Current medical treatment of lower urinary tract symptoms/BPH: do we have a standard?

被引:53
作者
Silva, Joao [1 ,2 ,3 ]
Silva, Carlos Martins [1 ,2 ,3 ]
Cruz, Francisco [1 ,2 ,3 ]
机构
[1] Hosp Sao Joao, Dept Urol, P-4200319 Oporto, Portugal
[2] Fac Med, Oporto, Portugal
[3] Inst Mol & Cell Biol, IBMC, Oporto, Portugal
关键词
benign prostatic hyperplasia; combined drug therapy; lower urinary tract symptoms; monotherapy; BENIGN PROSTATIC HYPERPLASIA; TOLTERODINE EXTENDED-RELEASE; OVERACTIVE BLADDER; BETA(3)-ADRENOCEPTOR AGONIST; COMBINATION THERAPY; ENLARGED PROSTATE; DOUBLE-BLIND; CLINICAL PROGRESSION; OUTLET OBSTRUCTION; ALPHA-BLOCKERS;
D O I
10.1097/MOU.0000000000000007
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose of reviewThe pharmacological treatment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) is based on alpha-blockers and 5-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 3-adrenoreceptor agonists.Recent findingsSilodosin 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 5mg/day with tamsulosin 0.4mg/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 3-adrenoreceptor agonist, while improving BPH/LUTS in men with bladder outlet obstruction, do not decrease urinary flow or detrusor pressure.SummaryThe 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.
引用
收藏
页码:21 / 28
页数:8
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