Fikret ERDEMİR, Uğur BOYLU, Mete KİLCİLER

TESTOSTERON VE ALT ÜRİNER SİSTEM SEMPTOMLARI/BENİGN PROSTATİK HİPERPLAZİ ARASINDAKİ İLİŞKİNİN DEĞERLENDİRİLMESİ

Alt üriner sistem semptomlarının AÜSS prevalansı 4. dekatta %8 ve 7. dekattan sonrada %70’den fazladır. Orta ve ileri yaşlardaki erkeklerde AÜSS’larının en sık nedeni benign prostatik hiperplazisidir BPH . Yaklaşık olarak 50-60 yaş arasındaki erkeklerin %50’sinde, 60-70 yaş arasındaki erkeklerin %60’ında ve 80 yaş üzerindeki erkeklerinde %90’ına yakınında çeşitli derece’lerde BPH bulunmaktadır. Erkeklerde AÜSS’larının patogenezi oldukça karışık olup pek çok faktörü içermektedir. Günümüze kadar AÜSS’nın patogenezini açıklama için ATP, pürinerjik sistem, RhoA/Rhokinaz yolu, nitrik oksit, substans P, yaşlılık, östrojen ve testosteron gibi pek çok klinik ve moleküler yapılar bildirilmiştir. Androjenlerin genitoüriner sistemin gelişiminde önemli rol oynadığı gösterilmiştir. Androjen reseptörlerinin üretra ve mesane epitelyal hücrelerinde geniş olarak bulunduğu bulunmuştur. Buna ilave olarak testosteron ve metabolitlerinin ratlarda otonomik sinir sisteminin bir parçası olan pelvik yapılarda refleks aktivitenin devamlılığını sağladığı gösterilmiştir. Araştırmacılar detrusor aktivitesini suprese eden post sinaptik non-genomik reseptörler üzerine testosteronun etki ettiğini belirtmişlerdir. Non-adrenerjik ve non-kolinerjik nörotransmittrer olarak hareket eden nitrik oksitin NO sadece peniste değil aynı zamanda üretra, mesane ve prostat da dahil olmak üzere üriner sistemin diğer yapılarında da bulunduğu ve testosteronun üriner sistemdeki etkinliğinin olasılıkla bu yapı aracılığı ile olduğu düşünülmektedir. Her ne kadar tam olarak açık olmasa da yakın zamanlarda yapılan birkaç çalışmada AÜSS ile testosteron arasında ilişki olduğu bildirilmiştir. Bu derlemenin amacı da AÜSS/BPH ve testosteron arasındaki ilişkinin literatürler eşliğinde değerlendirilmesidir

Anahtar Kelimeler:

Alt üriner sistem semptomları, prostat, mesane, etiyoloji, tedavi, testosteron

THE EVALUATION OF THE ASSOCIATION BETWEEN LOWER URINARY TRACT SYMPTOMS/ BENIGN PROSTATIC HYPERPLASIA AND TESTOSTERONE

The prevalence of lower urinary tract symptoms LUTS increases from 8% in the fourth decade of life to more than 70% in the seventh decade. Benign prostatic hyperplasia is the most common cause of LUTS in middle-aged and elderly men. Approximately 50% of men aged 50 to 60 years, 60% of men aged 60 to 70 years, and up to 90% of men aged >80 years have some degree of BPH. The pathogenesis of LUTS in men is complex and multifactorial. Up to know many molecular structures and clinical factors such as ATP, purinergic system, RhoA/Rho-kinase pathway, nitric oxide, substance P, ageing, oestrogen, and testosterone have been reported to explain of the pathogenesis of the lower urinary tract symptoms. It has been reported that androgens play major role in the development of genitourinary structures. Androgen receptors have been found to be present to a large extent in the epithelial cells of the urethra and the bladder. In addition, the role of testosterone and its metabolites on maintaining the reflex activity in the pelvic part of the autonomic nervous system could be demonstrated in rats. Others have postulated the influence of testosterone on postsynaptic non-genomic receptors which are suppressing detrusor activity. Not only the penis but also in other parts of the urogenital tract nitric oxide NO acts as a non-adrenergic non-cholinergic neurotransmitter and the action of testosterone on the urogenital tract may be mediated by this system. Although it is not clear , recently, several studies have suggested a relationship between LUTS and the testosterone. The aim of this review is to evaluate the association between LUTS/BPH and testosterone with the relevant literature

Keywords:

Lower urinary tract symptoms, prostate, mesane, etiology, pathogenesis, testosterone,

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