Điều trị tăng sản tuyến tiền liệt lành tính đã phát triển qua hai thập kỷ qua từ một sự lựa chọn đơn giản giữa chờ đợi theo dõi và cắt bỏ transurethral của tuyến tiền liệt để quyết định điều trị phức tạp hơn giữa các liệu pháp y tế khác nhau và phạm vi mở rộng các lựa chọn điều trị xâm lấn tối thiểu. | 18 Treatment options BENIGN PROSTATIC HYPERPLASIA Benign prostatic hyperplasia therapy has evolved over the last two decades from a simple choice between watchful waiting and transurethral resection of the prostate to more complex treatment decisions between various medical therapies and an expanding range of minimally invasive treatment options. Most patients who suffer some degree of bother from their benign prostatic hyperplasia-associated symptoms will now opt for medical therapy in the first instance. Plant extracts from a variety of sources Figure 122 are popular especially in continental Europe but there is little hard evidence from randomized trials of their efficacy and safety. a-Blockers such as doxazosin tamsulosin and alfuzosin can all be administered once per day and produce rapid and sustainable improvement of lower urinary tract symptoms and uroflow Figure 123 55. It has been argued that tamsulosin which has selec tivity for the a1A and a1D adrenoceptor subtypes and alfuzosin which is also relatively uroselective . has more impact on prostate obstruction than blood pressure have some advantages over doxazosin and terazosin which have a balanced effect on all three receptor subtypes. However doxazosin reduces the blood pressure in hypertensive men but has little or no impact on the blood pressure of normotensive individuals56. Doxazosin also reduces platelet adhesiveness and reduces LDL cholesterol and thus may offer some cardiovascular protection in addition to improvement of lower urinary tract symptoms and uroflow57. Both doxazosin and terazosin but not tamsulosin or alfuzosin have been shown to cause apoptosis within the prostate and it has been argued that this may rebalance the proliferative processes that underlie the condition Figure 124 . However the clinical utility of this is still unproven. American Dwarf Palm Saw Palmetto fruits Serenoa Repens Sabal Serrulata African Plum tree barks Pygom Africanum South African Star Grass Pine Spruce
