十一酸睾酮联合索利那新治疗经尿道前列腺电切术后早期出现下尿路症状的效果
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摘要
目的探讨睾酮联合索利那新治疗良性前列腺增生症(BPH)患者电切术后早期出现下尿路症状(LUTS)的临床效果。方法选取2017年1~9月肇庆市第二人民医院收治的BPH患者中,血清总睾酮(TT)低于正常范围、行经尿道前列腺电切术(TURP)术后第7天拔除尿管后出现LUTS的患者26例,随机分为实验组和对照组,每组各13例。实验组予睾酮补充联合索利那新口服治疗,对照组单纯予睾酮补充,疗程均为30 d。比较两组服药前、服药后第14天及第30天,前列腺特异抗原(PSA)、TT、国际前列腺症状评分(IPSS)、生活质量指数评分(QOL)、膀胱过度活动症状评分(OABSS)、最大尿流率(Qmax)、残余尿量(RU)和直肠指诊(DRE)的结果。结果治疗前两组各指标比较,差异均无统计学意义(P>0.05)。服药前、服药后第14天两组组内比较,IPSS、QOL评分差异有统计学意义(P<0.05);服药前、服药后第30天两组组内比较,TT、Qmax、IPSS、QOL及OABSS指标差异均有统计学意义(P<0.05)。组间比较显示,服药后第14天两组各指标比较,差异均无统计学意义(P>0.05);而服药后第30天实验组IPSS、QOL及OABSS评分均高于对照组,差异均有统计学意义(P<0.05)。两组患者服药第14天及第30天直肠指诊均未及前列腺硬结。结论 M受体阻滞剂索利那新联合睾酮补充能有效缓解TURP术后出现的LUTS症状,对于睾酮水平低下、伴有LUTS的BPH患者,可予睾酮补充联合M受体阻滞剂治疗。
Objective To investigate the clinical efficacy of Testosterone supplement combining with Solifenacin in the treatment for early stage of lower urinary tract symptoms(LUTS) after transurethral resection of the prostate(TUPP) for benign prostatic hyperplasia(BPH) patients. Methods Twenty-six cases with BPH treated in the Second People′s Hospital in Zhaoqing City from January 2017 to September 2017, that serum total testosterone(TT) was lower than normal range, and post TURP for 7 d with LUTS after removal of catheter were selected and they were randomly divided into experimental group and control group, with 13 cases in each group. The experimental group was applicated with Testosterone supplement and Solifenacin,and the control group was only supplemented with Testosterone supplement. The treatment course was 30 days. Prostate specific antigen(PSA), TT, International prostate symptom score-Quality of life(IPSS-QOL) score, overactive bladder symptom score(OABSS), the maximum flow rate(Qmax), residual urine(RU) and digital rectal examination between the two groups were compared before treatment, on 14 th day and 30 th day after treatment. Results Before treatment, the indices above between the two groups had no statistically significant differences(P > 0.05). There was a statistically significant difference in the IPSS-QOL scores in the two groups before and 14 th day after treatment(P < 0.05). There were significant differences in TT, Qmax, IPSS-QOL and OABSS in the two groups before and in 30 th day after treatment(P <0.05). On 14 th day after treatment, there was no significant difference between the two groups in the indices above(P >0.05). On 30 th day after treatment, the scores of IPSS-QOL and OABSS in the experimental group were all higher than those in the control group, the differences were statistically significant(P < 0.05). On 14 th and 30 th day after treatment, both groups were not touched prostatic induration in rectal digital examination. Conclusion M receptor blocker combining with Testosterone supplemen can relieve the symptoms of LUTS after TURP effectively, and for BPH patients with low testosterone levels and LUTS can simultaneously treat with Testosterone supplement and M receptor blocker.
Objective To investigate the clinical efficacy of Testosterone supplement combining with Solifenacin in the treatment for early stage of lower urinary tract symptoms(LUTS) after transurethral resection of the prostate(TUPP) for benign prostatic hyperplasia(BPH) patients. Methods Twenty-six cases with BPH treated in the Second People′s Hospital in Zhaoqing City from January 2017 to September 2017, that serum total testosterone(TT) was lower than normal range, and post TURP for 7 d with LUTS after removal of catheter were selected and they were randomly divided into experimental group and control group, with 13 cases in each group. The experimental group was applicated with Testosterone supplement and Solifenacin,and the control group was only supplemented with Testosterone supplement. The treatment course was 30 days. Prostate specific antigen(PSA), TT, International prostate symptom score-Quality of life(IPSS-QOL) score, overactive bladder symptom score(OABSS), the maximum flow rate(Qmax), residual urine(RU) and digital rectal examination between the two groups were compared before treatment, on 14 th day and 30 th day after treatment. Results Before treatment, the indices above between the two groups had no statistically significant differences(P > 0.05). There was a statistically significant difference in the IPSS-QOL scores in the two groups before and 14 th day after treatment(P < 0.05). There were significant differences in TT, Qmax, IPSS-QOL and OABSS in the two groups before and in 30 th day after treatment(P <0.05). On 14 th day after treatment, there was no significant difference between the two groups in the indices above(P >0.05). On 30 th day after treatment, the scores of IPSS-QOL and OABSS in the experimental group were all higher than those in the control group, the differences were statistically significant(P < 0.05). On 14 th and 30 th day after treatment, both groups were not touched prostatic induration in rectal digital examination. Conclusion M receptor blocker combining with Testosterone supplemen can relieve the symptoms of LUTS after TURP effectively, and for BPH patients with low testosterone levels and LUTS can simultaneously treat with Testosterone supplement and M receptor blocker.
