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Benign Prostatic Hyperplasia

Posted by admin on July 11th, 2011 No Comments

Definition Benign prostatic hyperplasia, a nearly ubiquitous condition, is the most common benign neoplasm of American men and occurs as a result of hormone-driven prostate growth. Pathophysiology The prostate gland comprises three types of tissue: epithelial or glandular, stromal or smooth muscle, and capsule. Both stromal tissue and capsule are embedded with О±1-adrenergic receptors. The precise pathophysiologic mechanisms that cause Benign prostatic hyperplasia are not clear. However, both intraprostatic dihydrotestosterone and type II 5 О±-reductase are thought to be involved. Benign prostatic hyperplasia commonly results from both static (gradual enlargement of the prostate) and dynamic (agents or situations that increase О±-adrenergic tone and constrict the gland's smooth muscle) factors. Examples of drugs that can exacerbate symptoms include testosterone, О±-adrenergic agonists (e.g., decongestants), anticholinergics (e.g., antihistamines, phenothiazines, tricyclic antidepressants, anticholinergic antispasmodics, Read more [...]

Posted in Benign Prostatic Hyperplasia

Alpha Blockers

Posted by admin on May 10th, 2011 No Comments

Overview Hyperplasia of the stromal tissue may or may not lead to significant enlargement of the prostate, but it usually leads to dynamic benign prostatic hyperplasia by increasing prostatic smooth muscle, which triggers increased smooth-muscle tension and resistance to urine flow. (The dynamic and static components of benign prostatic hyperplasia are discussed in the "Etiology and Pathophysiology" section.) Alpha1-adrenergic receptors in the bladder neck and prostatic capsule mediate tension in these muscles. Although the alpha1-adrenergic antagonists, or alpha blockers, currently used to block these receptors (e.g., doxazosin [Pfizer/AstraZeneca's Cardura/Cardura XL, generics] and terazosin [Abbott's Hytrin, generics]) reduce benign prostatic hyperplasia symptoms and resistance to urine flow, some of them also cause cardiovascular side effects. The latest entrants in this field (e.g., tamsulosin [Astel-las/Boehringer Ingelheim/Abbott's Harnal/Flomax/Omnic, others] and alfuzosin [Sanofi-Aventis's Xatral/Xatral SR/Uroxatral, others]) are prostate-specific or uroselective alpha blockers that reduce Read more [...]

Posted in Benign Prostatic Hyperplasia

Doxazosin

Posted by admin on May 10th, 2011 No Comments

Doxazosin (Pfizer's Cardura/Cardura XL, generics) is a long-acting alpha blocker selective for alpha1-adrenergic receptors; this agent has been used to treat hypertension since 1991. At the end of 2001, a once-daily formulation, Cardura XL (doxazosin GITS [gastrointestinal therapeutic system]), had been launched for benign prostatic hyperplasia and hypertension in 13 countries, including France, Germany, Spain, and the United Kingdom. Pfizer filed for approval of Cardura XL in April 2001 in the United States and was approved in 2005. Although doxazosin is not as selective as some of the newer alpha blockers, it has comparable efficacy and is a good alternative for patients who may have difficulty covering the cost of tamsulosin or alfuzosin. Since publication of Medical Therapy of Prostatic Symptoms (MTOPS), a study of the effects of combination therapy on benign prostatic hyperplasia progression, doxazosin is now implicated as an inhibitor of prostatic development when used in combination with finasteride. The study is described later in this section in conjunction with the 5-ARI finasteride. The Read more [...]

