Presicce Fabrizio, De Nunzio Cosimo, Tubaro Andrea
Department of Urology, Sant'Andrea Hospital, Rome - Italy.
Faculty of Health Sciences, Sapienza University of Rome, Rome - Italy.
Urologia. 2017 Aug 1;84(3):142-147. doi: 10.5301/uj.5000251. Epub 2017 Jun 19.
The medical armamentaria for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) have been extensively implemented over the past decade. Nevertheless, the timeliest moment for a possible treatment has not been fully established.
A systematic literature search in January 1996 until June 2016 was performed to answer the following question: in men with LUTS due to BPH, does early treatment result in better outcome? An ad hoc Population/patient Intervention/indicator Comparator/control Outcome (PICO) was developed.The Medline, PubMed and Scopus databases were searched. Each article title and abstract were reviewed for relevance and appropriateness with regard to the topic of this review.
Overtime, the introduction of novel medications and the implementation of surgical techniques have significantly improved the treatment outcomes and markedly reduced the rate of BPH surgery. Early treatments in patients at risk of disease progression may result in better clinical outcomes than a delayed approach. However, the evidence to support early intervention remains weak and criteria to identify the patient phenotype that could best benefit from immediate treatment remain ill-defined.On the contrary, the patients who ultimately undergo surgery following prolonged pharmacological treatment present with larger prostates, older age and comorbidities. At the same time, the technological progress has partly compensated this critical scenario, and commonly, a nonpejorative trend has been recorded in perioperative complications.
The ideal moment to begin a treatment in LUTS/BPH patients is still uncertain, and surprisingly, rare good quality studies are available on this topic.
在过去十年中，用于治疗良性前列腺增生（BPH）继发的下尿路症状（LUTS）的医疗手段已得到广泛应用。然而，尚未完全确定可能进行治疗的最恰当时间。
于1996年1月至2016年6月进行了系统的文献检索，以回答以下问题：在因BPH导致LUTS的男性患者中，早期治疗是否会带来更好的结果？制定了一个专门的人群/患者干预/指标比较/对照结局（PICO）。检索了Medline、PubMed和Scopus数据库。对每篇文章的标题和摘要进行了审查，以确定其与本综述主题的相关性和适用性。
随着时间的推移，新型药物的引入和手术技术的应用显著改善了治疗效果，并显著降低了BPH手术的发生率。对有疾病进展风险的患者进行早期治疗可能比延迟治疗产生更好的临床结果。然而，支持早期干预的证据仍然薄弱，确定最能从立即治疗中获益的患者表型的标准仍不明确。相反，经过长期药物治疗后最终接受手术的患者前列腺更大、年龄更大且存在合并症。同时，技术进步在一定程度上弥补了这一关键情况，并且通常在围手术期并发症方面记录到了非恶化趋势。
LUTS/BPH患者开始治疗的理想时机仍然不确定，令人惊讶的是，关于这个主题的高质量研究很少。
