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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 陳欣宏 | 當前攝護腺肥大相關下泌尿道症狀的藥物治療: 我們是否應該有標準的用藥原則? | 2014/4/29 上午 10:37:16 | 0 |
| 原 文 | 題 目 | Current medical treatment of lower urinary tract symptoms/BPH: do we have a standard? |
| 作 者 | Silva Joao et al. | |
| 出 處 | Current Opinion in Urology | |
| 出版日期 | 24(1):21-28, 2014 | |
| 評 論 |
由Silva Joao等人發表在2014年Current Opinion in Urology的這篇review文章是一篇相當有趣的論文，他們研究發現對於攝護腺肥大的藥物治療觀念，傳統上將甲型交感神經接受體阻斷劑(Alpha-blockers) 及5 Alpha還原酶抑制劑(5α-reductase inhibitors)、或合併兩者藥物(combination)， 當成主要治療劑型的用法，應該要接受新的挑戰。 新的藥物治療觀念包括(1)抗蕈毒鹼劑(antimuscarinics)單獨或合併甲型交感神經接受體阻斷劑的組合，不但可以改善病患尿液貯存的症狀，而且不會影響其排尿功能。(2)磷酸二酯酶抑制劑(PDE-5 inhibitors)單獨或合併甲型交感神經接受體阻斷劑的組合，不但比單獨使用甲型交感神經接受體阻斷劑有更好的排尿症狀改善效果，更可以改善病患的性功能。(3) β3腎上腺素接受體促效劑(β3-adrenoreceptor agonists - Mirabegron)，它可以增加病患膀胱容量，降低膀胱出口阻力，卻不會影響膀胱收縮壓或增加殘尿量。 目前攝護腺肥大的藥物治療觀念，正在緩緩的但持續演進當中，我們將不能只把攝護腺當成主要的治療標的，其他包括主要的相關下泌尿道症狀、攝護腺本身的特徵、及男性性功能等，都必須納入整體藥物治療的考量範圍；因此，對於攝護腺肥大的藥物治療，將不應該有所謂的標準，而是需要因應病患症狀的差異性，給予他們個別化(individualized)的藥物，這樣才能真正改善病患的生活品質。 |
|
| abstract |
Purpose of review: The pharmacological treatment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) is based on alpha-blockers and 5α-reductase inhibitors isolated or in combination. Silodosin, an alpha-1A specific alpha-blocker is the only innovation in these groups of agents. This classical paradigm is being challenged by antimuscarinics, 5-phosphodiesterase inhibitors (PDE5i) and β3-adrenoreceptor agonists. Recent findings: Silodosin is effective in reducing BPH/LUTS, including nocturia and shows little cardiovascular adverse events. Antimuscarinic drugs isolated or in combination with alpha-blockers improve storage symptoms without any harmful effect to the voiding function. PDE5i alone improve BPH/LUTS. Combination of PDE5i with alpha-blockers provides better symptomatic control than alpha-blockers alone. A recent head-to-head comparison of tadalafil 5 mg/day with tamsulosin 0.4 mg/day showed that these agents provided the same improvement in BPH/LUTS and, surprisingly, the same improvement in the urinary flow. In fact, previous studies with tadalafil had not shown any effect of tadalafil on flow. In addition, tadalafil but not tamsulosin improved sexual function. Mirabegron, the first β3-adrenoreceptor agonist, while improving BPH/LUTS in men with bladder outlet obstruction, do not decrease urinary flow or detrusor pressure. Summary: The standard medical treatment for BPH/LUTS is still based on alpha-blockers, 5ARIs or its combination. In the future, it is expected that BPH/LUTS treatment will become individualized, according to the type of symptoms, presence of sexual dysfunction and risk of BPH progression. This will challenge our concept of standard treatment for BPH/LUTS. |
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