Pharmacologic therapy for prostatism
Pharmacologic therapy for prostatism
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DOI：
10.4065/73.6.590
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发表时间：
1998-06-01
影响因子：
8.9
通讯作者：
Lieber, MM
中科院分区：
文献类型：
--
作者：
Lieber, MM
尽管过去治疗足够程度的良性前列腺增生的一般方法是手术干预（经尿道前列腺切除术），但目前有效药物治疗的可用性已经改变了最初的治疗策略。目前，有两种药物可用于治疗前列腺病：（1）选择性α-肾上腺素能阻滞剂（特拉唑嗪、多沙唑嗪和坦索罗辛）和（2）5α-还原酶抑制剂（非那雄胺）。α(1)-肾上腺素能受体的药物阻断被认为会导致前列腺和膀胱颈平滑肌松弛，从而降低尿道阻力，改善尿道阻力。排尿功能，并最大限度地减少前列腺症状。患者可能会在开始治疗后几周内注意到这些影响。非那雄胺的作用机制是阻断睾酮向二氢睾酮的转化以及相关的前列腺体积收缩。平均而言，前列腺体积可以减少25%，但需要12个月或更长时间的非那雄胺治疗才能最大程度地缩小和最大程度地减轻前列腺症状。患有中度前列腺病的中老年男性人口不断增加，无疑将促进治疗前列腺病和良性前列腺增生的其他药物选择的开发。
Although the general approach to management of a sufficient degree of benign prostatic hyperplasia in the past was surgical intervention (transurethral resection of the prostate), the current availability of effective pharmacologic therapy has changed the initial management strategy. At present, two types of drug are available for treatment of prostatism: (1) selective alpha-adrenergic blocking agents (terazosin, doxazosin, and tamsulosin) and (2) an inhibitor of the 5 alpha-reductase enzyme (finasteride), Pharmacologic blockade of the alpha(1)-adrenoceptors is thought to result in relaxation of the smooth muscle in the prostate and bladder neck, which reduces urethral resistance, improves voiding function, and minimizes the symptoms of prostatism. These effects may be noted by the patient within several weeks after initiation of treatment. The mechanism of action of finasteride is a blocking of the conversion of testosterone to dihydrotestosterone and an associated volume shrinkage of the prostate. On the average, a 25% reduction in prostate volume can be achieved, but a period of 12 months or longer of finasteride therapy is needed for maximal shrinkage and maximal decrease in symptoms of prostatism. The expanding population of middle-aged and elderly men with prostatism of moderate severity will undoubtedly prompt the development of additional pharmacologic options for treatment of prostatism and benign prostatic hyperplasia.