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作者：Jill Stein  
出處：WebMD醫學新聞

　　April 20, 2010（西班牙巴塞隆納）－研究團隊於歐洲泌尿醫學會第25屆年會報告，Alfuzosin（Uroxatral，賽諾菲安萬特藥廠），一種泌尿選擇性的alpha-1腎上腺受體阻斷劑，可以減輕性生活活躍、且有下泌尿道症狀（LUTS），代表可能罹患良性攝護腺肥大（BPH）男性的射精困難。
　　
　　愛爾蘭都柏林Mater Misericordiae醫院與大學醫學院的外科教授及諮詢泌尿學家John M. Fitzpatrick醫師向Medscape泌尿學表示，我們的資料顯示，因為BPH引起LUTS的性生活活躍男性，每天服用一次alfuzosin 10 mg，持續6個月，可以顯著改善LUTS以及因為LUTS造成的困擾，且站在心血管與性的觀點上，耐受性是良好的。
　　
　　Fitzpatrick醫師與其同事們以兩項問卷回覆，分析1681位男性，在試驗前與使用Alfuzosin 6個月後的反應。其中一項問卷根據排尿困難，另一項評估射精困難。這些受試者來自歐洲、亞洲、南美洲與俄羅斯。
　　
　　【LUTS男性的射精困難獲得緩解】
　　Fitzpatrick醫師表示，因BPH引起LUTS的性生活活躍男性，射精困難是很常見的，且令人困擾。
　　
　　事實上，他與來自麻州Watertown的新英格蘭研究機構共同作者Robert C. Rosen博士發現，一項早期研究顯示，有LUTS男性大約有75%射精力道下降，且精液量減少，這代表BPH。
　　
　　早期研究也顯示，輕微LUTS的男性，大約1/3認為有射精困難的問題，中度LUTS的男性，約有一半有這樣問題，而嚴重LUTS有2/3有這樣的問題。
　　
　　同樣的研究人員也發現，因BPH造成LUTS男性射精障礙可以因為某些治療而緩解，包括BPH相關手術，以及使用5-alpha-還原酶抑制劑加上alpha-1阻斷劑，或是僅使用tamsulosin。
　　
　　【兩項問卷顯示使用Alfuzosin會改善症狀】
　　這項研究中使用的問卷是男性性生活健康問卷（MSHQ-EjD）與國際攝護腺症狀分數（IPSS）的射精區塊。
　　
　　MSHQ-EjD是一個已經過確效的工具，評估三種射精困難症狀：性活動時射精能力下降、射精強度/力道下降、以及精液量下降或精子數目減少，以及因為射精困難造成的困擾。
　　
　　IPSS分數詢問有關排尿的7個問題，將每個問題分數加總，讓病患計算他們症狀的嚴重度。0~7分代表症狀輕微、8~18分代表中度症狀、18分以上代表嚴重症狀。
　　
　　試驗受試者根據問卷回覆結果分為三組：
　　* 沒有射精困難的人們，絕大部分時間可以用比平常時一樣的、或稍微弱一點的力道射精，且精液量正常或是將近正常。
　　* 有部分射精困難的人們，射精頻率、力道、與精液量都下降。
　　* 有完全射精困難的人們，無法射精。
　　
　　【多重評量結果顯示有改善】
　　Alfuzosin顯著改善IPSS分數（7.9[-41%]；P<0.0001），以及夜尿（-0.9[-18%]；P<0.001）。因為LUTS的困擾也顯著改善（-1.5[-28%]；P<0.0001）。
　　
　　MSHQ-EjD的結果顯示，因為射精困難的困擾，在收納病患時比較常見，alfuzosin可以顯著改善這個問題。
　　
　　此外，除了70歲以上男性，所有年齡族群，沒有射精困難的男性比例顯著增加，因為射精困難造成的困擾都顯著下降。
　　
　　Alfuzosin的耐受性良好，頭暈是最常見的不良反應（2.4%）。低血壓的發生率約為0.1%。沒有暈厥事件，且性方面不良反應是不常見的。
　　
　　賽諾菲安萬特藥廠贊助這項研究。Fitzpatrick醫師與Rosen醫師表示接受賽諾菲安萬特藥廠的諮詢費用。


Alfuzosin Improves Ejaculatory Dysfunction in Men With Probable BPH

By Jill Stein
Medscape Medical News

April 20, 2010 (Barcelona, Spain) — Alfuzosin (Uroxatral, Sanofi Aventis), a uroselective alpha-1-adrenergic receptor blocker, ameliorates ejaculatory dysfunction in sexually active men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hypertrophy (BPH), investigators reported here at the European Association of Urology 25th Annual Congress.

