α1肾上腺素能受体阻滞剂治疗青年男性原发性膀胱出口梗阻

Evaluation of the efficacy and safety of α1 adrenergic blockers for treating young men with primary bladder outlet obstruction

目的探讨α1肾上腺素能受体阻滞剂治疗青年男性原发性膀胱出口梗阻（PBNO）的疗效和安全性。方法经影像尿动力学等检查诊断为PBNO男性患者22例。平均年龄28（18～35）岁。排尿等待21例（95％）、尿线变细17例（77％）、尿频16例（73％）、尿急8例（36％）、会阴部隐痛6例（27%）。症状平均持续时间28（3～62）个月。晚睡前服用多沙唑嗪4mg，用药时间≥6个月。比较治疗前和治疗6个月后国际前列腺症状评分（IPSS）、生活质量评分（QOL）、尿流率、残余尿量和血压变化。治疗有效标准为最大尿流率（Qmax）增加≥3ml／s，IPSS下降〉40％。结果随访数据完整21例。平均服药时间（8．7±2．5）个月，平均随访时间（12．3±4．9）个月。治疗前后平均IPSS分别为（16．9±3．7）和（10．7±4．5）分，QOL评分由（4．3±1．2）分降至（2．5±1．0）分，平均Qmax由（9．8±3．5）ml／s增加至（14．9±3．6）ml／s，平均残余尿量由（78．2±35．6）ml降至（46．5±19．4）ml，治疗前后比较差异均有统计学意义（P〈0．01）。多沙唑嗪治疗PBNO有效者14例（67％）。治疗前后收缩压分别为（110．0±7．9）、（107．0±8．7）mmHg（1mmHg=0．133kPa），舒张压分别为（75．05．9）、（72．0±7．1）mmHg，治疗前后比较差异无统计学意义（P〉0．05）结论α1肾上腺素能受体阻滞剂治疗青年男性PBNO患者安全有效。

Objective To evaluate the efficacy and safety of α1-adrenergic blockers for treating young men with primary bladder neck obstruction （PBNO）. Methods A retrospective review was done of the presenting symptoms and videourodynamic findings of 22 young men younger than 35 years with PBNO. Mean age was 28 years （range 18 to 35）. The presenting symptoms were hesitancy in 21 （95%）, weak stream in 17（77%）, frequency in 16（73%）, urgency in 8（36%） and pelvic pain in 6 （27%）. Mean symptom duration was 28（3--62）months. A dose of 4 mg Doxazosion was administered for at least 6 months. International prostate symptom score（IPSS）, Quality of life（QOL）, uroflowmetry, post-void residual urine and blood pressure were assessed before and 6 months after medi cation. Improved urine flow was defined as at least 3 ml. per second increase in the maximum flow rate. Improved symptom was defined as more than a 40 % decrease in IPSS. Successful treatment was defined as improved in urine flow and symptoms. Results Follow-up data were available for 21 of 22 patients. The medication period was 8.7 ±2.5 months and follow-up duration was 12.3 ±4.9 months. Mean I-PSS decreased from 16.9±3.7 to 10.7±4.5. Mean QOL decreased from 4.3±1.2 to 2.5±1.0. Mean maximum flow rate increased from （9.8＋3.5）ml to （14.9±3.6）ml. per second. Mean post-void residual urine decreased from （78.2 ±35.6） ml to （46. 5 ±19.4） ml. There were significant differences（P〈0. 01）. Treatment was successful in 14 patients （67%）. Drug tolerability was good. Mean blood pressure was （110.0±7.9）/ （75.0±5.9）mm Hg and （107.0±8.7）/（72.0±7.1）mm Hg before medicine therapy and after 6 months medication（P〉0.05）. Conclusions Videourody namics is the diagnostic gold standard of PBNO. In our experience α1-adrenergic blockers are clinically effective therapy and safety for PBNO and have been well tolerated in young male patients.