Lower urinary tract symptoms in men.
Lower urinary tract symptoms in men.
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DOI：
10.1136/bmj.g4474
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发表时间：
2014-08-14
期刊：
影响因子：
--
通讯作者：
Wilt TJ
中科院分区：
文献类型：
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作者：
Hollingsworth JM;Wilt TJ
良性前列腺增生（BPH）是一种高度流行和昂贵的疾病，影响世界各地的老年男性。许多受影响的男性会出现下尿路症状，这会对他们的生活质量产生负面影响。在过去，经尿道前列腺切除术（TURP）是治疗的主要手段。然而，已经开发了几种有效的药物治疗，将BPH从急性手术实体转变为慢性疾病。具体而言，多项临床试验表明α肾上腺素受体拮抗剂可显著改善下尿路症状。此外，5α还原酶抑制剂单独使用或与α肾上腺素受体拮抗剂联合使用，可逆转BPH的自然病程，降低尿潴留的风险和手术干预的需要。较新的药物治疗方案，包括使用抗毒蕈碱剂或磷酸二酯酶5型抑制剂，已显示出前景的男性主要存储症状和伴随勃起功能障碍，分别。对于保守治疗或药物治疗效果不佳的男性，微创手术技术（如经尿道针消融、微波热疗和前列腺尿道提升术）可能有益，尽管它们缺乏TURP的持久性。各种激光手术也被引入，其改进的止血性能消除了传统手术的许多并发症。
Benign prostatic hyperplasia (BPH) is a highly prevalent and costly condition that affects older men worldwide. Many affected men develop lower urinary tract symptoms, which can have a negative impact on their quality of life. In the past, transurethral resection of the prostate (TURP) was the mainstay of treatment. However, several efficacious drug treatments have been developed, which have transformed BPH from an acute surgical entity to a chronic medical condition. Specifically, multiple clinical trials have shown that α adrenoceptor antagonists can significantly ameliorate lower urinary tract symptoms. Moreover, 5α reductase inhibitors, alone or combined with an α adrenoceptor antagonist, can reverse the natural course of BPH, reducing the risk of urinary retention and the need for surgical intervention. Newer medical regimens including the use of antimuscarinic agents or phosphodiesterase type 5 inhibitors, have shown promise in men with predominantly storage symptoms and concomitant erectile dysfunction, respectively. For men who do not adequately respond to conservative measures or pharmacotherapy, minimally invasive surgical techniques (such as transurethral needle ablation, microwave thermotherapy, and prostatic urethral lift) may be of benefit, although they lack the durability of TURP. A variety of laser procedures have also been introduced, whose improved hemostatic properties abrogate many of the complications associated with traditional surgery.