Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi

İbrahim ÇEVİK, (Marmara Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, İstanbul, Türkiye)
Hakan ÖZVERİ, (Marmara Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, İstanbul, Türkiye)
Selçuk YÜCEL, (Marmara Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, İstanbul, Türkiye)
Levent TÜRKERİ, (Marmara Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, İstanbul, Türkiye)
Atıf AKDAŞ (Marmara Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, İstanbul, Türkiye)
Türkiye Klinikleri Tıp Bilimleri Dergisi
5 0
Yıl: 2001 Cilt: 21 Sayı: 3 Sayfa Aralığı: 223 - 228 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi

Öz:
Bu derleme Benign Prostat Hiperplazisi (BPH)’ne bağlı alt üriner sistem semptomlarının (AUSS) medikal tedavisi ile ilgili güncel bilgileri kapsamaktadır. Altmış yaş üzerindeki erkeklerin %80’inde histopatolojik olarak BPH bulunmasına rağmen, bunların ancak %40’ında alt üriner sistem semptomları görülmektedir. Medikal tedavi, cerrahi girişim endikasyonu olmayan ve/veya cerrahi tedavinin uygulanamadığı hastalarda gündeme gelmektedir. BPH’da medikal tedavi alternatifleri fitoterapi, alfa-reseptör blokerleri, 5-a-redüktaz inhibitörleri ve antiandrojen tedavidir. Ancak, çalışmalar fitoterapötik ajanların etkisinin plasebo etkisi ile sınırlı olduğunu göstermiştir. Alfa reseptör blokerler ise, BPH’nın dinamik komponenti üzerine etki ederek üretral basıncı düşürür. Nonselektif alfa reseptör blokeri olan fenoksibenzamin BPH’e bağlı AUSS tedavisinde yüksek yan etki oranlarından dolayı artık kullanılmamaktadır. Selektif alfa blokerlerden prazosinin yan etkileri daha az görülse de fenoksibenzamin ile karşılaştırıldığında irritatif yakınmalar üzerinde daha az etkili olduğu izlenmiştir. Diğer bir kısa dönem etkili selektif alfa bloker olan alfuzosinin kullanımını ise günde üç kez alınmak zorunda kalınması kısıtlamaktadır. İndoramin ise kan beyin bariyerini aştığından dolayı merkezi sinir sistemine ait yan etkiler ortaya çıkarmaktadır. Uzun etkili selektif alfa blokerlerden terazosin ve doksazosin düşük yan etki ve belirgin iyileşme oranları ile BPH’e bağlı AUSS tedavisinde etkin bulunmuştur. Ancak her iki tedavi seçeneğinin etkili doza varabilmesi için 1 ya da 2 haftalık doz yükseltimine ihtiyacı vardır. Uzun etkili spesifik a-1A reseptör blokeri, tamsulosin ise doz yükseltimine ihtiyaç göstermemektedir. Yapılan çalışmalarda ise semptomatik düzelmede diğer ajanlardan fark göstermemektedir. Finasterid, 5-a-redüktazı inhibe ederek, serum testosteron düzeyini değiştirmeden dihidrotestosteron düzeylerini düşüren bir ajandır. Finasterid tedavisinin BPH’nın doğal seyrini değiştirdiği, prostatta küçülmeye yol açtığı ve bu etkinin 5. yılda da devam ettiği, hastanın semptomlarının düzeldiği ya da stabilleştiği tespit edilmiştir. Antiandrojen tedavide, GnRH agonistleri, progesteron, androjen reseptör blokerleri ve aromataz inhibitörleri kullanılabilir. Ancak, yan etkilerinin fazla olması ve yüksek maliyet nedenleri ile medikal tedavide en son düşünülmesi gereken ajanlardır. Medikal tedavide amaç yan etkisi az, etkili, kullanımı kolay olan bir ilacın uygulanmasıdır. Ancak henüz bu kriterlere uyan bir ilaç mevcut değildir.