Posted in Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia:Current Therapies

Posted by admin on May 10th, 2011 No Comments

Treatment of benign prostatic hyperplasia (benign prostatic hyperplasia) is directed primarily toward managing symptoms and improving patients' quality of life (QoL). The two dominating classes of pharmacological agents used to treat benign prostatic hyperplasia are alpha Mockers and 5-alpha-reductase inhibitors (5-ARIs). Both drug classes are effective in alleviating lower urinary tract symptoms (lower urinary tract symptoms ) associated with benign prostatic hyperplasia, thereby improving patients' comfort level. Alpha blockers are most useful in alleviating symptoms related to dynamic benign prostatic hyperplasia; 5-ARIs are used for the treatment of static benign prostatic hyperplasia. The dynamic and static forms of benign prostatic hyperplasia are discussed in the "Etiology and Pathophysiology" section. Alpha blockers work by relaxing prostatic muscle involved in dynamic benign prostatic hyperplasia; they cannot stop further growth of the prostate. 5-ARIs and gonadotropin modulators (used only in Japan) reduce the cellular growth seen in static benign prostatic hyperplasia. lower Read more [...]

Posted in Benign Prostatic Hyperplasia

Doxazosin

Posted by admin on September 7th, 2010 No Comments

Indications hypertension; benign prostatic hyperplasia Cautions care with initial dose (postural hypotension); cataract surgery (risk of intra-operative floppy iris syndrome); susceptibility to heart failure; hepatic impairment; pregnancy; breast-feeding; interactions: alpha-blockers Driving May affect performance of skilled tasks e.g. driving Side-effects gastro-intestinal disturbances; oedema, hypotension, postural hypotension; dyspnoea, rhinitis, coughing; asthenia, fatigue, vertigo, dizziness, headache, paraesthesia, sleep disturbance, anxiety, depression; respiratory-tract infection, urinary-tract infection, influenza-like symptoms; back pain, myalgia; less commonly weight changes, flushing, syncope, tremor, agitation, micturition disturbance, impotence, epistaxis, arthralgia, tinnitus, hypersensitivity reactions (including pruritus, purpura, rash), alopecia; very rarely cholestasis, hepatitis, jaundice, bronchospasm, gynaecomastia, priapism, abnormal ejaculation, leucopenia, thrombocytopenia, blurred vision Dose • Hypertension, 1 mg daily, increased after 1-2 weeks to 2 mg once Read more [...]

Posted in Drugs

Management of benign prostatic hyperplasia (BPH)

Posted by admin on June 3rd, 2010 No Comments

The National Prescribing Centre (NPC) [UK] Summary Symptoms of benign prostatic hyperplasia (BPH) are common in older men. They result from hyperplasia of glandular tissue and increased smooth muscle tone. Many men accept these symptoms as a normal part of the ageing process, and do not seek treatment. As BPH is not always a progressive condition, and the incidence of complications is low, 'watchful waiting' is appropriate for men whose symptoms are mild. Men suffering severe symptoms, or who develop complications of benign prostatic hyperplasia such as acute urinary retention or recurrent urinary tract infection, should be referred to a urologist for consideration of surgical treatment. Transurethral resection of the prostate is the most commonly used surgical procedure. It is more effective than drug therapy, but is occasionally associated with complications such as impotence and incontinence. Alphaj-adrenoceptor blocking drugs reduce smooth muscle tone in the prostatic tissue and bladder neck, decreasing resistance to urinary flow. They can produce cardiovascular side-effects, such Read more [...]

Posted in Benign Prostatic Hyperplasia

UroXatral: Drug for Treatment of BPH

Posted by admin on April 3rd, 2010 No Comments

Trade Name Drug: UroXatral Generic Name Drug: Alfuzosin HCl Company: Sanofi-Synthelabo Indication / Use: Benign prostatic hyperplasia Approval Date / FDA Class: 12 06 2003 / 1S Development and Mechanism of Action:Benign prostatic hyperplasia (BPH) is defined histologically. Clinically, it is characterized by lower urinary tract symptoms (urinary frequency, urgency, a weak and intermittent stream, needing to strain, a sense of incomplete emptying, and nocturia) and can lead to complications, including acute urinary retention. The mechanisms by which BPH causes symptoms and complications are unclear, although obstruction of the bladder outlet is an important factor. The best documented risk factors are increasing age and functioning testes. Estimates of the prevalence of symptomatic BPH indicate that approximately 50% of men ages 51 to 60 have benign prostatic hyperplasia. Community- and practice-based studies suggest that men with lower urinary tract symptoms can expect slow progression of the symptoms. However, symptoms can wax and wane without treatment. In men with symptoms of BPH, Read more [...]

