托特罗定治疗前列腺癌粒子植入术后迟发性膀胱过度活动症的疗效及安全性

Efficacy and safety of tolterodine on late-onset overactive bladder symptoms after prostate brachytherapy

目的评价托特罗定治疗前列腺癌放射性粒子植入术后迟发性膀胱过度活动症（OAB）的疗效和安全性。方法局限性前列腺癌患者26例，均接受125I放射性粒子植人治疗，术后6个月仍存在或发生尿频、尿急、夜尿增多或急迫性尿失禁等OAB症状，OAB评分（OABSS）≥3分。患者分为2组，托特罗定组（TR组）14例，给予酒石酸托特罗定2rag／次，2次／d治疗4周；坦索罗亨组（Ts组）12例，给予坦索罗辛0．2mg／d治疗4周。随访患者粒子植入前、药物治疗前、药物治疗后2岗和4周的国际前列腺症状评分（IPSS）、OABSS和夜尿次数，以评价疗效。随访药物治疗4周后残余尿量、尿潴留、口干、便秘、心动过速等不良反应的发生率，以评价治疗的安全性。结果2组患者年龄、前列腺体积、PSA、Gleason评分和粒子植入前及药物治疗前IPSS、OABSS、夜尿次数差异无统计学意义（P〉0．05）。药物治疗后2周TR组平均IPSS、OABSS和夜尿次数均低于Ts组（14．4与18．3分，5．9与8．4分，1．4与2．5次）；治疗4周后TR组指标进一步改善，并好于TS组。治疗4周后TR组残余尿、尿潴留、口干、便秘、心动过速发生率与Ts组比较差异无统计学意义（P〉0．05）。结论托特罗定治疗前列腺癌放射性粒子植入治疗术后迟发性OAB症状安全有效，口干和心动过速为主要的小良反应。

Objective To assess the efficacy and safety of tolterodine on late-onset overactive bladder symptoms after prostate bracbytherapy due to prostate carcinoma. Methods Twenty-six prostate cancer patients diagnosed by biopsy, who underwent prostate brachytberapy using iodine-125, were recruited in this trial. All cases complained of overactive bladder symptoms 6 months postoperatively. The 26 patients were divided into 2 groups： 14 men in tolterodine group （TR group） who were given tolterodine 2 mg twice a day; 12 men in tamsulosin group （TS group） who were given tamsulosin 0.2 mg once a day. Efficacy was assessed by changes in IPSS, OABSS and nighttime voiding at 2 weeks and 4 weeks after medical treatment respectively. Safety was assessed by postvoid residual （PVR） and acute urinary retention （AUR）, dry mouth, constipation and tachycardia at the fourth week after medical treatment. Results The age, tumor staging, GS, PSA, initial prostate volume, IPSS, OABSS, nighttime voiding, iodine-125 seeds implanted and needles punctured of both groups were comparable. IPSS, OABSS and nighttime voiding were significantly improved in TR group after 2 weeks of medical treatment and the above parameters were significantly improved than TS group （14.4 vs 18.3, 5.9 vs8.4, 1.4 vs2.5）. OAB symptoms of TR group were also significantly improved than TS group after 4 weeks of therapy. There were no significant differences of PVR and A UR, dry mouth, constipation and tachycardia between both groups. Conclusions Tolterodine is effective and safe in treating late-onset OAB symptoms after prostate brachytherapy, although the occurence of dry mouth and tachycardia might be increased.