"Our data show that alfuzosin 10?mg once daily given for 6 months in sexually active men with LUTS due to BPH significantly improves LUTS and bother due to LUTS, and is well tolerated from a cardiovascular and sexual standpoint," John M. Fitzpatrick, MD, professor of surgery and consultant urologist at Mater Misericordiae Hospital and University College in Dublin, Ireland, told Medscape Urology.

Dr. Fitzpatrick and colleagues analyzed responses to 2 questionnaires completed by 1681 men at baseline and after 6 months of alfuzosin treatment. One questionnaire focused on voiding difficulty, and the other evaluated ejaculatory dysfunction. Participants were from Europe, Asia, South America, and Russia.

Ejaculatory Dysfunction Ameliorated in Men With LUTS

"Ejaculatory dysfunction is very common and very bothersome in sexually active men who have LUTS suggestive of BPH," Dr. Fitzpatrick said.

In fact, he and his coauthor Robert C. Rosen, PhD, from the New England Research Institute in Watertown, Massachusetts, found during earlier research that about 75% of men with LUTS had a decreased force of ejaculation and decreased amount of semen, suggestive of BPH.

Earlier research also revealed that ejaculatory dysfunction was considered a problem by roughly one third of men with mild LUTS, half of men with moderate LUTS, and two thirds of men with severe LUTS.

These same investigators also found that ejaculatory dysfunction in men with LUTS suggestive of BPH can be aggravated by some treatments, including BPH-related surgery and the use of a 5-alpha-reductase inhibitor plus an alpha-1-blocker, or tamsulosin alone.

Two Questionnaires Show Symptom Improvement With Alfuzosin

The questionnaires used in this study were the ejaculatory domain of the Male Sexual Health Questionnaire (MSHQ-EjD) and the International Prostate Symptom Score (IPSS).

MSHQ-EjD is a validated tool that assesses 3 ejaculatory dysfunction symptoms: reduced ability to ejaculate during sexual activity, decreased strength/force of ejaculation and decreased amount/volume of semen, and bother resulting from ejaculatory dysfunction.

The IPSS asks 7 questions on voiding, and the sum of the scores on each question enable the patient to calculate the severity of his symptoms. A score of 0 to 7 indicates mild symptoms, a score of 8 to 18 denotes mild symptoms, and a score greater than 18 denotes severe symptoms.

Study participants were divided into 3 groups on the basis of their responses to the questionnaires:

Those with no ejaculatory dysfunction were consistently able to ejaculate all or most of the time with force as strong as or slightly less strong than usual and with the usual or near-usual volume.
Those with partial ejaculatory dysfunction had decreased frequency, force, and volume of their ejaculate.
Patients with complete ejaculatory dysfunction were unable to ejaculate.
Improvements Seen on Multiple Measures

Alfuzosin significantly improved IPSS score (7.9 [–41%]; P?< .0001) and nocturia (–0.9 [–18%]; P?< .001) from baseline. Bother due to LUTS also significantly improved (–1.5 [–28%]; P?< .0001).

Results on the MSHQ-EjD revealed that bother due to ejaculatory dysfunction, which was highly prevalent at enrollment, significantly improved with alfuzosin.

Also, the percent of men with no ejaculatory dysfunction increased in all age groups, except for men 70 years of age or older. Bother due to ejaculatory dysfunction decreased in all age groups, except for men 70 years of age or older.

Alfuzosin was well tolerated. Dizziness was the most frequently reported adverse event (2.4%). Hypotension occurred in 0.1%. There were no cases of syncope, and sexual adverse events were uncommon.

Sanofi Aventis provided funding for the study. Dr. Fitzpatrick and Dr. Rosen report receiving consulting fees from Sanofi Aventis.

European Association of Urology (EAU) 25th Annual Congress: Abstract?1000. Presented April?19, 2010.