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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

Cardiovascular Effects

Posted by admin on June 21st, 2011 No Comments

By blocking the alpha-1 adrenoceptor, these drugs cause peripheral vasodilation, which reduces total peripheral vascular resistance and thereby lowers high blood pressure. Indeed, reduction in blood pressure was the primary indication for which alpha-1 adrenoceptor antagonists were developed. The effects of selective alpha-1 blockade on the blood pressure of patients with benign prostatic hyperplasia are important in terms of the risk of adverse effects related to hypotension, both in normotensive patients and in those treated with other anti-hypertensives. Given that both benign prostatic hyperplasia and hypertension become more prevalent with increasing age, and that one would expect to find that a large proportion of older men have both conditions, these are very real concerns. Clinicians are often faced with the dilemma of what to do when treating a patient with benign prostatic hyperplasia who already has hypertension controlled by an agent other than alpha-blockers. Should the existing antihypertensive agent be withdrawn or the alpha-blockers be given in addition to existing medication? Read more [...]

Posted in Benign Prostatic Hyperplasia

Long-Term Complications

Posted by admin on June 21st, 2011 No Comments

Untreated, benign prostatic hyperplasia may lead to complications such as acute or chronic urinary retention, renal failure, serious or recurrent urinary tract infections, bladder decompensation, hydronephrosis, and calculi, particularly bladder calculi. Few studies, however, have quantified the long-term risk of these complications. Several authors have reviewed the available literature on the incidence and risk of such complications in detail. Acute Urinary Retention and Associated Risk Factors Bladder outlet obstruction may progress to acute urinary retention, a painful, sudden inability to urinate. Many patients consider this to be the most serious outcome of untreated benign prostatic hyperplasia, and it often requires emergency medical attention. Some clinicians considered acute urinary retention to be an absolute indication for surgical intervention while others have proposed catheterization and a voiding trial.' The recurrence of acute urinary retention within 1 week of catheterization is high, however. The etiology of acute urinary retention is not well understood. Based on previous studies, 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

Terazosin

Posted by admin on May 10th, 2011 No Comments

Terazosin (Abbott's Hytrin, generics) is a long-acting, alpha1-adrenergic-receptor blocker with a prolonged half-life that permits once-daily dosing. Abbott markets terazosin in the United States and several European countries; Mitsubishi-Tokyo Pharmaceuticals is the licensee in Japan. In March 2000, the FDA granted Mylan approval to market its generic version of terazosin; since then, several other generics have launched. The Hytrin Community Assessment Trial (HYCAT), a 12-month, multicenter study, was conducted in the United States to investigate the clinical effectiveness of terazosin therapy. Two thousand and eighty-four patients with AUASI scores greater than 12 (moderate to severe symptoms of benign prostatic hyperplasia) were randomized to terazosin, titrated to 10 mg, or to placebo. For patients unable to tolerate high-dose terazosin,5 mg tablets were administered instead of 10 mg. Periodic assessments during the 12-month treatment period showed a significant difference in AUASI scores between the active treatment group and the placebo group at every follow-up visit. The researchers 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

Terazosin

Posted by admin on September 5th, 2010 No Comments

Indications mild to moderate hypertension (see notes above); benign prostatic hyperplasia Cautions first dose may cause collapse due to hypotension (within 30-90 minutes, therefore should be taken on retiring to bed) (may also occur with rapid dose increase); pregnancy; interactions: Appendix 1 (alpha-blockers) Driving May affect performance of skilled tasks e.g. driving Side-effects also drowsiness, dizziness, lack of energy, peripheral oedema; urinary frequency and priapism reported Dose • Hypertension, 1 mg at bedtime (compliance with bedtime dose important, see Cautions); dose doubled after 7 days if necessary; usual maintenance dose 2-10 mg once daily; more than 20 mg daily rarely improves efficacy Terazosin (Non-proprietary) Tablets, terazosin (as hydro chloride) 2 mg, net price 28-tab pack = £2.34; 5 mg, 28-tab pack = £2.78; 10 mg, 28-tab pack = £7.06. Counselling, initial dose, driving Hytrin® (Amdipharm) Tablets, terazosin (as hydrochloride) 2 mg (yellow), net price 28-tab pack = £2.29; 5 mg (tan), 28-tab pack = £4.29; 10 mg (blue), 28-tab pack = £8.57; starter 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

Selective and non-selective α-blockers for BPH: Application

Posted by admin on March 31st, 2010 No Comments

Application to clinical practice An important issue is extrapolation of the results of alfuzosin (Uroxatral) to the terazosin (Hytrin) we prescribe in Canada. Although the affinity αa/αb receptor ratio is similar for alfuzosin and terazosin, their incidence of association with signs of hypotension differ. In placebo-controlled trials, patients treated with terazosin experienced obvious signs of hypotension, whereas incidence among patients receiving tamsulosin (Flomax) and alfuzosin (Uroxatral) was similar to that among patients treated with placebo. This indirect comparison between α-blockers has, of course, important limitations but should be borne in mind when extrapolating results to terazosin (Hytrin). Two trials have directly compared tamsulosin (Flomax) with terazosin (Hytrin). One single-blind trial was conducted among Asian men with high-normal blood pressure levels and symptomatic benign prostatic hyperplasia (BPH). They received 0.2 mg of tamsulosin (half the dose white men would receive) or 5 mg of terazosin daily. Both groups experienced significant improvement in Qmax and symptom Read more [...]

Posted in Drugs: α-blockers

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