Holtgrewe H L
Department of Urology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
Urology. 1998 Apr;51(4A Suppl):1-7. doi: 10.1016/s0090-4295(98)00048-x.
Management of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) has been central to urology for decades. The urologic community has increasingly come to realize that many men with LUTS do not have prostate enlargement and do not need their prostates debulked surgically. Of all the factors that have emerged to alter the trends associated with management of LUTS and BPH, none has had more impact than the advent of medical therapy. The selective, long-acting, alpha1-blocking agents terazosin, doxazosin, and tamsulosin have become most popular because of their specificity in the urinary tract, reduced side effects, and simplicity of dosage. In addition, finasteride, a 5-alpha-reductase inhibitor, was found to be effective in men with prostates of > or = 40 g. Furthermore, the larger the prostate at baseline, the greater the efficacy of finasteride on symptom relief and flow rate improvement. In addition to medical therapy, an array of device therapies has emerged in the management of LUTS and BPH. Laser prostatectomy is the oldest of the device therapies and includes transurethral vaporization of the prostate (VLAP), transurethral evaporation of the prostate (TUEP), and transurethral interstitial laser prostatectomy (TILP). Studies report beneficial outcomes approaching those achieved with transurethral resection of the prostate (TURP) with less morbidity and a shorter hospital stay. Common diseases contribute the most to national healthcare expenditures. The management of LUTS and BPH are such disorders and result in the expenditure of vast healthcare resources worldwide. The surgical strategies have an established record of outcomes documenting their potential for symptom relief and the avoidance of future complications. Medical and device therapies, although currently promising and attractive, therefore must prove comparable durability.
几十年来，下尿路症状（LUTS）和良性前列腺增生（BPH）的管理一直是泌尿外科的核心内容。泌尿外科界越来越意识到，许多有LUTS的男性并没有前列腺肿大，也不需要通过手术切除前列腺。在所有改变LUTS和BPH管理相关趋势的因素中，没有什么比药物治疗的出现产生的影响更大。选择性长效α1受体阻滞剂特拉唑嗪、多沙唑嗪和坦索罗辛因其在尿路中的特异性、副作用减少以及给药简单而变得最受欢迎。此外，发现5α还原酶抑制剂非那雄胺对前列腺≥40g的男性有效。此外，基线时前列腺越大，非那雄胺对缓解症状和改善尿流率的疗效就越大。除了药物治疗，在LUTS和BPH的管理中还出现了一系列器械治疗方法。激光前列腺切除术是最古老的器械治疗方法，包括经尿道前列腺汽化术（VLAP）、经尿道前列腺蒸发术（TUEP）和经尿道间质激光前列腺切除术（TILP）。研究报告称，其有益结果接近经尿道前列腺切除术（TURP），且发病率更低、住院时间更短。常见疾病对国家医疗保健支出的贡献最大。LUTS和BPH的管理就是这样的疾病，在全球范围内导致了大量医疗资源的消耗。手术策略有既定的结果记录，证明了它们缓解症状和避免未来并发症的潜力。因此，尽管目前药物和器械治疗前景广阔且颇具吸引力，但必须证明它们具有相当的耐久性。
