Pathogenic mechanisms linking benign prostatic hyperplasia, lower urinary tract symptoms and erectile dysfunction
Pathogenic mechanisms linking benign prostatic hyperplasia, lower urinary tract symptoms and erectile dysfunction
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DOI：
10.1177/1756287213488236
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发表时间：
2013-08-01
影响因子：
2
通讯作者：
Araujo Glina, Felipe Placco
中科院分区：
文献类型：
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作者：
Glina, Sidney;Araujo Glina, Felipe Placco
由良性前列腺增生症(BPH)引起的勃起功能障碍(ED)和下尿路症状(LUTS)是50岁以上男性的常见临床症状。有证据表明两者可能有共同的病理生理学。目的：本研究的目的是进行文献综述，旨在展示证明ED和LUTS/BPH单一病理生理学的理论和假说。方法：检索Medline中截至2012年12月15日的所有领域的医学主题标题(MESH)“勃起功能障碍”和“下尿路症状”。本次检索共检索到198篇相关文献进行分析。结果：根据发现的证据类型，对数据和文献进行了分类。有强有力的流行病学资料表明，LUTS/BPH是发生ED的危险因素。一些实验模型表明，动物膀胱的部分梗阻会导致排尿障碍，并对手术动物的勃起功能产生负面影响。动物体内肾上腺素能激素的增加会导致前列腺生长和尿动力学状况，与男性LUTS和ED的情况相似。动脉硬化可导致膀胱自满丧失、尿路梗阻和海绵体纤维化。使用磷酸二酯酶5型抑制剂(PDE-5I)和/或α-肾上腺素能阻滞剂治疗ED和LUTS/BPH强化了这样的假设，即至少在某些患者中，这两种临床表现可能具有相同的病理生理机制。
Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) are clinical entities very prevalent in men aged over 50 years. There is evidence that both may have a common pathophysiology.Objective: The objective of this study was to conduct a literature review aiming to show theories and hypotheses that justify a single pathophysiology for ED and LUTS/BPH.Methods: A search in Medline using the keywords of the Medical Subject Headings (MESH) 'erectile dysfunction' and 'lower urinary tract symptoms' in all fields of the database up to 15 December 2012. This search found 198 relevant articles that were analyzed.Results: The data and articles were divided according to the type of evidence found. There are strong epidemiological data showing that LUTS/BPH is a risk factor for developing ED. Several experimental models demonstrated partial obstruction of the bladder in animals causes voiding disorders as well as a negative impact on erectile function of the operated animals. The increased adrenergic tonus in animals leads to prostate growth and urodynamic conditions similar to those found in men with LUTS and ED. Arteriosclerosis may lead to loss of vesical complacency, urinary tract obstruction and fibrosis of the cavernous bodies. The use of phosphodiesterase type 5 inhibitors (PDE-5i) and/or alpha-adrenergic blockers to treat ED and LUTS/BPH reinforces the hypothesis that, at least in some patients, both clinical pictures may have the same pathophysiology.