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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 王炯珵 | 以Silodosin治療攝護腺肥大的病人，主觀症狀無法改善的原因之探討:使用壓力尿流速檢查 | 2013/9/24 上午 10:57:58 | 0 |
| 原 文 | 題 目 | What Are the Factors Contributing to Failure in Improvement of Subjective Symptoms Following Silodosin Administration in Patients With Benign Prostatic Hyperplasia? Investigation Using a Pressure-Flow Study |
| 作 者 | Yoshihisa Matsukawa,Ryohei Hattori,Naoto Sassa, Tokunori Yamamoto,and Momokazu Gotoh | |
| 出 處 | Neurourology and Urodynamics,32:266–270 (2013) | |
| 出版日期 | March,2013 | |
| 評 論 |
使用甲型交感神經阻斷劑(alpha-adrenoceptor antagonist)以及五甲型還原酶抑制劑(5-alpha reductase inhibitor)來治療攝護腺肥大相關的下泌尿道症狀，已在全球行之有年，而最新型的甲型交感神經阻斷劑Silodosin，在過去許多研究已發現對治療攝護腺肥大有良好效果。但是在治療效果不好的病人的原因為何呢，至今很少有研究去探討，所以本篇的研究是根據壓力尿流速的檢查來探討主觀下泌尿道症狀無法改善的原因。 這是從名古屋大學所做的一個單中心、回顧型的研究，主要納入受試者的條件包括了：1.IPSS(International Prostate Symptom Score)分數≧8分，2.QOL (IPSS-quality of life)≧3分，3.攝護腺體積≧20 ml，4.最大尿流速<15 ml/sec，排尿量>100ml，5.餘尿量<150ml，6.年紀≧50歲。 本篇作者將病患分為兩組，一組為有良好反應（good responders；GR），一組為沒有良好反應（poor responders；PR)。作者定義有良好反應者為IPSS症狀改善大於25％。這項研究中可以看到73位良好反應的病人，及31位沒有良好反應病人。這些病人在治療前的年紀、IPSS分數、QOL、OABSS、prostate size、還有尿路動力學檢查上面的一些參數，都沒有明顯的差異。唯一有差異的是，沒有良好反應組(PR)的餘尿量在治療前是比有良好反應(GR)高的。 在治療後我們可以看到，有良好反應組(GR)的治療前自發性逼尿肌收縮(involuntary detrusor contraction)，從47.9%降到15.1%，統計上是有差異的。可是沒有良好反應(PR)這組病患的自發性逼尿肌收縮，從64.5%只下降到45.2%，統計上並沒有差異，所以也對應到病人的主觀症狀、IPSS儲存尿液的症狀，以及OABSS膀胱過動症的症狀並沒有改善。因此可以看出對Silodosin治療效果不好的病患，主要是有儲存尿液的症狀無法獲得改善。但在膀胱出口阻塞的問題，兩組在治療前後都有明顯獲得改善。 結論是雖然Silodosin在治療攝護腺肥大所引起的下泌尿道症狀的確在尿路動力學上有主觀上的改善，但是在自發性逼尿肌收縮改善不好的病人，發現在主觀上IPSS的症狀並沒有良好的改善，所以儲存尿液的問題無法改善是導致攝護腺肥大病人主觀症狀無法改善的主要原因。 |
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| abstract |
AIMS: To investigate the factors responsible for failure in improvement of subjective symptoms following silodosin treatment on the basis of findings of a pressure-flow study (PFS). METHODS: A post hoc analysis of a prospective study to investigate the efficacy of silodosin in patients with BPH was conducted, and 104 patients were analyzed. The patients were administered silodosin 8mg/day for 4 weeks. At the baseline and after treatment, subjective symptoms were evaluated using the IPSS and OABSS. A PFS was conducted to measure storage and voiding function. The patients were divided into two groups: good responders (GR), patients with 25% or more improvement in IPSS, and poor responders (PR), <25% improvement. The clinical and objective findings for the two groups were compared. RESULTS: The mean IPSS and OABSS significantly improved in GR, but no significant improvement was observed in PR. PFS analysis revealed that all voiding and storage function parameters improved significantly in GR. Although PR showed a significant improvement in the voiding function parameters, it did not show significant changes in the storage function. Involuntary detrusor contraction (IDC) resolved in 68.6% of the patients in GR and in only 30% of the patients in PR, thereby showing a significant difference in the remedial effect between the two groups. CONCLUSIONS: The findings suggest that insufficient improvement in storage function is a contributing factor to the failure in improvement of subjective symptoms after silodosin treatment in patients with BPH. |
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