Zhang Amy Y, Xu Xinyi
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
University Hospitals Cleveland Medical Center Seidman Cancer Center, Cleveland, OH, USA.
SAGE Open Nurs. 2018 Dec 26;4:2377960818811773. doi: 10.1177/2377960818811773. eCollection 2018 Jan-Dec.
We conducted a systematic review of literature from the years 2000 through 2017 on the prevalence and burden of lower urinary tract symptoms (LUTS) in men aged 50 and older, and medical treatments of and alternative nonmedical approaches to LUTS. EBSCOhost (Medline with Full Text) was searched for observational, experimental, and review studies in peer-reviewed journals in the English language. Our review found that LUTS were highly prevalent in the world and estimated to affect 2.3 billion people in 2018, with 44.7% being men. Men with LUTS suffer from not only burdensome symptoms such as nocturia and urgency but also adverse psychological consequences (e.g., anxiety and depression) and financial burden. Current medical treatments are clinically effective, but their efficacy is compromised by side effects and low compliance rates. Alternative nonmedical treatments for LUTS were also sought worldwide. There is evidence that lifestyle modifications such as pelvic muscle exercises and bladder training, physical activity, dietary modification, and nutritional supplements can alleviate LUTS and improve patient quality of life; however, evidence based on rigorous methodology remains minimal and cannot be generalized across populations. Evidence of effectiveness of weight loss programs to reduce LUTS is inconclusive. We conclude that although behavioral treatment is a promising approach to alleviating LUTS, especially when combined with medical treatments, well-designed randomized controlled and longitudinal clinical trials on behavioral treatments of LUTS are still needed. Minimally invasive procedures and neuromodulation therapy also show positive results of alleviating LUTS but require further research as well.
我们对2000年至2017年期间的文献进行了系统综述，内容涉及50岁及以上男性下尿路症状（LUTS）的患病率和负担，以及LUTS的药物治疗和替代性非药物治疗方法。我们在EBSCOhost（提供全文的Medline）中检索了英文同行评审期刊上的观察性、实验性和综述性研究。我们的综述发现，LUTS在全球高度流行，据估计在2018年影响了23亿人，其中44.7%为男性。患有LUTS的男性不仅遭受夜尿症和尿急等令人困扰的症状，还面临不良心理后果（如焦虑和抑郁）以及经济负担。目前的药物治疗在临床上是有效的，但其疗效受到副作用和低依从率的影响。全球也在寻求LUTS的替代性非药物治疗方法。有证据表明，诸如盆底肌肉锻炼和膀胱训练、体育活动、饮食调整以及营养补充剂等生活方式的改变可以缓解LUTS并改善患者生活质量；然而，基于严格方法的证据仍然很少，且不能在不同人群中一概而论。减肥计划对减轻LUTS有效性的证据尚无定论。我们得出结论，尽管行为治疗是缓解LUTS的一种有前景的方法，尤其是与药物治疗相结合时，但仍需要针对LUTS行为治疗进行精心设计的随机对照和纵向临床试验。微创手术和神经调节疗法也显示出缓解LUTS的积极结果，但也需要进一步研究。
