�UroToday.com - Benign Prostatic Hyperplasia (BPH) is the most common benign neoplasm in the aging male. The Symptoms associated with BPH, termed LUTS can be vexatious enough to significantly wallop the life of manpower and their families. While the gold standard for BPH intervention is TURP, over the past 20 years in effect medical treatment has been developed.
The first line of medical treatment is the class of alpha adrenergic inhibitors and include the prostate specific agents: alfuzosin and tamsulosin. These agents which inhibit contraction of the smooth musculus tissue of the prostate transitional geographical zone relieve hindering and irritating symptoms. These agents, however, do non impact the course of the term. Side personal effects include vertigo, orthostatic hypotension and ejaculatory dysfunction.
5 alpha reductase inhibitors (5ARI) have likewise been developed to reduce prostate bulk and thus reduce the obstructive symptoms. These agents act by inhibiting the enzyme that converts testosterone to the highly active form dihydrotestosterone (DHT) which is responsible for prostate enlargement. 5ARI treatment is slow in onset taking as much as 6 weeks to have effect; they do delay the progression of histological BPH. The two agents currently available include: dutasteride and finasteride. Dutasteride inhibits both type I and type 2 5 alpha reductase while finasteride inhibits only if type 2. Side effects are mainly sexual with decreased ejaculate volume and libido.
Many men too have significant overactive vesica with LUTS which is not solved by either of the BPH agents. In these men combination therapy with an antimuscarinic agent may be helpful. Data available for combinations with tolterodine have been shown to further ameliorate the irritating, storage symptoms without risks of urinary retention. Side effects include: dry back talk and eyes and impairment.
Recent information have focused on the use of phosphodiesterase type 5 inhibitors (PDE 5i). As at that place is a high concentration of PDE 5 in the prostate gland and bladder neck, PDE 5i reduce the symptoms of LUTS. All triad currently usable PDE 5i agents have been show to have improvement of symptoms but not in urinary flow rates.
Presented by: Culley C. Carson, MD, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda
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