男性LUTS的合理化治疗来自2012EAU的启示课件.ppt

临床医生常有M受体拮抗剂是否会降低排尿时的膀胱力量的担心存在，那么，M受体拮抗剂是否存在引起尿潴留风险呢? Kaplan的研究显示，应用M受体拮抗剂治疗BPH办法OAB患者，对PVR/ Qmax并无无临床显著性影响，而且患者发生AUR的风险低。但是，值得注意的是，对于临床疑似BOO (PVR 200 mL 和/或 Qmax 5 mL/s)和既往/当前发生过AUR的患者，应谨慎应用M受体拮抗剂，以防止发生尿储留的风险。 * 同样是上述两项研究，证实M受体拮抗剂不会显著增加已证实存在BOO的LUTS患者AUR发生风险。 J Urol. 2006 Mar;175(3 Pt 1):999-1004; discussion 1004. Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. Abrams P, Kaplan S, De Koning Gans HJ, Millard R. Source Bristol Urological Institute, Southmead General Hospital, Bristol, United Kingdom. paul.abrams@bui.ac.uk Abstract PURPOSE: Antimuscarinic therapy for men with OAB and BOO is perceived as a potential risk for urinary retention. Using pressure flow urodynamics, we evaluated the safety of tolterodine vs placebo in men with OAB and BOO. MATERIALS AND METHODS: Men (older than 40 years) with BOO and confirmed detrusor overactivity were randomized to tolterodine (2 mg twice daily in 149) or placebo (in 72) for 12 weeks. Primary end points were Qmax and pdetQmax. RESULTS: Median treatment differences in Qmax (-0.7 ml per second, 95% CI -1.6 to 0.4) and pdetQmax (-7 cm H2O, 95% CI -3 to 11) were comparable. Tolterodine significantly reduced the BOOI vs placebo (-9 vs 0, p 0.02). There were significant treatment differences in volume to first detrusor contraction (+59 ml, 95% CI 19-100) and maximum cystometric capacity (+67 ml, 95% CI 35-103), favoring tolterodine over placebo (p 0.003). Change in PVR was significantly greater among patients treated with tolterodine (+25 ml) than placebo (0 ml, p 0.004). There were no significant between-group differences in the incidence of adverse events. Urinary retention was reported by 1 patient treated with placebo. CONCLUSIONS: Tolterodine did not adversely affect urinary function in men with OAB and BOO. Urinary flow rate was unaltered, and there was no evidence of clinically meaningful changes in voiding pressure and PVR or urinary reten