Benign prostatic hyperplasia (BPH) is a chronic condition that is more common in older men. BPH most commonly causes symptoms associated with LUTS and bladder outlet obstruction. Lower urinary tract symptoms (LUTS) in...Benign prostatic hyperplasia (BPH) is a chronic condition that is more common in older men. BPH most commonly causes symptoms associated with LUTS and bladder outlet obstruction. Lower urinary tract symptoms (LUTS) in men with BPH are a major cause of reduced quality of life in older men. If bladder outlet obstruction persists for a longer period of time, the contractility and voiding capacity of the detrusor muscle will gradually be affected by the obstructive factors, eventually leading to a loss of compensatory phase, characterised by a reduced electrical stimulation response, replacement of bladder muscle tissue by connective tissue, and a possible increase in voiding pressure, but a decrease in contractility of the detrusor muscle. As BOO progresses, it eventually leads to permanent contractile dysfunction of the detrusor muscle. Therefore, early initiation of surgical treatment in patients who are not well controlled by medication can reduce the complications associated with prostate enlargement. With the rise of minimally invasive treatment and the complications of open surgery, minimally invasive treatment of BPH has attracted increasing attention. Various emerging minimally invasive surgical modalities are being developed in clinical practice, and more and more minimally invasive techniques and concepts are focusing on safety, improving quality of life and reducing long-term complications to meet the different needs of different patients. Transurethral resection of the prostate (TURP) is currently the “gold standard” of minimally invasive surgical treatment, but with concerns about post-operative complications, the search for safer and more effective minimally invasive surgical options has become even more important. In recent years, with the increasing clinical application of new minimally invasive techniques such as various lasers, interventional treatments and implantable devices, there are more options for minimally invasive treatment of BPH. This article provides a brief review of research advances in the minimally invasive treatment of benign prostatic hyperplasia, with a view to informing clinical decisions.展开更多
Background： The medium-to-long-term use of antimuscarinics alone or in combination with an α-blocker in men with an enlarged prostate is still controversial. This double-blind, placebo-controlled, randomized clinica...Background： The medium-to-long-term use of antimuscarinics alone or in combination with an α-blocker in men with an enlarged prostate is still controversial. This double-blind, placebo-controlled, randomized clinical trial aimed to investigate the efficacy and safety of medium-to-long-term use of tolterodine extended release （ER） with or without tamsulosin in patients with benign prostate hyperplasia （BPH） and larger prostate size. Methods： Totally, 152 patients （age ≥50 years） with BPH, International Prostate Symptom Score （IPSS） ≥12, quality-of-life （QoL） score ≥3, and total prostate volume ≥25 ml were enrolled in this study. The patients were randomized into four groups （n = 38 in each） to receive tolterodine ER placebo plus tamsulosin placebo, 0.2 mg tamsulosin plus tolterodine ER placebo, 4 mg tolterodine ER plus tamsulosin placebo, or tolterodine ER plus tamsulosin once daily for 24 weeks. IPSS （total, storage, and voiding subscales）, QoL, maximum urinary flow rate （Qmax）, and postvoid residual volume （PVR） were collected at baseline, and at weeks 4, 12, and 24. Results： Compared with placebo, tolterodine ER plus tamsulosin significantly improved total IPSS （？7.15, ？12.20, and ？14.66 vs. ？3.51, ？5.78, and ？7.23）, storage IPSS （？3.56, ？5.63, and ？6.66 vs. ？1.52, ？1.21, and ？2.43）, voiding IPSS （？2.88, ？5.10, and ？6.48 vs. ？1.52, ？3.03, and ？2.97）, QoL （？1.21, ？2.40, and ？3.21 vs. ？0.39, ？1.41, and ？1.60）, Qmax （2.21, 7.97, and 9.72 ml/s vs. 2.15, 2.44, and 2.73 ml/s）, and PVR （？17.88, ？26.97, and ？27.89 ml vs. ？12.03, ？11.16, and ？16.73 ml） at weeks 4, 12, and 24, respectively; the differences were all statistically significant （P 〈 0.05）. Adverse events （AEs） were not increased with treatment progression. Tolterodine ER alone did not improve total IPSS （？4.61, ？6.79, and ？5.70）, voiding IPSS （？0.64, ？1.83, and ？1.45）, QoL （？0.69, ？1.21, and ？1.41）, or Qmax（？0.79, 2.83, and 1.11 ml/s）, compared with placebo （all P 〉 0.05）. However, a gradual increase in PVR （10.03, 10.41, and 12.89 ml） and more urinary AEs suggestive of urinary retention （11/38 vs. 4/38） were observed. Conclusion： Medium-to-long-term use of tolterodine ER plus tamsulosin should be recommended in patients with BPH and an enlarged prostate volume.展开更多