引文
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[4]李宁,薛东炜,牟刚,等.经尿道前列腺电切术后早期下尿路症状的多因素分析和尿动力学判定[J].中国医科大学学报,2009,38(5):351-352.
[5]张宇,刘永强,张军,等.改良经尿道前列腺电切除术对良性前列腺增生患者性功能及下尿路症状的临床影响分析[J].中国性科学,2016,25(10):11-14.
[6]Martov AG,Ergakov DV.Age-related androgen deficiency and benign prostatic hyperplasia:how to improve the rehabilitation of patients after transurethral surgery[J].Urologiia,2016(6):110-117.
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[9]Baas W,K觟hler TS.Testosterone replacement therapy and voiding dysfunction[J].Transl Androl Urol,2016,5(6):890-897.
[10]Zhang Y,Chen J,Hu L,et al.Androgen deprivation induces bladder histological abnormalities and dysfunction via TGF-βin orchiectomized mature rats[J].Tohoku J Exp Med,2012,226(2):121-128.
[11]Madeiro A,Gir觔o M,Sartori M,et al.Effects of the association of androgen/estrogen on the bladder and urethra of castrated rats[J].Clin Exp Obstet Gynecol,2002,29(2):117-120.
[12]Martov AG,Ergakov DV.Age-related androgen deficiency and benign prostatic hyperplasia:how to improve the rehabilitation of patients after transurethral surgery?[J].Urologiia,2016(6):110-117.
[13]Gorm Ley EA,Lightner DJ,Faraday M,et al.Diagnosis and treatment of overactive bladder(non-neurogenic)in adults:AUA/SUFU guideline[J].J Urol,2015,193(5):1572-1580.
[14]Füllhase C,Chapple C,Cornu JN,et al.Systematic review of combination drug therapy for non-neurogenic male lower urinary tract symptoms[J].Eur Urol,2013,64(2):228-243.
[15]M受体拮抗剂临床应用专家共识编写组.M受体拮抗剂临床应用专家共识[J].中华泌尿外科杂志,2014,35(2):81-86.
[16]Oelke M,Speakman MJ,Desgrandchamps F,et al.Acute Urinary Retention Rates in the General Male Population and in Adult Men With Lower Urinary Tract Symptoms Participating in Pharmacotherapy Trials:A Literature Review[J].Urology,2015,86(4):654-665.
[17]Traish A,Haider KS,Doros G,et al.Long-term dutasteride therapy in men with benign prostatic hyperplasia alters glucose and lipid profiles and increases severity of erectile dysfunction[J].Horm Mol Biol Clin Investig,2017,30(3):doi:10.1515/hmbci-2017-0015.
[18]Trost LW,Hellstrom WJ.Testosterone deficiency,supplementation,and prostate cancer:maintaining a balanced perspective[J].J Sex Med,2013,10(12):2879-2881.
[19]Khera M,Bhattacharya RK,Blick G,et al.Changes in prostate specific antigen in hypogonadal men after 12months of testosterone replacement therapy:support for the prostate saturation theory[J].J Urol,2011,186(3):1005-1011.
[20]Baas W,K觟hler TS.Testosterone replacement therapy and voiding dysfunction[J].Transl Androl Urol,2016,5(6):890-897.
[21]郑懿,申旭波,周远忠,等.十一酸睾酮治疗LOH的疗效与安全性的Meta分析[J].中华男科学杂志,2015,21(3):263-271.
[22]Jarvis TR,Chughtai B,Kaplan SA.Testosterone and benign prostatic hyperplasia[J].Asian Journal of Andrology,2015,17(2):212-216.
[23]Chapple C,Herschorn S,Abrams P,et al.Toherodine treatment improves storage symptoms suggestive of overactive bladder in men treated withαblocker[J].Eur Urol,2009,56(3):534-541.
