Ueki O, Kawaguchi K, Katsumi T, Murayama K, Kameda K, Nishino A, Sakai A, Haginaka T, Miyazaki K, Asari T, Egawa M
Department of Urology, Noto General Hospital.
Hinyokika Kiyo. 1998 Aug;44(8):565-73.
Alpha adrenergic blocker has become the first choice in the medical treatment of benign prostatic hyperplasia (BPH). The efficacy of alpha adrenergic blocker has been suggested to be related to the prostatic tissue components, and to be ineffective in treating the clinical symptoms caused by BPH in some cases. The efficacy and prostate reduction of an anti-androgenic agent, chlormadinone acetate, combined with alpha adrenergic blocker, tamsulosin hydrochloride, were evaluated using 40-BPH patients insufficiently treated with tamsulosin hydrochloride alone. Fifty mg of chlormadinone acetate and 0.2 mg of tamsulosin hydrochloride were administered orally once a day for 16 weeks to patients with a prostate subjective symptoms score, I-PSS, of greater than 13 or a peak flow rate of less than 12 ml/s, even after the treatment with 0.2 mg of tamsulosin hydrochloride alone for more than four weeks. Total I-PSS decreased significantly after four weeks. The total irritative symptom score did not change for 16 weeks, but the total obstructive symptom score decreased significantly, as did the total I-PSS. In objective data, the estimated volume of both total prostate and the transition zone on transrectal ultrasonogram decreased significantly at the end of the treatment, and the peak flow rate decreased significantly after 12 weeks. These findings suggest that the addition of chlormadinone acetate may be a reasonable alternative in the treatment of BPH patients responding insufficiently to tamsulosin hydrochloride alone, and that combination therapy using chlormadinone acetate and tamsulosin hydrochloride may be useful for BPH patients with serious obstructive symptoms.
α-肾上腺素能阻滞剂已成为良性前列腺增生(BPH)药物治疗的首选。α-肾上腺素能阻滞剂的疗效被认为与前列腺组织成分有关,且在某些情况下对治疗BPH引起的临床症状无效。使用40例单用盐酸坦索罗辛治疗效果不佳的BPH患者,评估抗雄激素药物醋酸氯地孕酮与α-肾上腺素能阻滞剂盐酸坦索罗辛联合应用的疗效及对前列腺的缩小作用。对于前列腺主观症状评分(I-PSS)大于13或即使单用0.2mg盐酸坦索罗辛治疗超过四周后最大尿流率仍小于12ml/s的患者,给予口服50mg醋酸氯地孕酮和0.2mg盐酸坦索罗辛,每日1次,共16周。四周后I-PSS总分显著下降。总的刺激性症状评分在16周内未改变,但总的梗阻性症状评分显著下降,I-PSS总分也下降。在客观数据方面,治疗结束时经直肠超声检查显示前列腺总体积和移行带体积均显著减小,12周后最大尿流率显著下降。这些发现表明,对于单用盐酸坦索罗辛反应不足的BPH患者,加用醋酸氯地孕酮可能是一种合理的选择,且醋酸氯地孕酮与盐酸坦索罗辛联合治疗可能对有严重梗阻症状的BPH患者有用。