文摘Benign prostatic hyperplasia (BPH) is a chronic condition that is more common in older men. BPH most commonly causes symptoms associated with LUTS and bladder outlet obstruction. Lower urinary tract symptoms (LUTS) in men with BPH are a major cause of reduced quality of life in older men. If bladder outlet obstruction persists for a longer period of time, the contractility and voiding capacity of the detrusor muscle will gradually be affected by the obstructive factors, eventually leading to a loss of compensatory phase, characterised by a reduced electrical stimulation response, replacement of bladder muscle tissue by connective tissue, and a possible increase in voiding pressure, but a decrease in contractility of the detrusor muscle. As BOO progresses, it eventually leads to permanent contractile dysfunction of the detrusor muscle. Therefore, early initiation of surgical treatment in patients who are not well controlled by medication can reduce the complications associated with prostate enlargement. With the rise of minimally invasive treatment and the complications of open surgery, minimally invasive treatment of BPH has attracted increasing attention. Various emerging minimally invasive surgical modalities are being developed in clinical practice, and more and more minimally invasive techniques and concepts are focusing on safety, improving quality of life and reducing long-term complications to meet the different needs of different patients. Transurethral resection of the prostate (TURP) is currently the “gold standard” of minimally invasive surgical treatment, but with concerns about post-operative complications, the search for safer and more effective minimally invasive surgical options has become even more important. In recent years, with the increasing clinical application of new minimally invasive techniques such as various lasers, interventional treatments and implantable devices, there are more options for minimally invasive treatment of BPH. This article provides a brief review of research advances in the minimally invasive treatment of benign prostatic hyperplasia, with a view to informing clinical decisions.
文摘Background： The medium-to-long-term use of antimuscarinics alone or in combination with an α-blocker in men with an enlarged prostate is still controversial. This double-blind, placebo-controlled, randomized clinical trial aimed to investigate the efficacy and safety of medium-to-long-term use of tolterodine extended release （ER） with or without tamsulosin in patients with benign prostate hyperplasia （BPH） and larger prostate size. Methods： Totally, 152 patients （age ≥50 years） with BPH, International Prostate Symptom Score （IPSS） ≥12, quality-of-life （QoL） score ≥3, and total prostate volume ≥25 ml were enrolled in this study. The patients were randomized into four groups （n = 38 in each） to receive tolterodine ER placebo plus tamsulosin placebo, 0.2 mg tamsulosin plus tolterodine ER placebo, 4 mg tolterodine ER plus tamsulosin placebo, or tolterodine ER plus tamsulosin once daily for 24 weeks. IPSS （total, storage, and voiding subscales）, QoL, maximum urinary flow rate （Qmax）, and postvoid residual volume （PVR） were collected at baseline, and at weeks 4, 12, and 24. Results： Compared with placebo, tolterodine ER plus tamsulosin significantly improved total IPSS （？7.15, ？12.20, and ？14.66 vs. ？3.51, ？5.78, and ？7.23）, storage IPSS （？3.56, ？5.63, and ？6.66 vs. ？1.52, ？1.21, and ？2.43）, voiding IPSS （？2.88, ？5.10, and ？6.48 vs. ？1.52, ？3.03, and ？2.97）, QoL （？1.21, ？2.40, and ？3.21 vs. ？0.39, ？1.41, and ？1.60）, Qmax （2.21, 7.97, and 9.72 ml/s vs. 2.15, 2.44, and 2.73 ml/s）, and PVR （？17.88, ？26.97, and ？27.89 ml vs. ？12.03, ？11.16, and ？16.73 ml） at weeks 4, 12, and 24, respectively; the differences were all statistically significant （P 〈 0.05）. Adverse events （AEs） were not increased with treatment progression. Tolterodine ER alone did not improve total IPSS （？4.61, ？6.79, and ？5.70）, voiding IPSS （？0.64, ？1.83, and ？1.45）, QoL （？0.69, ？1.21, and ？1.41）, or Qmax（？0.79, 2.83, and 1.11 ml/s）, compared with placebo （all P 〉 0.05）. However, a gradual increase in PVR （10.03, 10.41, and 12.89 ml） and more urinary AEs suggestive of urinary retention （11/38 vs. 4/38） were observed. Conclusion： Medium-to-long-term use of tolterodine ER plus tamsulosin should be recommended in patients with BPH and an enlarged prostate volume.
