Tamalunas Alexander, Paktiaval Richard, Lenau Philipp, Stadelmeier Leo Federico, Buchner Alexander, Kolben Thomas, Magistro Giuseppe, Stief Christian G, Hennenberg Martin
Department of Urology, University Hospital, LMU Munich, Munich, Germany.
Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany.
Patient Prefer Adherence. 2024 Dec 9;18:2507-2518. doi: 10.2147/PPA.S484632. eCollection 2024.
Lower urinary tract symptoms (LUTS) consist of voiding and storage symptoms. While the therapeutic efficacy of current LUTS medications is limited, and with more than 20% of patients suffering from mixed symptoms, current guidelines offer nothing more than combining monotherapies. An individualized approach is urgently warranted, and phytomedicines have become an integral part of patient-empowerment in therapeutic shared-decision making processes. Therefore, we aimed to investigate patients' preference of phytomedicines and treatment adherence at the dawn of an era leaving α-blocker monotherapies behind.
A questionnaire was prepared, and patients at our tertiary referral center were given the opportunity to voluntarily participate in our survey. We collected questionnaires from 300 patients during their visits from January 2022 to December 2022.
With 73% (218/300), most of our study cohort had either taken one or more or were currently on prescription medication for LUTS/BPH. Patients were prescribed α-blockers (72%), followed by 5α-reductase inhibitors (21%), and phosphodiesterase-5-inhibitor (5%), while antimuscarinics and β-agonists were rarely prescribed. However, 41% (89/218) of our patients, who were taking medication for LUTS, had taken or were currently taking phytomedicines, making this the second most common drug class in our patient cohort. Patients scored the efficacy of phytomedicines at a mean in the lower third, but 87% of patients attributed excellent tolerability, and only 9% experienced side effects. While 43% of patients recommended phytomedicines for other patients, two-thirds of patients thought phytomedicines should be covered by statutory health insurance.
We found that phytomedicines were the second most common drug class taken by LUTS patients at our hospital. Reasons may be easy availability as over the counter medication and a superior safety profile with less bothersome side effects than commonly prescribed drug classes. Taken together, phytomedicines may be able to bridge an important gap in LUTS pharmacotherapy to provide sufficient treatment adherence where prescription drug classes fail, and ultimately, adequate improvement of symptoms. However, patients need to be counseled on potentially limited efficacy.
下尿路症状（LUTS）包括排尿症状和储尿症状。尽管目前治疗LUTS的药物疗效有限，且超过20%的患者存在混合症状，但当前指南无非是将单一疗法联合使用。迫切需要一种个体化的方法，而植物药已成为治疗共同决策过程中患者自主选择的一个重要组成部分。因此，我们旨在研究在一个摒弃α受体阻滞剂单一疗法的时代之初，患者对植物药的偏好及治疗依从性。
编制了一份问卷，我们三级转诊中心的患者有机会自愿参与我们的调查。在2022年1月至2022年12月期间，我们从300名患者就诊时收集了问卷。
我们的研究队列中，73%（218/300）的患者曾服用过一种或多种治疗LUTS/良性前列腺增生（BPH）的处方药，或目前正在服用此类药物。患者服用的处方药中，α受体阻滞剂占72%，其次是5α还原酶抑制剂占21%，磷酸二酯酶-5抑制剂占5%，而抗毒蕈碱药和β受体激动剂很少被处方。然而，在我们正在服用LUTS药物的患者中，41%（89/218）的患者曾服用或目前正在服用植物药，使其成为我们患者队列中第二常见的药物类别。患者对植物药疗效的评分平均处于较低的三分之一，但87%的患者认为其耐受性极佳，只有9%的患者出现副作用。虽然43%的患者会向其他患者推荐植物药，但三分之二的患者认为植物药应由法定医疗保险覆盖。
我们发现植物药是我院LUTS患者服用的第二常见药物类别。原因可能是其作为非处方药容易获得，且安全性更高，副作用比常用处方药类别更少。总体而言，植物药或许能够填补LUTS药物治疗中的一个重要空白，在处方药类别疗效不佳时提供足够的治疗依从性，并最终充分改善症状。然而，需要向患者说明其疗效可能有限。
