Tamalunas Alexander, Keller Patrick, Schott Melanie, Atzler Michael, Ebner Benedikt, Hennenberg Martin, Stief Christian G, Magistro Giuseppe
Klinik für Urologie, LMU Klinikum München, Deutschland.
Ther Umsch. 2023 Apr;80(3):113-122. doi: 10.1024/0040-5930/a001423.
Benign Prostate Hyperplasia - Current Medical Therapy, New Developments, and Side Effects Lower urinary tract symptoms (LUTS) consist of both voiding and storage symptoms. Urethral obstruction leading to voiding symptoms is most commonly attributed to benign prostatic hyperplasia (BPH), where hyperplastic growth and increased smooth muscle tone in the hyperplastic prostate may lead to benign prostate obstruction (BPO). Spontaneous contractions of the detrusor muscle may cause storage symptoms, which are referred to as overactive bladder (OAB). With a considerable proportion of patients suffering from "mixed LUTS", a combination of voiding and storage symptoms, LUTS affect a large portion of the population worldwide, with major impact on quality of life (QoL). A demographic shift in society, will lead to higher incidence and prevalence of LUTS, with a growing economic burden. Standard-of-care medical treatment for LUTS/BPO includes α-adrenoceptor antagonists and phosphodiesterase-5 (PDE-5) inhibitors, for reduction of prostate smooth muscle tone, and 5α-reductase inhibitors (5-ARI) to slow down disease progression. Medical therapy for LUTS/OAB includes muscarinic receptor antagonists, and β-agonists for relief of spontaneous bladder contractions. When left untreated, LUTS may cause considerable adverse events, ranging from acute urinary retention with kidney failure, and recurring infections, to social withdrawal, and depression.
良性前列腺增生——当前的医学治疗、新进展及副作用 下尿路症状(LUTS)包括排尿症状和储尿症状。导致排尿症状的尿道梗阻最常见的原因是良性前列腺增生(BPH),增生的前列腺组织过度生长以及平滑肌张力增加可能导致良性前列腺梗阻(BPO)。逼尿肌的自发收缩可能导致储尿症状,即所谓的膀胱过度活动症(OAB)。相当一部分患者患有“混合性LUTS”,即排尿症状和储尿症状同时存在,LUTS影响着全球很大一部分人群,对生活质量(QoL)有重大影响。社会人口结构的变化将导致LUTS的发病率和患病率升高,经济负担也会加重。LUTS/BPO的标准治疗药物包括α-肾上腺素能受体拮抗剂和磷酸二酯酶-5(PDE-5)抑制剂,用于降低前列腺平滑肌张力,以及5α-还原酶抑制剂(5-ARI)以减缓疾病进展。LUTS/OAB的药物治疗包括毒蕈碱受体拮抗剂和β-激动剂,用于缓解膀胱自发收缩。若不进行治疗,LUTS可能会引发相当多的不良事件,从急性尿潴留伴肾衰竭、反复感染到社交退缩和抑郁。