Научно обоснованное обновление рекомендаций по обследованию и лечению мужчин с симптомами нижних мочевыводящих путей


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Аннотация

Цель настоящего обзора заключалась в обобщении фактических данных о диагностике и лечении симптомов нижних мочевыводящих путей (СНМП) у мужчин. В связи со старением популяции, распространенность СНМП у мужчин неизбежно возрастает. Таким образом, профилактика развития симптомов и сохранение качества жизни (КЖ) являются высокими приоритетами, как для врачей, так и для пациентов. В настоящее время существует большое количество различных медикаментозных методов лечения для мужчин с СНМП, которые приводят к значительному уменьшению выраженности симптомов, увеличению скорости потока мочи и улучшению качества жизни. Мета-анализы продемонстрировали высокую эффективность ингибиторов 5-а-редуктазы, М-холиноблокаторов, а-адреноблокаторов, а в последнее время - и ингибиторов фосфодиэстеразы-5. Также существуют данные высокого уровня доказательности в отношении эффективности сочетания всех вышеуказанных препаратов с а-адреноблокаторами, за исключением ингибиторов фосфодиэстеразы-5, в связи с чем мужчинам с сопутствующими симптомами накопления мочи, объемом простаты>30 мл и ПСА>1,4 нг/л или эректильной дисфункцией можно назначать комбинированную терапию. За последние несколько лет наблюдается увеличение количества данных об эффективности менее инвазивных методов цистометрии. Несмотря на то что они не позволяют получать такую же информацию, как цистометрия, они могут играть важную роль в ответах на конкретные вопросы и при проведении консультаций мужчин с ДГПЖ/СНМП. Для применения этих новых методов в обследовании пациентов необходима стандартизация и использование определенных показаний. В эпоху персонализированной медицины соответствующий отбор пациентов, вероятно, является ключом к наиболее эффективной стратегии обследования и лечения.

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Об авторах

A. Mangera

Клиника Университета Шеффилда

Email: mangeraaltaf@hotmail.com
клинический научный сотрудник Великобритания

Ch. Chapple

Клиника Университета Шеффилда

Великобритания

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