缩小才是硬道理

缩小才是硬道理BPH(benignprostatehyperplasia)LUTS(lowerurinarytractsymptoms)尿等待尿滴沥前列腺体积增大(BPE)压迫尿道急性尿潴留(AUR)BPH:前列腺体积增大

随年龄增高，前列腺体积逐年增大发病率高前列腺体积在40岁以后加速增长50岁以上男性约有50%患BPH80岁以上患病者达到80%至100%良性前列腺增生是泌尿外科最常见的疾病之一直接危害急性尿潴留反复血尿难治性尿路感染膀胱结石、憩室肾功能损害疝夜尿的危害睡眠质量下降跌倒等神经衰弱失眠抑郁TextText夜尿方法一增加排尿压力方法二减小尿道阻力能够选择的突破口减少尿道阻力更为容易静力性因素：前列腺体积增大压迫BPH梗阻动力性因素：平滑肌痉挛使用坦索罗辛等α受体阻滞剂夜尿尿频尿不尽尿急解除静力性因素才能缓解刺激症状缩小前列腺体积是BPH重要治疗目标ICBPH制定的治疗目标:缩小前列腺体积和/或减轻梗阻预防远期并发症缓解症状Ch.Chatelain,etal.20015thinternationalconsultationonBPH,recommendationoftheinternationalscientificcommittee:Evaluationandtreatmentoflowerurinarytractsymptomsinoldermen.ICBPH＝国际良性前列腺增生症咨询委员会（InternationalConsultationonbenignProstaticHyperplasia）BPH=良性前列腺增生症（benignprostatehyperplasia）H-还原酶5αRI是缩小前列腺体积的根本解决方案StonerE,GuessH.Treatmentofbenignprostatichyperplasiawith5

-reductaseinhibitors.TheEndocrinologist.1995;5:1-7.OOH睾丸酮OOH双氢睾丸酮HNHOCONHC(CH3)

3保列治®NADPH5

保列治®(非那雄胺)循证医学一级证据证实9,109,1011111111McConnellJD,BruskewitzR,WalshP,etal.,Theeffectoffinasterideontheriskofacuteurinaryretentionandtheneedforsurgicaltreatmentamongmenwithbenignprostatichyperplasia.FinasterideLong-TermEfficacyandSafetyStudyGroup.NEnglJMed.1998;338(9):557-63.6.MichaelMarberger.TheMTOPSStudy:NewFindings,NewInsights,andClinicalImplicationsfortheManagementofBPH.EuropeanUrology2006;S5(9):627-646.9.TheManagementofBenignProstaticHyperplasiaGuideline,AUA10.RosetteJ,MadersbacherS,AlivizatosG,etal.GuidelinesonBenignProstaticHyperplasia.EuropeanAssociationofUrology2008.11.McConnellJD,RoehrbornCG,BautistaOM,etal.,TheLong-TermEffectofDoxazosin,Finasteride,andCombinationTherapyontheClinicalProgressionofBenignProstaticHyperplasia.Ref12,P2392,Col1,Para2,L7-10;Col2,L10-14;P2394,Col2,Para3,L1-4;P2393,Col1,Para3,Last3linesAUA=美国泌尿学协会(AmericanUrologicalAssociation)EAU=欧洲泌尿外科学会(EuropeanAssociationofUrology)保列治®(非那雄胺)显著改善疾病进展持续4年的PLESS研究显示：保列治®提高最大尿流速率44.McConnellJD,BruskewitzR,WalshP,etal.,Theeffectoffinasterideontheriskofacuteurinaryretentionandtheneedforsurgicaltreatmentamongmenwithbenignprostatichyperplasia.FinasterideLong-TermEfficacyandSafetyStudyGroup.NEnglJMed.1998;338(9):557-63.Ref4,P561,Col2,Fig-3P<0.001持续4年的PLESS(n=3040)研究显示：保列治®使BPH相关手术风险降低55%1保列治®(非那雄胺)显著减少手术风险1.McConnellJD,BruskewitzR,WalshP,etal.,Theeffectoffinasterideontheriskofacuteurinaryretentionandtheneedforsurgicaltreatmentamongmenwithbenignprostatichyperplasia.FinasterideLong-TermEfficacyandSafetyStudyGroup.NEnglJMed.1998;338(9):557-63.Ref1,P560,Fig2;P559,Col1,Para1,L3-6保列治®(非那雄胺)显著减少AUR的发生风险持续4年的PLESS(n=3040)研究显示：保列治®使AUR的发生风险降低57%11.McConnellJD,BruskewitzR,WalshP,etal.,Theeffectoffinasterideontheriskofacuteurinaryretentionandtheneedforsurgicaltreatmentamongmenwithbenignprostatichyperplasia.FinasterideLong-TermEfficacyandSafetyStudyGroup.NEnglJMed.1998;338(9):557-63.Ref1,P560,Fig2;P559,Col1,Para2,L1-4AUA指南对于伴有LUTS症状的BPH患者，5αRI是合适并有效的治疗方案对于无症状困扰的BPH患者，5αRI可以预防疾病进展EAU指南对于伴中重度LUTS症状和前列腺体积增大(＞30ml－40ml)的

BPH患者，5αRI是被认可的治疗方案5αRI可用于BPE患者预防疾病进展CUA指南非那雄胺用于治疗有前列腺体积增大伴LUTS症状的BPH患者.对于具有BPH临床进展高危性的患者，非那雄胺可用于防止BPH的临床进展，推荐使用5αRI用于前列腺体积增大的BPH患者NaYanqunet,al.Chinessdiagnosisandtherapyguidelineofurinarysurgery,2006,volum1stMadersbacherSetal.EAU2004GuidelinesonAssessment,TherapyandFollow-UpofMenwithLowerUrinaryTractSymptomsSuggestiveofBenignProstaticObstruction(BPHGuidelines).EurUrol2004;46:547-54.AUAguidelineonmanagementofbenignprostat