladder or to stress urinary incontinence published in peer-reviewed journals.
Previous randomized controlled trials have shown that both antimuscarinic drugs and α1-adrenoceptor blockers can be useful for treatment of male lower urinary tract symptoms, including the overactive bladder syndrome, and that combination of the two principles may offer additional benefits over monotherapy with either agent. This has been further confirmed in several recent studies. There seems to be an associated increase in postvoid residual urine volume by the combinations, but not a significantly increased risk of retention. The efficacy of other combinations, for example, α1-adrenoceptor blocker and 5α-reductase inhibitor, has also been further documented. Recent evidence supports the use of mirabegron, alone or in combination with solifenacin, as a treatment alternative of male overactive bladder syndrome. Monotherapy with phosphodiesterase 5 inhibitors seems to be as effective as α1-adrenoceptor blockers in male lower urinary tract symptoms. Only a few recent studies have been performed on the pharmacological treatment of male stress urinary incontinence, confirming that duloxetine had a modest positive effect in men with postprostatectomy incontinence.
For treatment of storage symptoms in men with lower urinary tract symptoms, combinations of antimuscarinics and α1-adrenoceptor blockers have produced the most promising results. Duloxetine exerts only modest relief of male stress urinary incontinence, but may be recommended in some patients.
总结同行评审期刊上发表的关于治疗膀胱过度活动症或压力性尿失禁所致男性尿失禁的最新医学数据。
既往随机对照试验表明，抗毒蕈碱药物和α1肾上腺素能受体阻滞剂均可用于治疗男性下尿路症状，包括膀胱过度活动症，且两种药物联合使用可能比单一药物治疗带来更多益处。这在最近的几项研究中得到了进一步证实。联合用药似乎会使排尿后残余尿量有所增加，但尿潴留风险并未显著增加。其他联合用药方案（如α1肾上腺素能受体阻滞剂与5α还原酶抑制剂）的疗效也得到了进一步证实。最近的证据支持使用米拉贝隆单独或与索利那新联合，作为男性膀胱过度活动症的一种治疗选择。磷酸二酯酶5抑制剂单药治疗在男性下尿路症状方面似乎与α1肾上腺素能受体阻滞剂同样有效。最近仅有少数关于男性压力性尿失禁药物治疗的研究，证实度洛西汀对前列腺切除术后尿失禁男性有一定的积极作用。
对于治疗有下尿路症状男性的储尿期症状，抗毒蕈碱药物与α1肾上腺素能受体阻滞剂联合使用取得了最有前景的结果。度洛西汀对男性压力性尿失禁仅有一定缓解作用，但在某些患者中可能值得推荐。
