Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Urol. 2017 Oct;198(4):905-912. doi: 10.1016/j.juro.2017.05.031. Epub 2017 May 10.
We compared the effects on lower urinary tract symptoms and bladder outlet obstruction of combination therapy with α1-blocker and 5α-reductase inhibitor or a switch to 5α-reductase inhibitor monotherapy. We determined the factors influencing changes in lower urinary tract symptoms after α1-blocker withdrawal.
A total of 140 outpatients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia received combination therapy with silodosin 8 mg per day and dutasteride 0.5 mg per day for 12 months. Of the patients 132 were randomized to continue combination therapy or switched to dutasteride monotherapy through silodosin withdrawal as the monotherapy group. Parameter changes from before randomization to 12 months after randomization were assessed based on subjective symptoms and urodynamic findings of voiding and storage function.
Efficacy analysis included 57 patients on combination therapy and 60 on monotherapy. The change in I-PSS (International Prostate Symptom Score) after randomization was -0.7 and -0.6 in the combination therapy and monotherapy groups, respectively. The bladder outlet obstruction index changed from 46.1 to 41.8 in the combination therapy group and from 42.9 to 39.9 in the monotherapy group. No significant differences in subjective symptoms and bladder outlet obstruction were observed between the 2 groups. However, storage function decreased in the monotherapy group and lower urinary tract symptoms deteriorated significantly after the switch to dutasteride monotherapy in patients with a higher body mass index.
We found that α1-blocker withdrawal from combination therapy was reasonable and tolerable with regard to the effect on lower urinary tract symptoms and bladder outlet obstruction. However, withdrawal must be performed carefully in patients with a high body mass index.
我们比较了联合治疗α1受体阻滞剂和 5α-还原酶抑制剂与转为 5α-还原酶抑制剂单药治疗对下尿路症状和膀胱出口梗阻的影响。我们确定了影响α1受体阻滞剂停药后下尿路症状变化的因素。
共有 140 名患有下尿路症状提示良性前列腺增生的门诊患者接受了每天 8 毫克西洛多辛和每天 0.5 毫克度他雄胺的联合治疗，共 12 个月。其中 132 例患者随机分为继续联合治疗或通过西洛多辛停药转为度他雄胺单药治疗的单药治疗组。根据排尿和储存功能的主观症状和尿动力学检查结果，评估从随机分组前到随机分组后 12 个月的参数变化。
疗效分析包括 57 例联合治疗患者和 60 例单药治疗患者。随机分组后 I-PSS（国际前列腺症状评分）的变化分别为联合治疗组-0.7 和单药治疗组-0.6。膀胱出口梗阻指数从联合治疗组的 46.1 降至 41.8，从单药治疗组的 42.9 降至 39.9。两组间主观症状和膀胱出口梗阻无显著差异。然而，在单药治疗组中，储存功能下降，在那些体重指数较高的患者中转用度他雄胺单药治疗后，下尿路症状明显恶化。
我们发现，联合治疗中α1受体阻滞剂的停药在缓解下尿路症状和膀胱出口梗阻方面是合理和可耐受的。然而，对于体重指数较高的患者，停药必须小心进行。
