agxАндрология и генитальная хирургияAndrology and Genital Surgery2070-97812412-8902MedINK Publishing House LLC10.17650/2070-9781-2014-1-6-14agx-78Research ArticleОБЗОРНАЯ СТАТЬЯREVIEWМедикаментозное лечение симптомов нижних мочевых путей у мужчин. Роль уроселективности в выборе препаратаDrug treatment of lower urinary tract symptoms in males. Role uroselectivity in the choice of drugАляевЮ. Г.AlyaevYu. G.

НИИ уронефрологии и репродуктивного здоровья человека

Research Center of Uronephrology and Reproductive Health

zaida-gadzhieva@rambler.ruГаджиеваЗаида КамалудиновнаGadzhievaZ. K.

НИИ уронефрологии и репродуктивного здоровья человека

Research Center of Uronephrology and Reproductive Health

zaida-gadzhieva@rambler.ruРапопортЛ. М.RapoportL. M.

НИИ уронефрологии и репродуктивного здоровья человека

Research Center of Uronephrology and Reproductive Health

zaida-gadzhieva@rambler.ruКазиловЮ. Б.KazilovYu. B.

НИИ уронефрологии и репродуктивного здоровья человека

Research Center of Uronephrology and Reproductive Health

zaida-gadzhieva@rambler.ruГБОУ ВПО «Первый Московский государственный медицинский университет им. И. М. Сеченова» Минздрава РоссииРоссияI. M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation201403122014151614Copyright © Аляев Ю.Г., Гаджиева З.К., Рапопорт Л.М., Казилов Ю.Б., 20142014Аляев Ю.Г., Гаджиева З.К., Рапопорт Л.М., Казилов Ю.Б.Alyaev Y.G., Gadzhieva Z.K., Rapoport L.M., Kazilov Y.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://agx.elpub.ru/jour/article/view/78

У большинства пациентов расстройства мочеиспускания обусловлены как механическим, так и функциональным факторами. Своевременное выявление характера уродинамических нарушений, в первую очередь инфравезикальной обструкции и гиперактивности детрузора, у больных доброкачественной гиперплазией предстательной железы имеет важное практическое значение, так как без учета этого фактора существенно ухудшаются функциональные результаты хирургического лечения. α1-адреноблокаторы являются первой линией терапии для мужчин с симптомами нижних мочевых путей (СНМП). Они должны быть предложены пациентам с умеренными и тяжелыми СНМП. Выбор α1-адреноблокатора должен склоняться к более селективным представителям класса.

Селективность α-адреноблокатора обеспечивает наряду с высокой эффективностью низкий процент побочных реакций, особенно со стороны сердечно-сосудистой системы.

Так же как и α-адреноблокаторы, М-холиноблокаторы различаются по степени селективности в отношении воздействия именно на мочевой пузырь. Солифенацин более селективен в отношении мочевого пузыря, чем толтеродин и осибутинин. Селективность данного препарата по отношению к мочевому пузырю выражается относительно низкой частотой возникновения побочных эффектов, особенно сухости во рту, при его применении, а также возможностью длительной терапии. Комбинированное лечение α1-адреноблокатором с М-холиноблокатором может рассматриваться у пациентов с умеренными и тяжелыми СНМП с преобладанием симптомов наполнения, особенно если монотерапия не привела к облегчению симптомов.

Most patients lower urinary tract symptoms (LUTS) caused both mechanical and functional factors. Timely identification of the nature of urodynamics, primarily of bladder outlet obstruction and detrusor overactivity, in patients with benign prostatic hyperplasia is of practical importance, since without this factor significantly worse functional outcome of surgical treatment. α1-adrenoblockers are the first line therapy for men with bothersome LUTS. They should be offered to patients with moderate to severe LUTS. Choosing α1-adrenoblocker should lean toward more selective class representatives. Selectivity α1-adrenoblocker provides high efficiency along with a low percentage of adverse effects, especially for cardiovascular system.

As well as α-adrenoblockers, M-cholinobloсkers varying degrees of selectivity of the impact is on the bladder. Solifenacin is more selective for the bladder than tolterodine and oxybutynin. The selectivity of the drug with respect to the bladder is reflected in the relatively low frequency of adverse effects, especially occurrence of dry mouth in its application, as well as the possibility of long term therapy. Combined treatment with α1-adrenoreceptor antagonist with M-cholinergic antagonists may be considered in patients with moderate to severe LUTS with a predominance of filling symptoms, especially if monotherapy led to relief of symptoms.

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The authors declare that there are no conflicts of interest present.