Posted in Drugs: α-blockers

Pharmacotherapy for BPH (Benign Prostatic Hyperplasia)

Posted by admin on March 3rd, 2010 No Comments

Mechanisms of Obstruction and Rationale for Pharmacotherapy Current pharmacotherapy for Benign Prostatic Hyperplasia (BPH) is based on agents that relax the smooth muscles of prostatic urethra and stroma and those that deprive acinar cells of androgen. Various agents have been tried in the treatment of BPH (Table). They may be broadly grouped into those affecting the dynamic component of urethral obstruction, namely the smooth muscle and prostatic stroma, and those affecting the glandular elements by androgen deprivation. The mechanism of action of many agents claimed to be useful in Benign Prostatic Hyperplasia is not clearly understood. TABLE — Drugs That Have Been Tried in the Medical Management of Benign Prostatic Hyperplasia (Some agents act by more than one mechanism) Drug Class Drug (Code Designation) Trade Name α1-Adrenergic antagonists Prazosin HCl Minipress Terazosin HCl Hytrin Doxazosin mesylate Cardura Phentolamine mesylate YM-617 Nicergoline Sermion Indoramin Baratol Ketanserin Yohimbine HCI Antiandrogens Selective 5α-Reductase Read more [...]

Posted in Pharmacotherapy

Management of Benign Prostatic Hyperplasia (BPH): Pharmacotherapy

Posted by admin on February 14th, 2010 No Comments

Pharmacologic agents designed to relax prostatic smooth muscle (alpha-adrenergic blockers) and reduce prostatic size (androgen suppression) have been reported to be safe and effective in treating benign prostatic hyperplasia (BPH). The selective alpha-1 blockers doxazosin and terazosin, and the 5-alpha reductase inhibitor finasteride, have been approved by the FDA for the treatment of BPH. Patients with clinically significant BPH are candidates for pharmacotherapy unless they are experiencing severe symptomatology (e.g., serious urinary retention). These agents are reported to improve symptoms of benign prostatic hyperplasia (BPH) with minimal morbidity at a substantial cost savings relative to TURP. Pharmacotherapy: Alpha-Adrenergic Blockers Alpha-1 adrenergic blockers prazosin (Minipress), terazosin (Hytrin) and doxazosin (Cardura) have all been extensively studied in patients with benign prostatic hyperplasia (BPH). These agents relax smooth muscle at the bladder neck and prostatic urethra, offering symptomatic improvement in a relatively short period of time. Although prazosin has demonstrated Read more [...]

Posted in Management

Research and Treatments Ahead for Prostatitis

Posted by admin on January 8th, 2010 No Comments

Every year, men make over two million visits to the doctor because of prostatitis, a condition that causes chronic pelvic pain, urinary problems and often pain during ejaculation. While experts still don't know for sure what causes this disease, or how to cure it, great strides have been made in the past few years. "It's really unknown whether [the cause] is a small microbial agent such as a bacterium or virus, cytokines or autoimmune factors, toxins in the urine or some kind of oxidative stress. But there's evidence of all of these, particularly psychological and immunological [factors]," according to Dr. Mark Samuel Litwin of the University of California at Los Angeles. Dr. Litwin addressed an audience of urologists at the annual meeting of the American Urological Association in Atlanta last week. Litwin pointed out that "there is a tremendous psychological burden associated with this chronic condition." Prostatitis can affect men of any age, but is most common among those between 35 and 50. In the past, men with prostatitis were usually treated with antibiotics because it was assumed Read more [...]

Posted in Prostatitis

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