Chapple_EU_Genito.qxp 27/7/07 04:24 Page 12
Benign Prostatic Hyperplasia
A number of studies have attempted to investigate if symptom control is Therefore, many men previously presumed to have BOO may actually
maintained after discontinuing the α-antagonist following initial have OABS or a combination of BOO and OABS. The high prevalence of
combination therapy.
32,33
They concluded that α-antagonist therapy can both pathologies means that significant numbers of men will suffer
be withdrawn after 6–12 months’ combination therapy, although patients from both conditions; on pressure flow urodynamics the conditions are
with more severe symptoms may require longer combination treatment. frequently seen to co-exist. Consequently, a large group of men with
After 6–12 months it would be anticipated that the 5ARIs would have LUTS may indeed benefit from an anticholinergic in combination with
begun to have a noticeable effect. However, it is unknown if the an α-antagonist or other therapy, as current evidence would suggest
improvement in disease progression seen with combination therapy in the that monotherapy with an anticholinergic in this group of patients is
MTOPS study would continue if the α-antagonist were discontinued. not particularly effective. Hopefully, additional trials will confirm the
true role and potential benefit of anticholinergics in the treatment of
Recommendations LUTS/BOO.
The MTOPS study provides compelling evidence for the benefit of
combination therapy and this approach may be valid in certain patients Phosphodiesterase Type-5 Inhibitors
at high risk of progression; however, patients will need to be on Phosphodiesterase type-5 inhibitors (PDE5-I) are commonly used in the
combination therapy indefinitely, and side effects are more common with treatment of erectile dysfunction. Several basic science
38,39
and
such a regime. A full cost–benefit analysis has yet to endorse this anecdotal
40
reports have suggested that this class of drugs may be of
approach to the treatment of LUTS/BOO. benefit in BOO. To investigate this further, a placebo-controlled RCT of
281 men using tadalafil from 21 centres in the US has been
performed.
41
The recently published results show a statistically and
Some remarkably efficacious medical
clinically relevant improvement in both storage and voiding LUTS
treatments have emerged for the
secondary to BPH and also in QoL assessments, but no improvement in
flow rate was seen. In addition to being well tolerated, tadalafil also
treatment of lower urinary tract
improved erectile function in those men with LUTS and erectile
symptoms/bladder outlet obstruction
dysfunction. Further trials have reported similar results that concur
with these findings, and this may open a new avenue for medical
over the last two decades.
treatment for LUTS/BOO.
Emerging Medical Treatments Final Thoughts
Some remarkably efficacious medical treatments have emerged for the
Anticholinergics treatment of LUTS/BOO over the last two decades. Each has specific uses,
There is emerging evidence and ongoing trials to investigate the such as the immediate treatment of symptoms or long-term decrease in
combination of α-antagonists and anticholinergics in the treatment of disease progression. This has resulted in a marked decline in the number
BOO/LUTS, particularly in men with significant storage symptoms.
34–36
of surgical interventions required to treat BPH.
3
Amid the ever-ageing
Previously, it had been thought that OAB was more prevalent in population, this condition will become an even greater health and
females; however, a recent multinational population-based cross- economic burden; however, with the continuing development of known
sectional study of over 19,000 individuals found that OABS rates were treatments, an increasing understanding of the use of combinations of
similar in both men and women (11.8%).
37
There is also a great deal of these drugs and the emergence of new medical treatments we will
overlap in the storage and voiding LUTS experienced in BOO and OAB hopefully be able to further improve the non-surgical management of
with nocturia and daytime urinary frequency being common to both. this condition in the future. ■
1. Berry SJ, Coffey DS, Walsh PC, Ewing LL, J Urol, 1984;132(3): 15. Chang DF, Campbell JR, J Cataract Refract Surg, 2005;31(4): 30. Kaplan S, Garvin D, Gilhooly P, et al., Urology, 2000;56(4):
474–9. 664–73. 610–16.
2. Lytton B, Emery JM, Harvard BM, J Urol, 1968;99(5):639–45. 16. Barendrecht MM, Koopmans RP, de la Rosette JJ, Michel MC, 31. McConnell JD, Roehrborn CG, Bautista OM, et al., N Engl J
3. Wei JT, Calhoun E, Jacobsen SJ, J Urol, 2005;173(4): 1256–61. BJU Int, 2005;95(Suppl. 4):19–28. Med, 2003;349(25):2387–98.
