Schmidbauer C P, Madersbacher S
Universitätsklinik für Urologie, Wien.
Wien Med Wochenschr. 1996;146(8):161-4.
Almost 60% of elderly men suffer from symptoms of BPH, which have significant impact on their daily lives. Transurethral resection of the prostate (TURP) is currently the most effective therapy for relieve of obstruction and obstructive symptoms. Morbidity of TURP and disappointing results in patients with mild or moderate symptoms make surgery not suitable for all patients. 2 groups of drugs were currently developed, and showed efficacy in double-blinded placebo-controlled studies: alpha-blocking agents and 5 alpha-reductase inhibitors. Inhibition of alpha-adrenoreceptors significantly increases urinary flow rates and improves symptoms of BPH. Long-acting drugs, who selectively block alpha 1-adrenoreceptors (terazosin, doxazosin, tamsulosin) have the advantage, when compared with non-selective-alpha-blockers, that they have generally less adrenergic side effects. After intake alpha-adrenorceptor antagonists develop almost immediate action. 5 alpha-reductase inhibitors (finasteride) reduce prostatic size by 27%, they increase urinary flow rates and improve prostatic symptom scores, whilst adverse effects are extremely low. Full medical action is after 4 to 6 weeks. Both, alpha-Blockers and 5 alpha-reductase inhibitors need permanent administration for maintenance of action. Yet, synergistic effects, using their different modes of action have not been demonstrated after application of both drugs. Herbal products have not proved efficacious inspite of singular surprising results in clinical trials, their efficacy to treat BPH related symptoms was classified as placebo alike. Prior to therapy urological diagnosis and exclusion of prostate cancer is mandatory. Pharmacotherapy with alpha 1-adrenoreceptor antagonists and 5 alpha-reductase inhibitors have a place in the management of BPH patients with mild to moderate disease, who are bothered by their symptoms, or for those awaiting or wishing to delay surgery.
近60%的老年男性患有良性前列腺增生（BPH）症状，这些症状对他们的日常生活有重大影响。经尿道前列腺切除术（TURP）是目前缓解梗阻和梗阻性症状最有效的治疗方法。TURP的发病率以及在轻度或中度症状患者中令人失望的结果使得手术并不适用于所有患者。目前研发了两类药物，并且在双盲安慰剂对照研究中显示出疗效：α受体阻滞剂和5α还原酶抑制剂。抑制α肾上腺素能受体可显著增加尿流率并改善BPH症状。与非选择性α受体阻滞剂相比，选择性阻断α1肾上腺素能受体的长效药物（特拉唑嗪、多沙唑嗪、坦索罗辛）具有优势，即它们通常具有较少的肾上腺素能副作用。服用α肾上腺素能受体拮抗剂后几乎立即起效。5α还原酶抑制剂（非那雄胺）可使前列腺体积缩小27%，增加尿流率并改善前列腺症状评分，同时副作用极低。完全的药物作用在4至6周后显现。α受体阻滞剂和5α还原酶抑制剂都需要长期服用以维持疗效。然而，两种药物联合应用后，尚未证实它们不同作用方式的协同效应。尽管在临床试验中个别结果令人惊讶，但草药产品尚未被证明有效，它们治疗BPH相关症状的疗效被归类为与安慰剂相似。在治疗前，必须进行泌尿外科诊断并排除前列腺癌。α1肾上腺素能受体拮抗剂和5α还原酶抑制剂的药物治疗在管理有轻度至中度疾病且受症状困扰的BPH患者中，或对于那些等待或希望推迟手术的患者中占有一席之地。