Anahtar Kelime:

Konular: Genel ve Dahili Tıp

Medical treatment of lower urinary tractsymptoms due to benign prostatic hyperplasia

Öz:
This review contains update information about the medical treatment of lower urinary tract symptoms (LUTS) due to BPH. Although, 80% of men over the age of 60 have histopathological BPH, only 40% have lower urinary tract symptoms. Currently, medical treatment is advised to patients who does not have any indication for surgery and/or can not be operated. The medical therapy alternatives in BPH are phytotherapy, alpha receptor blockers, 5-a-reductase inhibitors and antiandrogens. However, studies revealed that efficacy of phytotherapy agents were limited in the efficacy of placebo. Alpha receptor blockers decrease the urethral pressure by influencing the dynamic component of BPH. Phenoxybenzamin, nonselective alpha receptor blocker, is no longer prescribed due to adverse effects in the treatment of LUTS in BPH. Prazosin, selective alpha blocker, has minor adverse effects but also lesser afficacy than of phenoxybenzamine in irritative symptoms. Obligatory three times use in a day limits alfuzosin, short term selective alpha blocker. Besides, Indoramin has central nervous system side effects since it passes blood brain barrier. Long term selective alpha blockers, terazosin and doxazosin were found to be effective with less side effects and remarkable improvement in treatment of LUTS due to BPH. Nevertheless, both choices need dose tapering for 1-2 weeks. Long term specific a-1A receptor blocker, tamsulosin does not need dose tapering. Also the improvement rates in tamsulosin are not different than in other selective agents. Finasteride decreases the level dihydrotestosterone by inhibiting 5-a-reductase while remains the level of testosterone as the same. The finasteride therapy is found to change the natural progress of BPH and to cause the shrinkage in prostate. Besides, it improves and/or stabilizes the symptomatology and improvement continues in the fifth year. GnRH agonists, progesteron, androgen receptor blockers and aromatase inhibitors are used in antiandrogen therapy. Nevertheless, antiandrogen agents should be regarded as the last treatment option due to adverse effects and high costs. The aim of the medical treatment is to use a drug that has fewer side effects, effective and easy to use. However, there is no drug available currently that meet these criteria.
Anahtar Kelime:

Konular: Genel ve Dahili Tıp
Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Bibliyografik
  • 1.Barry MJ. Epidemiology and natural history of benign prostatic hy- perplasia. Urol Clin North Am 1990; 17:495-506.
  • 2.Schulze H, Berges R, Paschold K et al. Neue konservative Therapieausaetze bei der benigren Prostahyperplasie. Urologe A 1982; 31:8.
  • 3.Gerber GS, Zagaja GP, Bales GT et al. Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on uro-dynamic parameters and voiding symptoms. Urology 1998; 51:1003-07.
  • 4.Descotes JL, Rambeaud JJ, Deschseaux P et al. Placebo controlled evaluation of the efficacy and tolerability of Permixon in benign prostatic hyperplasia after exclusion of placebo responders. Clin Drug Invest 1995; 9:291-7.
  • 5.Lowe FC and Fagelman E. Phytotherapy in the treatment of benign prostatic hyperplasia. Curr Opin Urol 1998; 8:27-9.
  • 6.Lowe FC and Fagelman E. Phytotherapy in the treatment of benign prostatic hyperplasia. An Update Urology 1999; 53:671-8.
  • 7.Caine M. The present role of alfa adrenergic blockers in the treatment of benign prostate hypertrophy. J Urol 1986; 136:1.
  • 8.Caine M. Reflections on alpha blockade therapy for benign prostate hyperplasia. Brit J Urol 1995; 75:265-70.
  • 9.Shapiro E, Hartanto V, Lepor H. Anti-desmin versus anti-actin for quantifying density of prostate smooth muscle. Prostate 1992; 20:259-68.
  • 10.Furuya S, Kumamoto Y, Yokoyama E et al. Alpha adrenergic activity and urethral pressure profilometry in prostatic zone in benign prostate hypertrophy. J Urol 1982; 128:836-9.
  • 11.Gillenwater JY, Mobley DL. A sixteen-week, double blind, placebo controlled, dose titration study using doxazosin tablets for the treatment of benign prostatic hyperplasia in normontensive males. J Urol 1993; 324A, abstr 447.
  • 12.Mallöy BJ, Price DT, Price RR et al. a-1-adrenergic receptor subtypes in human detrusor. J Urol 1998; 160:937-43.
  • 13.Maruenda J, Bhatnagar V, Lowenthal DT. Hypertension in the elderly with coexisting benign prostatic hyperplasia. Urology 1999; 53(Suppl 3A):7-12.
  • 14.Caine M, Pfau A, Perlberg S. The use of alpha-adrenergic blockers in benign prostatic obstruction. Br J Urol 1976; 138:979-83.
  • 15.Hedlung H, Andersson KE, Ek A. Effects of prazosin in patients with benign prostatic obstruction. J Urol 1983; 130:275-8.
