Clinical Implications for the Early Treatment of Benign Prostatic Enlargement (BPE): a Systematic Review

原文：2018年发布于 Curr Urol Rep 19卷第9期 70  浏览量：2895次 原文链接

作者单位： Department of Urology, Sant'Andrea Hospital - Faculty of Health Sciences, Sapienza University of Rome, Rome, Italy. fabriziopresicce@libero.it. Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Via di Grottarossa 1035, 00198, Rome, Italy. fabriziopresicce@libero.it. Department of Urology, Sant'Andrea Hospital - Faculty of Health Sciences, Sapienza University of Rome, Rome, Italy. Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Via di Grottarossa 1035, 00198, Rome, Italy.

归属分类：良性前列腺增生治疗及预后证据

DOI： 10.1007/s11934-018-0823-y

关键词： Disease Progression Humans Lower Urinary Tract Symptoms/etiology Male Prostatic Hyperplasia/complications/*drug therapy Risk Factors Time Factors Treatment Outcome Benign prostatic hyperplasia Early treatment Luts Outcomes complications Pharmacological treatment Prostate Surgery

PURPOSE OF REVIEW: Therapeutic options for the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) have considerably increased in recent years. However, the ideal timing to initiate medical treatment of LUTS/BPE has not been fully established. The aim of this review was to systematically collect available evidence on the influence of early treatment on the natural history of LUTS/BPE patients. RECENT FINDINGS: A systematic literature search from January 1996 until April 2018 was performed by combining the following MESH terms: Lower Urinary Tract Symptoms, Benign Prostatic Enlargement, male, medical treatment, surgical treatment, early treatment/intervention, and early intervention/treatment. The Medline, PubMed, and Scopus databases were searched. Each article title and abstract was reviewed for relevance and appropriateness with regard to the topic of this review. In recent years, the medical armamentarium for the management of LUTS secondary to BPE has been extensively implemented, significantly improving treatment outcomes and markedly reducing the need for BPE surgery. Early intervention in patients at risk for disease progression may offer better clinical outcomes compared to a deferred approach. However, evidences supporting early treatment are scarce, and criteria to discriminate patients that could mostly benefit from immediate treatment remain poorly defined. Moreover, as a result of delayed surgery after prolonged medical treatment, patients undergoing surgical relief show larger prostates, older age, and comorbidities. Nevertheless, technological advancements in surgical techniques have largely counterweighed this critical scenario, and commonly, a non-pejorative trend has been reported in perioperative complications. The timeliest moment to start a medical treatment in LUTS/BPE patients is still undefined, and unexpectedly, peer-reviewed evidence remains scarce. Further studies are awaited to better discriminate patients who mostly benefit from early treatment of LUTS/BPE.