4. Chute CG, Panser LA, Girman CJ, et al., J Urol, 1993;150(1): 17. van Kerrebroeck P, Jardin A, van Cangh P, Laval KU, Eur Urol, 32. Barkin J, Guimaraes M, Jacobi G, et al., Eur Urol,
85–9. 2002;41(1):54–60. 2003;44(4):461–6.
5. Roehrborn CG, Marks L, Harkaway R, Prostate Cancer Prostatic 18. Chapple CR, Baert L, Thind P, et al., Eur Urol, 33. Baldwin KC, Ginsberg PC, Roehrborn CG, Harkaway RC,
Dis, 2006; 9(1):30–34. 1997;32(4):462–70. Urology, 2001;58(2):203–9.
6. Issa MM, Regan TS, Am J Manag Care, 2007;13(Suppl. 1):S4–9. 19. Lowe FC, Clin Ther, 1997;19(4):730–42. 34. Kaplan SA, Roehrborn CG, Rovner ES, et al., JAMA,
7. Issa MM, Fenter TC, Black L, et al., Am J Manag Care, 20. Lowe FC, BJU Int, 2005; 95(Suppl. 4):12–18. 2006;296(19):2319–28.
2006;12(Suppl. 4):S83–9. 21. Kloner RA, Jackson G, Emmick JT, et al., J Urol, 2004; 35. Blake-James BT, Rashidian A, Ikeda Y, BJU Int, 2007;99(1):
8. Jacobsen SJ, Jacobson DJ, Girman CJ, et al., J Urol, 172(5 Part 1):1935–40. 85–96.
1997;158(2):481–7. 22. Chapple CR, Euro Urol, 2005;4(7):20–22. 36. Novara G, Galfano A, Ficarra V, Artibani W, Eur Urol, 2006;
9. McConnell JD, Bruskewitz R, Walsh P, et al., N Engl J Med, 23. Crawford ED, BJU Int, 2005;95(Suppl. 4):1–5. 50(4):675–83.
1998;338(9):557–63. 24. Speakman MJ, Kirby RS, et al., BJU Int, 2004;93(7):985–90. 37. Irwin DE, Milsom I, Hunskaar S, et al., Eur Urol, 2006;50(6):
10. European Association of Urology Guidelines, European 25. Bruskewitz R, Girman CJ, Fowler J, et al., Urology, 1306–15.
Association of Urology, 2007. 1999;54(4):670–78. 38. Uckert S, Kuthe A, Jonas U, Stief CG, J Urol, 2001;166(6):
11. Crawford ED, Wilson SS, McConnell JD, et al., J Urol, 26. Andriole GL, Kirby R, Eur Urol, 2003;44(1):82–8. 2484–90.
2006;175(4):1422–6, discussion 6–7. 27. Edwards JE, Moore RA, BMC Urol, 2002;2(1):14. 39. Guh JH, Hwang TL, Ko FN, et al., Mol Pharmacol, 1998;53(3):
12. Madersbacher S, Alivizatos G, Nordling J, et al., Eur Urol, 28. Roehrborn CG, Marks LS, Fenter T, et al., Urology, 2004;63(4): 467–74.
2004;46(5):547–54. 709–15. 40. Sairam K, Kulinskaya E, McNicholas TA, et al., BJU Int,
13. Chapple CR, PBJU Int, 2004;94(5):738–44. 29. Study Number: ARI40001 – Year 1, Last updated 22 December 2002;90(9):836–9.
14. Chapple C, et al. In: McConnel J, et al., Male Lower Urinary 2004. GlaxoSmithKline Website.http://ctr.gsk.co.uk/Summary/ 41. McVary KT, Roehrborn CG, Kaminetsky JC, et al., J Urol,
Tract Dysfunction, Health Publications Ltd, 2006;143–94. dutasteride/studylist.asp (Accessed 18 July 2006). 2007;177(4):1401–7.
12 EUROPEAN GENITO-URINARY DISEASE 2007
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