  • 16.Martorana G, Giberti C, Damonte P et al. The effect of prazosin in benign prostatic hypertrophy: a placebo controlled double-blind study. IRCS Med Sci 1984; .12:11-2.
  • 17.Kirby RS, Coppinger SWC, Corcoran MO et al. Prazosin in the treatment of prostatic obstruction: A placebo controlled study. Br J Urol 1987; 60:136-42.
  • 18.Hedlung H, Andersson KE. Effects of prazosin and carbachol in patients with benign prostatic obstruction. Scan J Urol Nephrol 1988; 22:19-22.
  • 19.Chappie CR, Christmas TJ, Milroy EJG. A twelve week placebo controlled study of prazosin in the treatment of prostatic obstruction. Urol Int 1990; 45(Suppl l):47-55.
  • 20.Le Due A, Cariou G, Baron JC et al. A multicenter, double blind, placebo controlled of the efficacy of prazosin in the treatment of dysuria associated with benign prostate hypertrophy. Urol Int 1990; 45(Suppl l):56-62.
  • 21.Wilde MI, Fitton A, McTavih D. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential in benign prostatic hyperplasia. Drugs 1993; 45:410-29.
  • 22.Jardin A, Bensadoun H, Delauche-Cavallier MC et al. and the BPH-ALF Group: Alfuzosin for treatment of benign prostatic hypetro-phy. Lancet 1991; 337:1457-61.
  • 23.Buzelin JM, Hebert M, Blondin P and the PRAZALF Group: Alpha-blocking treatment with alfuzosin in symptomatic benign prostatic hyperplasia: Comparative study with prazosin. Br J Urol 1993; 72:922-7.
  • 24.Jardin A, Bensadoun H, Delauche-Cavallier MC. Long term treatment of benign prostatic hypertrophy with "alfuzosin: A 24-30 month survey. Br J Urol 1994; 74:579-84.
  • 25.Kerrebroeck PV, Jardin A, Laval KU et al. Efficacy and safety of a new prolonged release formulation of alfuzosin 10 mg once daily versus alfuzosin 2.5 mg thrice daily and placebo in patients with symptomatic benign prostatic hyperplasia. Eur Urol 2000; 37:306-13.
  • 26.Alan M, Hubert G, Pallon D et al. Long-term follow-up following with first episode of acute urinary retention. Eur Urol 2000; 37(Suppl 2):119 A475.
  • 27.Stott MA, Abrams P. Indoramin in the treatment of prostatic bladder outflow obstruction. Br J Urol 1991; 67:499-501.
  • 28.Lepor H, Henry D, Laddu AR. The efficacy and safety of terazosin for the treatment of symptomatic BPH. Prostate 1991; 18:345-55.
  • 29.Lowe FC, Olson PJ, Padley RJ. Effects of terazosin therapy on blood pressure in men with benign prostatic hyperplasia concurrently treated with other antihypertensive medications. Urology 1999; 54:81-5.
  • 30.Lepor H, Auerbach S, Puras Baez A et al. A randomized, placebo controlled multiceter study of the efficacy and safety of terazosin in the treatment of benign prostate hyperplasia. J Urol 1992; 148:1467-74.
  • 31.Lloyd SN, Buckley JF, Chilton CP. Terazosin in the treatment of benign prostatic hyperplasia: A multicenter, placebo controlled trial. Br J Urol 1992; 70:17-21.
  • 32.Dİ Silverio F. Use of terazosin in the medical treatment of benign prostatic hyperplasia: Experience in Italy. Br J Urol 1992; 70:22-6.
  • 33.Brawer MK, Adams G, Epstein H and the Terazosin Benign Prostatic Hyperplasia Group: Terazosin in the medical treatment of benign prostatic hyperplasia. Arch Fam Med 1993; 2:929-35.
  • 34.Roehrborn CG, Oesterling JE, Arbor A, Lloyd K, Lynch J, Padley RJ, for the HYCAT Investigator Group: Hytrin Community Assessment Trial (HYCAT): Evaluation of the clinical effectiveness of terazosin versus placebo in the treatment of patients with symptomatic benign prostatic hyperplasia. J Urol 153(Suppl):272A, abstr 175.
  • 35.Roehrborn CG, Oesterling JE, Auerbach S, Kaplan SA, Lloyd LK. HYCAT investigation group: The Hytrin Community Asesstment Trial Study: a one-year study of terazosin versus placebo in the treatment of men with symptomatic benign prostatic hyperplasia. Urology 1996; 47:159-68.