[24]侯岩松,何屹,王华,等.经尿道前列腺切除术中膀胱洗液量对高龄患者血流动力学及内环境的影响[J].中国性科学,2016,25(5):11-14.
[2]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:62-53.
[3]Ngai HY,Yuen KKS,Ng CM,et al.Metabolic syndrome and benign prostatic hyperplasia:An update[J].Asian J Urol,2017,4(3):164-173.
[4]李宁,薛东炜,牟刚,等.经尿道前列腺电切术后早期下尿路症状的多因素分析和尿动力学判定[J].中国医科大学学报,2009,38(5):351-352.
[5]张宇,刘永强,张军,等.改良经尿道前列腺电切除术对良性前列腺增生患者性功能及下尿路症状的临床影响分析[J].中国性科学,2016,25(10):11-14.
[6]Martov AG,Ergakov DV.Age-related androgen deficiency and benign prostatic hyperplasia:how to improve the rehabilitation of patients after transurethral surgery[J].Urologiia,2016(6):110-117.
[7]Terai A,Ichioka K,Matsui Y,et al.Association of lower urinary tract symptoms with erectile dysfunction in Japanese men[J].Urology,2004,64(1):132-136.
[8]Egan KB,Miner MM,Suh M,et al.Do baseline estrogen and testosterone affect lower urinary tract symptoms(LUTS)prior to or after pharmacologic treatment with tadalafil?[J].Andrology,2015,3(6):1165-1172.
[9]Baas W,K觟hler TS.Testosterone replacement therapy and voiding dysfunction[J].Transl Androl Urol,2016,5(6):890-897.
[10]Zhang Y,Chen J,Hu L,et al.Androgen deprivation induces bladder histological abnormalities and dysfunction via TGF-βin orchiectomized mature rats[J].Tohoku J Exp Med,2012,226(2):121-128.
[11]Madeiro A,Gir觔o M,Sartori M,et al.Effects of the association of androgen/estrogen on the bladder and urethra of castrated rats[J].Clin Exp Obstet Gynecol,2002,29(2):117-120.
[12]Martov AG,Ergakov DV.Age-related androgen deficiency and benign prostatic hyperplasia:how to improve the rehabilitation of patients after transurethral surgery?[J].Urologiia,2016(6):110-117.
[13]Gorm Ley EA,Lightner DJ,Faraday M,et al.Diagnosis and treatment of overactive bladder(non-neurogenic)in adults:AUA/SUFU guideline[J].J Urol,2015,193(5):1572-1580.
[14]Füllhase C,Chapple C,Cornu JN,et al.Systematic review of combination drug therapy for non-neurogenic male lower urinary tract symptoms[J].Eur Urol,2013,64(2):228-243.
[15]M受体拮抗剂临床应用专家共识编写组.M受体拮抗剂临床应用专家共识[J].中华泌尿外科杂志,2014,35(2):81-86.
[16]Oelke M,Speakman MJ,Desgrandchamps F,et al.Acute Urinary Retention Rates in the General Male Population and in Adult Men With Lower Urinary Tract Symptoms Participating in Pharmacotherapy Trials:A Literature Review[J].Urology,2015,86(4):654-665.
[17]Traish A,Haider KS,Doros G,et al.Long-term dutasteride therapy in men with benign prostatic hyperplasia alters glucose and lipid profiles and increases severity of erectile dysfunction[J].Horm Mol Biol Clin Investig,2017,30(3):doi:10.1515/hmbci-2017-0015.
[18]Trost LW,Hellstrom WJ.Testosterone deficiency,supplementation,and prostate cancer:maintaining a balanced perspective[J].J Sex Med,2013,10(12):2879-2881.
[19]Khera M,Bhattacharya RK,Blick G,et al.Changes in prostate specific antigen in hypogonadal men after 12months of testosterone replacement therapy:support for the prostate saturation theory[J].J Urol,2011,186(3):1005-1011.
[20]Baas W,K觟hler TS.Testosterone replacement therapy and voiding dysfunction[J].Transl Androl Urol,2016,5(6):890-897.
[21]郑懿,申旭波,周远忠,等.十一酸睾酮治疗LOH的疗效与安全性的Meta分析[J].中华男科学杂志,2015,21(3):263-271.
[22]Jarvis TR,Chughtai B,Kaplan SA.Testosterone and benign prostatic hyperplasia[J].Asian Journal of Andrology,2015,17(2):212-216.
[23]Chapple C,Herschorn S,Abrams P,et al.Toherodine treatment improves storage symptoms suggestive of overactive bladder in men treated withαblocker[J].Eur Urol,2009,56(3):534-541.
[24]侯岩松,何屹,王华,等.经尿道前列腺切除术中膀胱洗液量对高龄患者血流动力学及内环境的影响[J].中国性科学,2016,25(5):11-14.