5α還原酶抑製劑使用是否可以預防再發性的攝護腺肥大相關之急性尿滯留?
呂其峰、溫玉清、李良明、林克勳、林雍偉、蕭志豪
台北市立萬芳醫院（委託臺北醫學大學經營辦理）泌尿科
Does 5α reductase inhibitor prevent secondary benign prostate hyperplasia related acute urinary retention?
Chi-Fong Lu, Yu-Ching Wen, Liang-Ming Lee, Ke-Hsun Lin, Yung-Wei Lin, Chi-Hao Hsiao.
Department of Urology, Taipei Municipal Wanfang Hospital (Managed by Taipei Medical University)
Purpose: To determine whether the use of 5α reductase inhibitor prevent secondary benign prostate hyperplasia (BPH) related acute urinary retention (AUR) after the first episode of urine retention.
Materials and Methods: From Jan 2006- Jun 2016, totally 1161 patients with urine retention were collected. After exclusion of bladder and external sphincter dysfunction, 133 patients enrolled in our study. Patients were divided into two groups: group 1, 33 patients use 5α reductase inhibitor (Dutasteride) + α blocker, and group 2, 95 patients use α blocker only. Patient’s characteristics of age, prostate size, maximal urinary flow rate (Qmax), PSA level and Dutasteride treatment time were recorded and compared. Patients were followed up at least 6 months with maximum of 24 months if no event occurs. Event of secondary BPH related AUR and surgery were recorded. For statistics, survival analysis using Kaplan-Merier method was applied for comparing the rate of secondary BPH related AUR. Log rank test and paired - t test were used for statistical comparison.
Results: Patient’s characteristics were similar between 2 groups except the prostate size (group 1 vs. group 2: 65.0 vs 37.1ml, p=0.001). Totally 43 patients (32%) experienced secondary AUR within 24 months. The average time to secondary AUR was 8.4 months. The rate of secondary BPH related AUR was significantly lower in study group (18.2% vs 39.4%, p = 0.028). The rate of BPH related surgery was lower in group 1 but no significant differences between two groups (9.1% vs 14.9%, p=0.328). Prostate size and PSA level were significantly reduced in the group 1 compared with the group 2 for 23.5%(p<0.001), 60.4% (p<0.001) respectively.
Conclusions: The use of 5α reductase inhibitor in patients with first episode of BPH related AUR significantly prevent secondary AUR. BPH related surgery was lower in dutasteride group but no statistical difference.