  • 36.Debruyne FM, Witjes WP, Fitzpatrick J, Kirby R, Kirk D. The international terazosin trial: a multicenter study of the long term efficacy and safety of terazosin in the treatment of benign prostatic hyperplasia. The ITT Group. Eur Urol 1996; 30:369-76.
  • 37.Christensen MM, Holme JB, Rasmussen PC et al. Doxazosin treatment in patients with prostatic obstruction. Scand J Urol Nephrol 1993; 27:39-44.
  • 38.Holme JB, Christensen MM, Rasmussen PC et al. 29-week doxazosin treatment in patients with symptomatic benign prostatic hyperplasia. Scand J Urol Nephrol 1994; 28:77-82.
  • 39.Fawzy A, Sullivan J, Cook E et al. Long-term (4-year) efficacy of doxazosin for the treatment of benign prostatic hyperplasia. J Urol 1996; 155:573A.
  • 40.Roehborn CG, Siegel RL. Safety and efficacy of doxazosin in benign prostatic hyperplasia: a pooled analysis of three double-blind placebo-controlled studies. Urology 1996; 48:406-15.
  • 41.Chappie CR, Carter P, Christmas TJ et al. A three month double-blind study of doxazosin as treatment for benign prostatic outlet obstruction. Br J Urol 1994; 74:50-6.
  • 42.Janknegt RA, Chappie CR, for the Doxazosin Study Groups: Efficacy and safety of the alpha-1-blocker doxazosin in the treatment of benign prostatic hyperplasia. Analysis of 5 studies. Eur Urol 1993;24:319-26.
  • 43.Fawzy A, Braun K, Lewis GP et al, for the Multicenter Group: Doxazosin in the treatment of benign prostatic hyperplasia in nor-motensive patients: A multicenter study. J Urol 1995; 154:105-9.
  • 44.Gillenwater JY, Conn RL, Chrystant SG et al. for the Multicenter Group: Doxazosin for the treatment of benign prostatic hyperplasia in patients with mild to moderate essential hypertension. A double-blind, placebo-control-led, dose response multicenter study. J Urol 1995; 154: 110-5.
  • 45.Tewari A, Narayan P. Alpha-adrenergic blocking drugs in the management of benign prostatic hyperplasia: intractions with antihypertensive therapy. Urology 1999; 53(Suppl 3A):14-20.
  • 46.Roehrborn CG, Bruskewitz R, Nickell GC et al. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years. Eur Urol 2000; 37:528-36.
  • 47.de Mey C. a-1 blockers for BPH: Are there differences. Eur Urol 1999; 36(Suppl 3):52-63.
  • 48.Chappie CR, Wyndaele JJ, Nordling J et al. on behalf of the European Tamsulosin Study Group: Tamsulosin, the first prostate-selective a-lA-adrenoceptor antagonist. A metaanlysis of two-randomized, placebo controlled multicentre studies in patients with benign prostatic obstruction (symptomatic BPH). Eur Urol 1996; 29:155-67.
  • 49.Lepor H. for the Tamsulosin Investigator Group: Clinical evaluation of tamsulosin, a selective a-lc antagonist. J Urol 1995; 153(Suppl):274A, abstr 182.
  • 50.Lepor H. NY and Tamsulosin Invastigator Group: Long term evaluation of tamsulosin: A prostate selective a-1 antagonist. J Urol 1996; 155-.585A.
  • 51.Narayan P,Tewari A. Owerview of alpha-blocker therapy for benign prostatic hyperplasia 1998; 51(Suppl 4A):38-45.
  • 52.Seo KK, Lee MY, Lim SW, Kim SC. Comparison of relaxation responses of cavernous and trigonal smooth muscles from rabbits by alpha-1-adrenoceptor antagonists; prazosin, terazosin, doxazosin and tamsulosin. J Korean Med Sci 1999; 14:69-74.
  • 53.Cooper KL, McKiernan JM, Kaplan SA. Alpha adrenoceptor antagonists in the treatment of benign prostatic hyperplasia. Drugs 1999; 57:9-17.
  • 54.Stoner E and the Finasteride Study Group: The clinical effects of a 5 a reductase inhibitor, finasteride, on benign prostate hiperplasia. J Urol 1992; 147:1298.
  • 55.Finasteride Study Group: Finasteride (MK 906) in the treatment of benign prostatic hiperplasia. Prostate 1993; 22:291.
  • 56.Gormley GJ, Stoner E, Bruskewitz RC et al. for the Finas-teride Study Group: The effect of finasteride in men with benign prostatic hiperplasia. N Engl J Med 1992; 327:1185.
  • 57.Moore E, Bracken B, Bremmer W et al. Proscar: Five year experience. Eur Urol 1995; 28:304-9.
  • 58.Geller J. Five year follow-up of patients with benign prostatic hiperplasia treated with finasteride. Eur Urol 1995; 27:267-73.
  • 59.Boyle P, Gould AL, Blue Bell PA. Prostate volume predicts outcome of treatment of BPH with finasteride: Meta analysis of randomized clinical trials. J Urol 1996; 155:572A.
  • 60.McConnell JD, Bruskewitz R, Walsh P, Andriole G, Lieber M and the PLESS Study Group: The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. N Eng J Med 1998; 338:557-63.
  • 61.Lepor H. for the VA Cooparative Studies BPH Study Group: A department of Veterans Affairs (VA) cooparative randomized placebo controlled clinical trial of the safety and efficacy of terazosin and finasteride monotherapy and terazosin/finasteride combination therapy in men with clinical BPH. J Urol 1996; 155:587A.
  • 62.Roehrborn CG, Bruskewitz R, Nickell GC et al. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years. Eur Urol 2000; 37:528-36.
  • 63.Roehrborn C. A doble-blind comparison of doxazosin and finasteride in symptomatic benign prostatic hyperplasia: A multinational european trial. Eur Urol 2000; 37:118, A472.
  • 64.Hansen BJ, Hald T. Review of current medical treatment of benign prostatic hyperplasia. Eur Urol 1993; 24(Suppl l):41-9.
APA ÇEVİK İ, ÖZVERİ H, Yücel S, Türkeri L, AKDAŞ A (2001). Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi. , 223 - 228.
Chicago ÇEVİK İbrahim,ÖZVERİ Hakan,Yücel Selçuk,Türkeri Levent,AKDAŞ Atıf Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi. (2001): 223 - 228.
MLA ÇEVİK İbrahim,ÖZVERİ Hakan,Yücel Selçuk,Türkeri Levent,AKDAŞ Atıf Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi. , 2001, ss.223 - 228.
AMA ÇEVİK İ,ÖZVERİ H,Yücel S,Türkeri L,AKDAŞ A Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi. . 2001; 223 - 228.
Vancouver ÇEVİK İ,ÖZVERİ H,Yücel S,Türkeri L,AKDAŞ A Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi. . 2001; 223 - 228.
IEEE ÇEVİK İ,ÖZVERİ H,Yücel S,Türkeri L,AKDAŞ A "Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi." , ss.223 - 228, 2001.
ISNAD ÇEVİK, İbrahim vd. "Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi". (2001), 223-228.
APA ÇEVİK İ, ÖZVERİ H, Yücel S, Türkeri L, AKDAŞ A (2001). Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi. Türkiye Klinikleri Tıp Bilimleri Dergisi, 21(3), 223 - 228.
Chicago ÇEVİK İbrahim,ÖZVERİ Hakan,Yücel Selçuk,Türkeri Levent,AKDAŞ Atıf Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi. Türkiye Klinikleri Tıp Bilimleri Dergisi 21, no.3 (2001): 223 - 228.
MLA ÇEVİK İbrahim,ÖZVERİ Hakan,Yücel Selçuk,Türkeri Levent,AKDAŞ Atıf Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi. Türkiye Klinikleri Tıp Bilimleri Dergisi, vol.21, no.3, 2001, ss.223 - 228.
AMA ÇEVİK İ,ÖZVERİ H,Yücel S,Türkeri L,AKDAŞ A Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi. Türkiye Klinikleri Tıp Bilimleri Dergisi. 2001; 21(3): 223 - 228.
Vancouver ÇEVİK İ,ÖZVERİ H,Yücel S,Türkeri L,AKDAŞ A Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi. Türkiye Klinikleri Tıp Bilimleri Dergisi. 2001; 21(3): 223 - 228.
IEEE ÇEVİK İ,ÖZVERİ H,Yücel S,Türkeri L,AKDAŞ A "Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi." Türkiye Klinikleri Tıp Bilimleri Dergisi, 21, ss.223 - 228, 2001.
ISNAD ÇEVİK, İbrahim vd. "Benign prostat hiperplazisi’ne bağlı alt üriner sistem semptomlarının medikal tedavisi". Türkiye Klinikleri Tıp Bilimleri Dergisi 21/3 (2001), 223-228.
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