Pharmacotherapy in LUTS/BPH in everyday clinical practise. How to choose the optimal alternative?


Authors: M. Ghazal
Published in: Urol List 2013; 11(2): 12-24

Overview

Benign hyperplasia of the prostate (BPH) is the most common non-malignant male disease that can be managed by non invasive procedures. The incidence is not evident due to the existence of different forms of this disease (histological, asymptomatic – compensated obstruction, symptomatic for example subvesical obstruction). It is generally acceptable, that nearly 40 % of men in their forties are affected by some lower urinary tract symptoms. Because there are additional diseases of both sexes that can cause identical symptoms the term lower urinary tract symptoms (LUTS) was introduced. In case of prostate obstruction accurate terminology is LUTS/BPH (Coffey). Diagnostic workup is quite undemanding, however differential diagnosis is unbelievably broad. It is true that basic examination includes digital rectal examination, appropriate diagnosis (including a specific questionnaire IPSS) and urine analysis to rule out infection. Prostate specific antigen (PSA) level is important in patients perspective for a therapy of possibly diagnosed prostate cancer. The examination of urinary flow by means of uroflowmetry (UFM) having in mind the limits of urine volume and data as such.

Key words:
benign prostatic hyperplasia, lower urinary tract symptoms, pharmacotherapy


Sources

1. Arrighi HM, Metter EJ, Guess HA et al. Natural history of benign prostatic hyperplasia and risk of prostatectomy the Baltimore Longitudinal Study of Aging. Urology 1991; 35: 4–8.

2. Chute CG, Panser LA, Girman CJ et al. The prevalence of prostatism: a population based survey of urinary symptoms. J Urol 1993; 150: 85–89.

3. Chapple CR, Roehrborn CG.. A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 2006; 49(4): 651–658.

4. Hora M. Fytopreparáty v léčbě BHP. Urol List 2004; 4: 42–45.

5. Wilt T, Ishani A, Mac Donald R et al. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev 2002; (1): CD001044.

6. Wilt T, MacDonold R, Rutks I. Tamsulosin for benign prostatic hyperplasia. Cochrane Database Syst Rev 2002; (4): CD002081.

7. Veselský Z. Pygeum africanum v kauzální terapii benigní hyperplazie prostaty. JAMA-CS, 8 (4), 2000, 326.

8. Schneider T, Rübben H. Bennesseltrockenextrakt (Bazoton®-uno) in der Langzeittherapie des benignen Prostatasyndroms (BPS). Ergebnisse einer randomisierten, doppelblinden, placebokontrollierten Multicenterstudie über 12 Monate. Urologe A 2004; 43(3): 302–306.

9. Safarinejad MR. Urtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomised, double-blind, placebo-controlled, crossover study. J Herb Pharmacother 2005; 5(4): 1–11.

10. Berges RR, Windeler J, Trampisch HJ et al. Randomised, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Beta-sitosterol study group. Lancet 1995; 345(8964): 1529–1532.

11. Klippel KF, Hiltl DM, Schipp B. A multicentric, placebo controlled, double-blind clinical trial of betasitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. Br J Urol 1997; 80(3): 427–432.

12. Bach D. Placebokontrollierte Langzeit therapie studie mit Kürbissamenextrakt bei BPH-bedingten Miktionsbeschwerden. Urologe B 2000; 40: ­437–443.

13. Wilt T, Mac Donald R, Ishani A et al. Cernilton for benign prostatic hyperplasia. Cochrane Database Syst Rev 2000; (2): CD001042.

14. Lopatkin N, Sivkov A, Walther C et al. Long-term efficacy and safety of a combination of sabal and urtica extract for lower urinary tract symptoms – a placebo controlled, double-blind, multicenter trial. World J Urol 2005; 23(2): 139–146.

15. Sökeland J, Albrecht J. Kombination aus Sabalund Urticaextrakt vs. Finasterid bei BPH (Stad. I bis IInach Alken). Urologe A 1997; 36(4): 327–333.

16. Wilt T, Ishani A, Mac Donald R et al. Beta-sitosterols for benign prostatic hyperplasia. Cochrane Database of Syst Rev 2000; (2): CD001043.

17. Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database of Syst Rev 2002; (3): CD001423.

18. Bent S, Kane C, Shinohara K et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med 2006; 354(6): 557–566.

19. Carraro JC, Raynaud JP, Koch G et al. Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostate hyperplasia: A randomised international study of 1,098 patients. Prostate 1996; 29(4): 231–240.

20. Debruyne F, Koch G, Boyle P et al. Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: A 1-year randomised international study. Eur Urol 2002; 41(5): 497–506.

