Department of Urology, University of Minnesota, Minneapolis, MN, USA.
Curr Urol Rep. 2024 May;25(5):93-98. doi: 10.1007/s11934-024-01199-4. Epub 2024 Mar 7.
This review aims to identify and summarize the current literature on the most recent therapeutic agents and combination strategies for the medical management of lower urinary tract symptoms resulting from benign prostatic hyperplasia.
The latest advancements in BPH therapy have been in combination strategies. Alpha blockers continue to be the mainstay of treatment, but research is exploring the synergistic benefits of combining them with 5-alpha reductase inhibitors (5-ARIs), phosphodiesterase-5 (PDE5) inhibitors, and beta-3 agonists. The alpha-blocker + 5-ARI combination remains ideal for enlarged, significantly reducing clinical progression risk compared to monotherapy. Alpha-blocker + PDE5 inhibitor combinations appear safe and potentially beneficial for men with concomitant erectile dysfunction; sildenafil might hold an edge over tadalafil based on limited data. Beta-3 agonists show synergistic effects with alpha blockers for residual storage symptoms, offering similar efficacy to anticholinergics but with a better side effect profile.
本文旨在识别和总结目前有关治疗良性前列腺增生引起下尿路症状的最新治疗药物和联合策略的文献。
BPH 治疗的最新进展在于联合策略。α受体阻滞剂仍然是治疗的主要方法，但研究正在探索将其与 5-α 还原酶抑制剂（5-ARI）、磷酸二酯酶-5（PDE5）抑制剂和β-3 激动剂联合使用的协同益处。α受体阻滞剂+5-ARI 联合治疗对于增大的前列腺仍然是理想的选择，与单药治疗相比，可显著降低临床进展风险。α受体阻滞剂+PDE5 抑制剂联合治疗对于伴有勃起功能障碍的男性似乎是安全且可能有益的；根据有限的数据，西地那非可能优于他达拉非。β-3 激动剂与α受体阻滞剂对残余储尿症状具有协同作用，其疗效与抗胆碱能药物相似，但副作用谱更好。
