Özer GÜZEL, Çetin Volkan ÖZTEKİN, Mustafa SUNGUR, Özgür UĞURLU, Ömer Gökhan DOLUOĞLU, Nasır YILMAZ, Mesut ÇETİNKAYA

Benign Prostat Hiperplazisinde Tolterodin ve Tamsulosin Kombinasyonunun Semptomlar ve Mesane Çıkım Obstrüksiyonu Üzerine Etkisi

Amaç: Çalışmanın amacı tamsulosin, tolterodin monoterapisi ile kombinasyon tedavisinin benign prostat hiperplazisinde semptomatik ve ürodinamik açıdan kaşılaştırılmasıdır. Gereç ve Yöntemler: Benign prostat hiperplazisine bağlı alt üriner sistem semptomları olan 66 erkek hasta tamsulosin, tolterodin ve tolterodin+tamsulosin olarak üç gruba ayrıldı. Tedavi öncesi ve sonrası yaş, prostat spesifik antijen, prostat hacimleri, “international prostate symptom scor” değerleri belirlendi. Basınç akım çalışması ile Qmax, PdetQmax, sistometrik mesane kapasiteleri ve detrüsör aşırı aktivitesi, rezidüel idrar miktarı, Abrams-Griffith obstrüksiyon skorları (ObstInd) saptandı. Altı ay süre ile birinci gruptaki hastalara tolterodin günde iki kez 2 mg, ikinci gruptaki hastalara tamsulosin günde bir kez 0.4 mg ve üçüncü gruptakilere her iki preparat aynı dozlarda kombinasyon olarak verildi. Tedavi sonrası “international prostate symptom score”, ve basınç-akım çalışması tekrarlandı. Elde edilen değişimler her grup kendi içinde ve gruplar arasında karşılaştırıldı. Bulgular: Tolterodin grubunda rezidüel idrar miktarında istatistiksel anlamlı değişiklik saptanmadı ancak tamsulosin ve kombinasyon gruplarında rezidüel idrar miktarı anlamlı olarak azaldı. Qmax, PdetQmax, sistometrik kapasite, Abrams-Griffith obstrüksiyon skorları tolterodin ve tamsulosin gruplarında anlamlı olarak değişmez iken kombinasyon grubunda anlamlı düzeyde iyileşme saptandı. Tamsulosin grubu, “international prostate symptom score –total”, “international prostate symptom score –obstrüktif”, Vr, PdetQmax ve ObstInd de kombinasyon grubu ile benzer etkinlik gösterirken, kombine tedavi international prostate symptom score irritatif alt skorunda ve noktüri sayısında her iki gruptan daha etkindi. Sonuç: Benign prostat hiperplazisine bağlı alt üriner sistem semptomlarından aşırı aktif mesane semptomu olan ve alfa blokör tedaviden fayda görmeyen hastaların kombine tedaviden fayda göreceğini düşünmekteyiz. Anahtar kelimeler: Alt Üriner Sistem Semptomları; Benign Prostat Hiperplazisi; Antikolinerjik Tedavi.

Anahtar Kelimeler:

Alt Üriner Sistem Semptomları; Benign Prostat Hiperplazisi; Antikolinerjik Tedavi.

Effects of Tolterodine and Tamsulosin Combination on Sypmtoms and Bladder Outlet Obstruction in Patients with Benign Prostate Hyperplasia

Aim: To compare the symptomatic and urodynamic aspects of mono-therapies and combination therapies of tolterodine and tamsulosin. Meterial and Methods: Sixty-six patients with lower urinary tract symptoms due to benign prostatic hyperplasia were separated into three treatment groups as tolterodine only group, tamsulosin mono-therapy group, and tolterodine+tamsulosin combination therapy group. Demographics of the patients were noted and prostate specific antigen, prostate volumes, and international prostate symptom scores were determined before and after the treatment. Qmax, PdetQmax, cystometric bladder capacities and detrusor hyperactivities, residual urine portions, Abrams-Griffith obstruction scores (ObstInd) were established. Patients took 2 mg of tolterodine twice a day in first group, 0.4 mg of tamsulosine once a day in second group, and equal doses of these medicines were given as combination in third group. All three groups took the medications for six months. International prostate symptom score and pressure-flow studies were repeated after the treatment, and the differences were analyzed both in, and between the groups. Results: There was no statistically significant difference in tolterodine group for residual urine portions, but these values were significantly lowered in tamsulosin group and combination-therapy groups. Qmax, PdetQmax, cystometric capacity, and Abrams-Griffith obstruction scores were similar in tolterodine and tamsulosin monotherapy groups, whereas significant improvements were achieved in combination therapy group. Tamsulosin group had similar international prostate symptom score -total, international prostate symptom score -obstructive, Vr, PdetQmax and ObstInd values with combination therapy group. Moreover, combination therapy group was significantly more efficient in international prostate symptom score irritative sub-score and nocturia frequency. Conclusions: We concleded that patients who have overactive bladder symptoms and lower urinary tract symptoms due to benign prostatic hyperplasia, and who do not benefit from alpha-blockers will benefit from combined treatment. Key words: Lower Urinary Tract Symptoms; Benign Prostatic Hyperplasia; Anticholinergic Treatment.

Keywords:

Lower Urinary Tract Symptoms; Benign Prostatic Hyperplasia; Anticholinergic Treatment.,

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Başvuru Tarihi: 29.05.2012, Kabul Tarihi: 20.07.2012
For citing/Atıf için:
Correspondence/İletişim
Özer G, Öztekin ÇV, Sungur M, Uğurlu Ö, Doluoğlu,
ÖG, Yılmaz N, Mesut Ç. Effects of tolterodine and
tamsulosin combination on sypmtoms and bladder outlet
obstruction in patients with benign prostate hyperplasia.
J Turgut Ozal Med Cent 2013;20(1):12-18 DOI:
7247/jtomc.20.1.4
E-mail: drozerguzel@gmail.com