21. Fjellestad-Paulsen A, Höglund P, Lundin S et al. Pharmacokinetics of 1-deamino-8-D-arginine vasopressin after various routes of administration in healthy volunteers. Clin Endocrinol 1993; 38(2): 177–182.

22. Rembratt A, Graugaard-Jensen C, Senderovitz T et al. Pharmacokinetics and pharmacodynamics of desmopressin administered orally versus intravenously at daytime versus night-time in healthy men aged ­55–70 years. Eur J Clin Pharmacol 2004; 60(6): 397–402.

23. Hvistendahl GM, Riis A, Norgaard JP et al. The pharmacokinetics of 400 μg of oral desmopressin in elderly patients with nocturia, and the correlation between the absorption of desmopressin and clinical effect. BJU Int 2005; 95(6): 804–809.

24. Asplund R, Sundberg B, Bengtsson P. Desmopressin for the treatment of nocturnal polyuria in the elderly: a dose titration study. Br J Urol 1998; 82(5): 642–646.

25. Cannon A, Carter PG, McConnell AA et al. Desmopressin in the treatment of nocturnal polyuria in the male. BJU Int 1999; 84: 20–24.

26. Mattiasson A, Abrams P, Van Kerrebroeck P et al. Efficacy of desmopressin in the treatment of nocturia: a double-blind placebo-controlled study in men. BJU Int 2002; 89(9): 855–862.

27. Lose G, Mattiasson A, Walter S et al. Clinical experiences with desmopressin for long-term treatment of nocturia. J Urol 2004; 172(3): 1021–1025.

28. Van Kerrebroeck P, Rezapour M, Cortesse A et al. Desmopressin in the treatment of nocturia: a double blind placebo-controlled study. Eur Urol 2007; 52(1): 221–229.

29. Rembratt A, Riis A, Norgaard JP. Desmopressin treatment in nocturia; an analysis of risk factors for hyponatremia. Neurourol Urodyn 2006; 25(2): ­105–109.

30. Weatherall M. The risk of hyponatremia in older adults using desmopressin for nocturia: a systema­tic review and meta-analysis.Neurourol Urodyn 2004; 23(4): 302–305.

31. Bae JH, Oh MM, Shim KS et al. The effects of longterm administration of oral desmopressin on the baseline secretion of antidiuretic hormone and serum sodium concentration for the treatment of nocturia: a circadian study. J Urol 2007; 178(1): 200–203.

32. Lepor H, Shapiro E. (1984). Characterisation of alpha1 adrenergic receptors in human benign prostatic hyperplasia. J Urol 1984, 132: 1226–1229.

33. Shapiro E, Lepor H. Alpha 2adrenergic receptors in hyperplastic human prostate: identification and characterization using /3H/ rauwolscine. J Urol 1986, 135: 1038–1043.

34. Caine M, Raz S, Ziegler M. Adrenergic a cholinergic receptors in the human prostatic capsule and bladder neck. Br J Urol 1975, 47: 193–202.

35. Caine M. The present role of alpha adrenergic blockers in the treatment of benign prostatic hyperplasia. J Urol 1986, 136: 1–4.

36. Ford APDW, Daniels DV, Chang DJ et al. Pharmacological pleiotropism of the human recombinant alfa1A-adrenoceptor: implications for ­alfa1-adrenoceptor classification, B J Pharm 1997, 121: ­1127–1135.

37. Kenny BA, Naylor AM, Wyllie MG.: Prostatic adrenoceptors in Kirby R, McConnell JD, Fitzpatrick JM, Roehrborn CG, Boyle P (1996). Textbook of Benign Prostatic Hyperplasia, ISIS, Oxford, 566 pp.

38. Marberger M, Harkaway R, de la Rosette J. Optimizing the medical management of benign prostatic hyperplasia. Eur Urol 2004; 45: 411–419.

39. Navrátil P. Uroselektivita alfuzosinu při léčbě pacientů se symptomy BPH. Čes Urol 2001; 2: 4–8.

40. MacDonald JD, Roehrborn CG, Bautista OM et al. Afluzosin for treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia: a systematic review of effi cacy and adverse effects. Urology 2005; 66 (4): 780–788.

41. Djavan B, Marberger M. A meta-analysis on the effi cacy and tolerability of alpha 1-adrenoreceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Eur Urol 1999; 36: 1–13.

42. Gormley GJ, Stoner E., Bruskewitz RC. The effect of finasteride in men with benign prostate hyperplasia. The Finasteride Study Group (see Comments). N Engl J Med 1992; 327: 1185–1191.

