Luciani L G, Mattevi D, Vattovani V, Cai T, Giusti G, Malossini G
Departamento de Urología, Hospital Santa Chiara, Trento, Italy.
Departamento de Urología, Hospital Santa Chiara, Trento, Italy.
Actas Urol Esp (Engl Ed). 2022 Sep;46(7):442-446. doi: 10.1016/j.acuroe.2022.03.001. Epub 2022 Mar 23.
Our objective is to assess the long-term results of phytotherapy, focusing on the interval between phytotherapy and pharmacological treatment and the predisposing risk factors to such switch on a 10-year follow-up.
The data of patients taking phytotherapy for mild to moderate male lower urinary tract symptoms (LUTS) from January to December 2010 were retrospectively reviewed from a prospectively maintained database. Patients were followed for 10 years through medical visits and telephone consultations.
102 patients underwent at least one cycle of phytotherapy for LUTS. Twenty (19.6%) patients resolved their symptoms after one phytotherapy cycle and stopped any treatment, 27 (26.4%) continued phytotherapy, and 52 (51%) switched to alpha-blockers and/or 5a-reductase inhibitors after a median interval of 24 months. The reasons for treatment switch were symptoms (n = 45) or clinical progression (increased residual volume n = 15; urinary retention, n = 5). Patients switching to synthetic drugs had median higher age (60 vs 49), prostate volume (40 vs 26 cc), prostate specific antigen (PSA) (1.9 vs 0.9 ng/ml), residual volume (40 vs 0 cc), and a lower maximum flow rate (Qmax) (12 vs 15 ml/s) at presentation.
46% patients with mild to moderate LUTS undergoing phytotherapy will be either free of treatment or still on phytotherapy at 10 years from disease presentation. Older patients with larger prostates, increased residual volume and PSA, should be informed regarding their higher risk of symptomatic or clinical progression: the risk of a treatment switch to alpha-blockers or 5a-reductase inhibitors becomes an actual fact after an average span of 2 years.
我们的目的是评估植物疗法的长期效果，重点关注植物疗法与药物治疗之间的间隔以及在10年随访中导致这种转变的易感风险因素。
回顾性分析2010年1月至12月前瞻性维护数据库中接受植物疗法治疗轻至中度男性下尿路症状（LUTS）患者的数据。通过门诊和电话咨询对患者进行了10年随访。
102例患者接受了至少一个周期的LUTS植物疗法。20例（19.6%）患者在一个植物疗法周期后症状缓解并停止任何治疗，27例（26.4%）继续接受植物疗法，52例（51%）在中位间隔24个月后改用α受体阻滞剂和/或5α还原酶抑制剂。治疗转变的原因是症状（n = 45）或临床进展（残余尿量增加n = 15；尿潴留，n = 5）。改用合成药物的患者在就诊时年龄中位数更高（60岁对49岁）、前列腺体积更大（40cc对26cc）、前列腺特异性抗原（PSA）更高（1.9ng/ml对0.9ng/ml）、残余尿量更多（40cc对0cc）且最大尿流率（Qmax）更低（12ml/s对15ml/s）。
接受植物疗法的轻至中度LUTS患者中，46%在疾病出现10年后将无需治疗或仍在接受植物疗法。前列腺较大、残余尿量和PSA增加的老年患者应被告知其出现症状或临床进展的风险较高：平均2年的时间跨度后，改用α受体阻滞剂或5α还原酶抑制剂进行治疗的风险就会成为现实。
