摘要：良性前列腺增生 （benign prostatic hyperplasia，BPH） 是中老年男性常见的排尿障碍性疾病，也是泌尿外科临床诊疗中最为常见的疾病之一。下尿路症状 （lower urinary tract symptoms，LUTS） 主要包括储尿期症状 （尿频、尿急、尿失禁及夜尿增多等）、排尿期症状 （排尿等待、排尿困难及排尿间断等） 以及排尿后症状（尿不尽感、尿后滴沥等）。导致 LUTS的原因除了BPH 以外，还包括膀胱功能障碍、尿道及周围组织异常等。随着对 BPH及 LUTS的深入研究，以及循证医学的发展，各国泌尿外科学会BPH诊治指南的重心，从过去以BPH产生梗阻的解剖结构及病理诊治为主，转向了以 LUTS症状学诊治为主。2022年4月由 ELTERMAN等发表在 Canadian Urological Association Journal上的“加拿大泌尿外科学会男性下尿路症状/良性前列腺增生指南更新”一文，通过对2018版加拿大泌尿外科学会BPH诊治指南的更新，总结了继发于BPH的男性LUTS的最新诊治策略。本文对该指南更新内容进行介绍及解读。

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柴攀，张铁铁，杜鹏.《加拿大泌尿外科学会男性下尿路症状/良性前列腺增生指南更新》解读[J]. 泌尿外科杂志（电子版）,2023,15(4):3-16. DOI:10.20020/j.CNKI.1674-7410.2023.04.02

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2022年4月由ELTERMAN 等发表在 CanadianUrological Association Journal 上的“加拿大泌尿外科学会男性下尿路症状/良性前列腺增生指南更新”一文，通过对2018版加拿大泌尿外科学会（CanadianUrological Association，CUA）良性前列腺增生（benignprostatic hyperplasia，BPH）诊治指南的更新，总结了继发于 BPH 的男性下尿路症状（lower urinarytract symptoms，LUTS）的最新诊治策略。文中的信息包括对 2010 版指南的评审，以及从更新的MEDLINE中检索英文文献进一步获得的信息，也包括对最新的美国泌尿外科学会（American UrologicalAssociation，AUA）和欧洲泌尿外科学会指南的评审。该指南是针对50岁以上出现LUTS和良性前列腺增大（benign prostatic enlargement，BPE）和/或 良 性 前 列 腺 梗 阻（benign prostatic obstruction，BPO）的典型男性患者。与 BPO 以外的原因相关的男性 LUTS 可能需要更广泛的诊断检查和不同的治疗考虑。指南更新力求使其适用于所有正在经受LUTS或患有BPE的患者。该指南更新同时阐述了诊断和治疗两方面的问题。诊断指南描述了以下内容：必要项目，推荐项目，可选择项目以及不推荐项目。诊断指南的推荐项目以及治疗原则基于加拿大泌尿外科医师普遍认同的临床规范和（或）专家共识而建立。诊断性建议不提供推荐等级。治疗指南使用 GRADE分类法总结证据并提出治疗建议。

1 诊断指南

    1.1 必要项目

    1.2 推荐项目 

        1.2.1 症状量表 （包括烦恼程度评估）

        1.2.2 前列腺特异性抗原

    1.3 可选择项目

    1.4 不推荐项目

    1.5 考虑手术者的进一步检查

        1.5.1 手术适应证

        1.5.2 术前检查

2 治疗指南 

    2.1 治疗原则

    2.2 治疗后随访 

        2.2.1 观察等待

        2.2.2 药物治疗

        2.2.3 手术治疗

    2.3 药物治疗

        2.3.1 α-受体阻滞剂

        2.3.2 5α-还原酶抑制剂

        2.3.3 联合治疗 （α-受体阻滞剂和 5-ARIs）

        2.3.4 M 受体拮抗剂和 β-3 受体激动剂

        2.3.5 M 受体拮抗剂或 β-3激动剂与 α-阻滞剂联合应 用

        2.3.6 磷酸二酯酶 5 抑制剂

        2.3.7 去氨加压素

        2.3.8 植物制剂

    2.4 手术治疗

        2.4.1 经尿道前列腺电切术 （transurethral resection of the prostate，TURP）

        2.4.2 开放性前列腺摘除术

        2.4.3 微创前列腺摘除术

        2.4.4 前列腺解剖内镜下剜除术

        2.4.5 光选择性前列腺汽化术 （photoselective laser vaporization of prostate，PVP）

        2.4.6 经尿道前列腺切开术 （transurethral incision of the prostate，TUIP）

        2.4.7 微创技术

    2.5 合并特殊情况的诊治 

        2.5.1 急性尿潴留

        2.5.2 膀胱逼尿肌收缩力不足/下降

        2.5.3 BPH相关血尿

        2.5.4 不除外前列腺癌的BPH患者

3 解读

4 总结

BPH 继发的 MLUTS 仍然是困扰男性最常见的年龄相关疾病之一。随着人口老龄化的发展，越来越多的男性患者将从他们的保健医那里寻求建议及针对症状的治疗指导。本指南文件中提供的信息基于对现有最佳证据的共识评估，将有助于泌尿外科医生努力为患者提供最先进的医疗照护。

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