Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples, Naples, Italy.
Italian Society of Urodynamics Publication Group, Naples, Italy.
Neurourol Urodyn. 2018 Aug;37(6):1865-1874. doi: 10.1002/nau.23554. Epub 2018 Mar 31.
To perform a systematic review and meta-analysis of studies evaluating the urodynamic outcomes of alpha-1 adrenergic antagonists (ABs), 5-alpha reductase inhibitors (5-ARIs), phosphodiesterase type 5 inhibitors (PDE5is), and phytotherapic compounds in patients with lower urinary tract symptoms related to benign prostatic obstruction (LUTS/BPO).
A systematic review of PubMed/Medline, ISI Web of Knowledge, and Scopus databases was performed in June 2017. We included full papers that met the following criteria: original research; English language; human studies; enrolling LUTS/BPO patients; reporting maximum urinary flow (Qmax), and detrusor pressure at maximum urinary flow (PdetQmax). The primary endpoint was variation in bladder outlet obstruction index (BOOI). Secondary endpoints were variations in Qmax and PdetQmax.
Twenty-three studies involving 1044 patients were included in the final analysis. Eighteen, three, two, and one study evaluated the urodynamic outcomes of ABs, 5-ARIs, PDE5is, and phytotherapic compounds, respectively. BOOI, PdetQmax, and Qmax improved in a statistically significant manner in patients receiving ABs and in those receiving 5-ARIs. The overall pooled data showed a mean BOOI change of -15.40 (P < 0.00001) and of -10.55 (P = 0,004) for ABs and 5-ARIs, respectively. Mean PdetQmax and Qmax changes were:12.30 cm H O (P < 0.00001) and +2.27 ml/s (P < 0.00001) for ABs and -9.63 cm H O (P = 0.05), and +1.18 mL/s (P = 0.04) for 5-ARIs. PDE5is and phytotherapic compounds had no significant effects on urodynamic parameters.
ABs and 5-ARIs efficiently improve BOOI in men with LUTS/BPO. Both treatments are associated with a clinically significant decrease in PdetQmax but only marginal improvements in Qmax.
对评估α-1 肾上腺素能拮抗剂（ABs）、5-α 还原酶抑制剂（5-ARIs）、磷酸二酯酶 5 抑制剂（PDE5is）和植物化合物治疗与良性前列腺增生（BPO）相关下尿路症状（LUTS/BPO）患者的尿动力学结果的研究进行系统评价和荟萃分析。
2017 年 6 月，我们对 PubMed/Medline、ISI Web of Knowledge 和 Scopus 数据库进行了系统评价。我们纳入了符合以下标准的全文：原始研究；英语；人类研究；招募 LUTS/BPO 患者；报告最大尿流率（Qmax）和逼尿肌最大尿流时压力（PdetQmax）。主要终点是膀胱出口梗阻指数（BOOI）的变化。次要终点是 Qmax 和 PdetQmax 的变化。
最终分析纳入了 23 项涉及 1044 名患者的研究。18、3、2 和 1 项研究分别评估了 ABs、5-ARIs、PDE5is 和植物化合物的尿动力学结果。接受 ABs 和 5-ARIs 治疗的患者 BOOI、PdetQmax 和 Qmax 均有统计学意义的改善。总体汇总数据显示，ABs 和 5-ARIs 的平均 BOOI 变化分别为-15.40（P<0.00001）和-10.55（P=0.004）。平均 PdetQmax 和 Qmax 的变化分别为：12.30cm H2O（P<0.00001）和+2.27ml/s（P<0.00001），ABs 和-9.63cm H2O（P=0.05），和+1.18ml/s（P=0.04），5-ARIs。PDE5is 和植物化合物对尿动力学参数没有显著影响。
ABs 和 5-ARIs 可有效改善 LUTS/BPO 男性的 BOOI。两种治疗方法均与 PdetQmax 显著降低相关，但 Qmax 仅略有改善。
