Schneider_edit.qxp 27/7/07 04:06 Page 18
Benign Prostatic Hyperplasia
over a multiple-year period, there is no significant reduction in a four-and-a-half-year follow-up period. It seems as if α-blockers could
progression of prostate size or risk of acute urinary retention or even reduce symptom progression and 5-ARIs have a positive influence on
surgery. Nevertheless, they can be used in patients who have had an reduction of complications such as acute urinary retention.
23,24
acute urinary retention for trial without catheter.
Nevertheless, not all BPH patients profit from combination therapy
Dutasteride and Finasteride because side effects as well as effectiveness increase. Higher age, high
Dutasteride and finasteride differ due to their selectivity for isoenzymes IPSS, big prostates and high PSA values seem to be good indications for
as well as due to their pharmacokinetic properties. For all 5-ARIs, combination therapy.
sufficient study data are available to prove their effectiveness on BPH,
especially when used in patients with a prostate volume >40ml. The Alternative Medical Treatment Options
effects on urinary flow rate and symptom improvement are similar to Muscarinic receptor antagonists, especially in combination with
α-blockers, but need up to six months to achieve the maximum effect. α-blockers and phosphodiesterase-5-inhibitors, are evaluated in
At the same time, 5-ARIs lead to a reduction of the prostate volume of several studies referring to their effectiveness in BPH patients. There
about 25%. These effects are consistent over several years and seem to be some promising results and muscarinic receptor
progression of symptom impairment, prostate size and risk of acute antagonists alone and in combination therapy are used more and
urinary retention, as well as the risk of prostate surgery due to BPH, is more frequently in clinical practice, but no guidelines are yet available
significantly reduced. PSA levels are reduced by about 50%, but due to missing data.
25
doubling PSA levels still allows appropriate interpretation of PSA
levels.
21,22
There is no significant difference in effectiveness between Botolinum toxin injections, desmopressin and anti-inflammatory
finasteride and dutasteride. substances are being investigated for their possible use in LUTS, but the
place for these new therapies has not been clearly defined.
26
In order to find the perfect treatment
Conclusion
option for each patient, it is fundamental
Ultimately, urologists have many options to treat every individual in the
to combine our knowledge from several
optimal way due to the huge choice of pharmacological substances
available, and they will have even more options in the future. In order to
years of everyday urological work with
find the perfect treatment option for each patient, it is fundamental to
national and/or international guidelines
combine our knowledge from several years of everyday urological work
with national and/or international guidelines on BPH/LUTS. This includes
on benign prostatic hyperplasia/lower
questions such as: “Would you like to take medication every day to
urinary tract symptoms. improve your symptoms?” and even “Would you prefer one week in
hospital to have TURP and stop taking medication after that?” Medical
Combination Therapy treatment can improve symptoms only to a certain degree; again, it is our
Most commonly, α-blockers and 5-ARIs are combined for addition of duty not to miss the point at which this medical therapy is no longer
effectiveness. Although first data from short-term studies showed no effective enough and patients would benefit a lot more from
improvement in reduction of progression, the MTOPS study did show a surgical/interventional BPH therapy, even if there are no absolute
significant reduction of progression defined as symptom impairment over indications such as acute urinary retention or hydronephrosis. ■
1. Asplund R, Nocturia, nocturnal polyuria an sleep quality in the 12. Akerstedt T, Nilsson PM, Sleep as restitution: an introduction, prostate spcific antigen and its usefulness as a marker for
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and depression, BJU Int, 2004;93:1253–6. activities and associated risks, Eur Urol Suppl, 2005;3(6):24–32. the detection of prostate cancer: results of a randomised,
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sleep, Urology, 2004;64(Suppl. 6A):21–4. and actigraphic evidence of sleep fragmentation in patients Group, Proscar Long-term Efficacy and Safety Study, Urology,
5. Menefee LA, Cohen MJ, Anderson WR, et al., Sleep disturbance with irritable bowel syndrome, Sleep, 2003;26:747–52. 998;52:195–201.
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18 EUROPEAN GENITO-URINARY DISEASE 2007
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