43. Russel DW, Wilson JD. Steroid 5 alpha reductase: two genes/two enzymes. Annu Rew Biochem. 1994; 63: 25–61.

44. Thigpen AE, Silver RI. Tissue distribution and onto­gens of steroid 5 alpha reductase isoenzyme expresion. J Clin Invest. 1993; 92: 903–910.

45. Aumuller G, Eicheler W, Rennenberg H. Immunocytochemical evidence for differential subcellular localization of 5 alpha reductase isoenzymes in human tissues. Acta Anat (Basel) 1996; 156: ­241–252.

46. Norman RW, Coakes KE, Wright AS, Rittmaster RS. Androgen metabolism in men recieving fi nasteris before prostatectomy. J Urol 1993; 150: 1736–1739.

47. Steers WD. 5 Alpha reductases activity in the prostate. Urology 2001; 58(suppl 6a): 17–24.

48. Bartsch G, Rittmaster RS, Klocker H. Dihydrotestosteron and the concept of 5 alpha reductase inhibition in human benign prostatic hyperplasia. World J Urol 2002; 19: 413– 425.

49. Thompson IM, Goodman PJ, Tangen CM et al. The influence of finasteride on the development of prostate cancer. N Engl J Med 2003; 349: 293–295.

50. Yang XJ, Lecksell K, Short K et al. Does long-term fi nasteride therapy affect the histological features of benign prostatic tissue and prostate cancer on ­needle biopsy? Urology 1999; 53: 696–700.

51. Ruggieri MR, Braverman AS, Pontari MA. Combined USB of a-adrenergic and muscarinic antagonists for the treatment of voiding dysfunction. J Urol 2005; 174: 1743–1748.

52. Abrams P, Kaplan S, De Koning Gans HJ, Miliard R. Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 2006; 175: 999–1004.

53. Van Kerrenbroeck P, Kreder K, Jonas U, Zinner N, Wein A, for the Tolterodine Study Group. Tolterodine once-daily: superior efficacy and tolerability in the treatment of overactive bladder. Urology 2001; 57: 414–421.

54. Cardozo L, Lisec M, Miliard R et al. Randomized, double-blind placebo controlled trial of the once daily antimuscarinic agent solifenacin succinate in patients with overactive bladder, J Urol 2004; 172: 1919–1924.

55. Lepor H, Williford WO, Barry MJ et al. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. N Engl J Med 1996; 335(8): 533–539.

56. Kirby R, Roehrborn CG, Boyle P et al; Prospective European Doxazosin and Combination Therapy Study Investigators. Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination The rapy (PREDICT) trial. Urology 2003; 61(1): ­119–126.

57. McConnell JD, Roehrborn CG, Bautista O et al; Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003; 349(25): 2387–2398.

58. Roehrborn CG, Siami P, Barkin J et al; CombAT Study Group. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol 2010; 57(1): 123–131.

59. Barkin J, Guimarăes M, Jacobi G et al. Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride. Eur Urol 2003; 44(4): 461–466.

60. Nickel JC, Barkin J, Koch C et al. Finasteride monotherapy maintains stable lower urinary tract symptoms in men with benign prostatic hyperplasia following cessation of alpha blockers. Can Urol Assoc J 2008; 2(1): 16–21.

61. Issa MM, Lin PJ, Eaddy MT et al. Comparative ana­lysis of alpha-blocker utilization in combination with 5-alpha reductase inhibitors for enlarged prostate in a managed care setting among Medicareaged men. Am J Manag Care 2008; 14 (5 Suppl 2): S160–S166.

62. Galeo BJ, Galee MA. Phosphodiesterase-5 inhi­bitors for lower urinary tract symptoms in men. Ann Pharmacother 2008; 42: 111–115.

63. McVary KT, Monnig W, Camps Jr JL et al. Sildenafil citrate improves erectile function and urinary symptoms in men with erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, double-blind trial. J Urol 2007; 177: 1071–1077.

64. Stief CG, Porst H, Neuser D, Beneke M, Ulbrich E. A randomized placebo controlled study to assess the efficacy of twice daily Vardenafi l in the treatment of LUTS secondary to BPH. Eur Urol 2008; 53: 1236–1244.

65. McVary KT, Roehrborn CG, Kaminetsky JC et al. Tadalafi l relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol 2007; 177: 1401–1407.

66. Roehrborn CG, McVary KT, EKon-Mboussa A, Viktim L. Tadalafil administered once a day in the treatment of men with LUTS secondary to BPH; a dose-finding study. J Urol 2008; 180: 1228–1234.

67. Wright PJ. Comparison of phosphodiesterase type 5 (PDE5) inhibitors. Int J Clin Pract 2006; 60(8): 967–975.

68. