Benign Prostat Hiperplazisi ve Antimuskarinik Tedavi

Yıl 2016, Cilt: 21 Sayı: 2, 163 - 168, 30.04.2016

Mehmet Kaynar , Emre Altıntaş Serdar Göktaş

https://doi.org/10.21673/anadoluklin.180743

Öz

Alt üriner sistem semptomları (AÜSS) terimi; üriner sistem semptomlarına sahip erkek hastaları
değerlendirmede kullanılan prostatizm, semptomatik benign prostat hiperplazisi (BPH) ve klinik
BPH terimlerinin yerini almaktadır. BPH, aşırı aktif mesane (AAM), nokturnal poliüri, üriner sistem
enfeksiyonları, distal üreter taşları ve mesane tümörleri gibi birçok sağlık sorunu AÜSS’ye neden
olabilir. Yaygın kullanılan bir terim olan AÜSS kapsamına giren semptomlar; depolama (acil
idrar yapma hissi, sık idrara çıkma, gece idrar yapmak için uyanma ve urge inkontinans), işeme
(işeme gücünde azalma, idrarı başlatmakta gecikme, kesik kesik idrar yapma) ve işeme sonrası
(işeme sonrası damlama, yetersiz boşaltım hissi) ile ilgili semptomlar olarak üç alt grupta toplanmıştır.
Günümüzde BPH için uygulanan en yaygın ve standart tıbbi tedavide α1-adrenerjik
reseptör antagonistleri kullanılmaktadır. Bu tedavinin yetersiz kaldığı düşünülen durumlar için
alternatif tedavi arayışları halen sürmektedir. Bu çalışmalar sonucunda, BPH’nin tedavisinde α1-
blokerler ile birlikte kullanılan antimuskarinik ilaçlar, bir kombine tedavi olarak literatürdeki yerini
almıştır. Bu derlemede; BPH’den muzdarip hastalarda antimuskarinik tedavilerinin etkinliği ve
güvenilirliği değerlendirilmiştir.

Anahtar Kelimeler

BPH, muskarinik antagonistler

Benign Prostatic Hyperplasia and Antimuscarinic Treatment

Öz

The term lower tract urinary symptoms (LUTS) has been replacing the terms such as prostatism, symptomatic benign prostatic hyperplasia (BPH), and clinical BPH used in the evaluation of male patients with symptoms associated with the urinary system. Many health conditions including BPH, overactive bladder (OAB), nocturnal polyuria, urinary tract infections, distal ureteral calculi, and bladder tumors can cause LUTS. The symptoms covered by the commonly used term LUTS are categorized into three subgroups; those associated with storage, those associated with urination, and those seen after urination. Today the standard and most common medical treatment for BPH is the use α1- adrenergic receptor blockers. However, the search for alternative treatment modalities continues, especially for situations in which α1-adrenergic receptor blockers are considered as insufficient. With the relevant reports in the literature, this led to the use of antimuscarinic drugs together with the α1-adrenergic receptor blockers as a combination therapy to treat BPH. This paper reviews the effectiveness and safety of the use of antimuscarinic treatments in patients with BPH.

Anahtar Kelimeler

BPH, muscarinic antagonists

Kaynakça

• Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, et al. EAU guidelines on the tre- atment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obs- truction. Eur Urol. 2013;64(1):118–40.
• Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulm- sten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.
• Kaplan SA, Bowers DL, Te AE, Olsson CA. Differential diagnosis of prostatism: a 12-year retrospective analysis of symptoms, urodynamics and satisfaction with the- rapy. J Urol. 1996;155(4):1305–8.
• Hyman MJ, Groutz A, Blaivas JG. Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings. J Urol. 2001;166(2):550–2.
• Coyne KS, Sexton CC, Vats V, Thompson C, Kopp ZS, Milsom I. National community prevalence of overacti- ve bladder in the United States stratified by sex and age. Urology. 2011;77(5):1081–7.
• Chapple CR, Roehrborn CG. A shifted paradigm for the further understanding, evaluation, and treatment of lo- wer urinary tract symptoms in men: focus on the blad- der. Eur Urol. 2006;49(4):651–9.
• Chess-Williams R, Chapple CR, Yamanishi T, Yasuda K, Sellers DJ. The minor population of M3-receptors me- diate contraction of human detrusor muscle in vitro. J Auton Pharmacol. 2001;(5–6) 21:243–8.
• Matsui M, Motomura D, Karasawa H, Fujikawa T, Jiang J, Komiya Y, et al. Multiple functional defects in periphe- ral autonomic organs in mice lacking muscarinic acetyl- choline receptor gene for the M3 subtype. Proc Natl Acad Sci USA. 2000;97(17):9579–84.
• Abrams P, Kaplan S, De Koning Gans HJ, Millard R. Sa- fety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstructi- on. J Urol. 2006;175(3):999–1004.
• Kaplan SA, Walmsley K, Te AE. Tolterodine exten- ded release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol. 2005;174(6):2273–5.
• Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA. 2006; 296(19):2319–28.
• Roehrborn CG, Kaplan SA, Kraus SR, Wang JT, Ba- vendam T, Guan Z. Effects of serum PSA on efficacy of tolterodine extended release with or without tam- sulosin in men with LUTS, including OAB. Urology. 2008;72(5):1061–7.
• Roehrborn CG, Kaplan SA, Jones JS, Wang JT, Bavendam T, Guan Z. Tolterodine extended release with or without tamsulosin in men with lower urinary tract symptoms including overactive bladder symptoms: effects of pros- tate size. Eur Urol. 2009;55(2):472–9.
• Roehrborn CG, Abrams P, Rovner ES, Kaplan SA, Hers- chorn S, Guan Z. Efficacy and tolerability of tolterodine extended-release in men with overactive bladder and ur- gency incontinence. BJU Int. 2006;97(5):1003–6.
• Kaplan SA, Roehrborn CG, Dmochowski R, Rovner ES, Wang JT, Guan Z. Tolterodine extended release impro- ves overactive bladder symptoms in men with overactive bladder and nocturia. Urology. 2006;68(2):328–32.
• Jones JS, Oelke M, MacDiarmid S, Wang JT, Guan Z. Ef- ficacy and tolerability of fesoterodine in men with ove- ractive bladder: a pooled analysis of 2 phase III studies. Urology. 2010;75(5):1149–55.
• Kaplan SA, Goldfischer ER, Steers WD, Gittelman M, Andoh M, Forero-Schwanhaeuser S. Solifenacin treatment in men with overactive bladder: effects on symptoms and patient-reported outcomes. Aging Male. 2010;13(2):100–7.
• Athanasopoulos A, Gyftopoulos K, Giannitsas K, Fisfis J, Perimenis P, Barbalias G. Combination treatment with an alpha-blocker plus an anticholinergic for bladder out- let obstruction: a prospective, randomized, controlled study. J Urol. 2003;169(6):2253–6.
• Lee KS, Choo MS, Kim DY, Kim JC, Kim HJ, Min KS, et al. Combination treatment with propiverine hydroch- loride plus doxazosin controlled release gastrointestinal therapeutic system formulation for overactive bladder and coexisting benign prostatic obstruction: a prospec- tive, randomized, controlled multicenter study. J Urol. 2005;174(4):1334–8.
• Lee JY, Kim HW, Lee SJ, Koh JS, Suh HJ, Chancellor MB. Comparison of doxazosin with or without tolterodine in men with symptomatic bladder outlet obstruction and an overactive bladder. BJU Int. 2004;94(6):817–20.
• Lee SH, Chung BH, Kim SJ, Kim JH, Kim JC, Lee JY. Initial combined treatment with anticholinergics and α-blockers for men with lower urinary tract symptoms related to BPH and overactive bladder: a prospective, ran- domized, multi-center, double-blind, placebo-controlled study. Prostate Cancer Prostatic Dis. 2011;14(4):320–5.
• Kaplan SA, McCammon K, Fincher R, Fakhoury A, He W. Safety and tolerability of solifenacin add-on therapy to alpha-blocker treated men with residual urgency and frequency. J Urol. 2009;182(6):2825–30.
• Kaplan SA, Roehrborn CG, Gong J, Sun F, Guan Z. Add- on fesoterodine for residual storage symptoms sugges- tive of overactive bladder in men receiving α-blocker treatment for lower urinary tract symptoms. BJU Int. 2012;109(12):1831–40.
• Kaplan SA, He W, Koltun WD, Cummings J, Schneider T, Fakhoury A. Solifenacin plus tamsulosin combinati- on treatment in men with lower urinary tract symptoms and bladder outlet obstruction: a randomized controlled trial. Eur Urol. 2013;63(1):158–65.
• Filson CP, Hollingsworth JM, Clemens JQ, Wei JT. The efficacy and safety of combined therapy with α-blockers and anticholinergics for men with benign prostatic hyperplasia: a meta-analysis. J Urol. 2013;190(6):2153– 60.
• Hao N, Tian Y, Liu W, Wazir R, Wang J, Liu L, et al. Anti- muscarinics and α-blockers or α-blockers monotherapy on lower urinary tract symptoms-a meta-analysis. Uro- logy. 2014;83(3):556–62.
• McVary KT, Roehrborn CG, Avins AL, Barry MJ, Brus- kewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793–803.
• Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Ma- dersbacher S, Mamoulakis C, et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstructi- on. Eur Urol. 2015; 67(6):1099–109.