Chapple C R
Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
Eur Urol. 1998;34 Suppl 2:10-7; discussion 46. doi: 10.1159/000052283.
The risk of mortality and long-term morbidity, including loss of sexual function, associated with surgical procedures for symptomatic benign prostatic hyperplasia (BPH) has prompted research into alternative medical therapies. Phytotherapy involves the use of herbal formulations, where the mechanisms of action are usually obscure and although studies have confirmed their effectiveness in symptom relief and improving quality of life (QOL), few placebo-controlled trials exist. Both the 5 alpha-reductase inhibitor finasteride and alpha 1-adrenoceptor antagonists (e.g. alfuzosin, doxazosin, prazosin, tamsulosin and terazosin) have been recommended as appropriate treatment options for patients with lower urinary tract symptoms (LUTS) associated with benign prostatic obstruction (BPO), and their efficacy has been proven in several placebo-controlled trials. Finasteride reduces the static component of BPO--by reducing the size of the prostate--and, as a result, symptom relief is slow (6-12 months) and is predominantly restricted to patients with large prostates (> 40 g). The alpha 1-adrenoceptor antagonists, on the other hand, reduce the dynamic component of obstruction--relaxation of smooth muscle in the prostate, urethra and bladder neck--and provide rapid symptom relief after only a few doses, relieving LUTS more effectively than finasteride and irrespective of prostate size. All of the various alpha 1-adrenoceptor antagonists provide effective and comparable relief of LUTS, and an improvement in bothersomeness and symptom-related QOL. However, it is also important that the therapy is fast acting and acceptable to the patient, in that it does not interfere with other medication or produce unpleasant side effects. These documented properties of the alpha 1A-adrenoceptor antagonists make them an ideal choice for the medical treatment of symptomatic BPH.
与有症状的良性前列腺增生（BPH）手术相关的死亡风险和长期发病率，包括性功能丧失，促使人们对替代药物疗法进行研究。植物疗法涉及使用草药配方，其作用机制通常不明，尽管研究已证实其在缓解症状和改善生活质量（QOL）方面的有效性，但很少有安慰剂对照试验。5α-还原酶抑制剂非那雄胺和α1-肾上腺素能受体拮抗剂（如阿夫唑嗪、多沙唑嗪、哌唑嗪、坦索罗辛和特拉唑嗪）已被推荐作为伴有良性前列腺梗阻（BPO）的下尿路症状（LUTS）患者的合适治疗选择，并且它们的疗效已在多项安慰剂对照试验中得到证实。非那雄胺通过缩小前列腺体积来降低BPO的静态成分，因此症状缓解缓慢（6 - 12个月），且主要限于前列腺较大（> 40 g）的患者。另一方面，α1-肾上腺素能受体拮抗剂可降低梗阻的动态成分——前列腺、尿道和膀胱颈平滑肌的松弛——并且仅需几剂即可快速缓解症状，比非那雄胺更有效地缓解LUTS，且与前列腺大小无关。所有各种α1-肾上腺素能受体拮抗剂均能有效且相当程度地缓解LUTS，并改善困扰程度和与症状相关的生活质量。然而，同样重要的是，该疗法起效快且患者可接受，即它不干扰其他药物或产生不良副作用。α1A-肾上腺素能受体拮抗剂的这些已记录特性使其成为有症状BPH药物治疗的理想选择。
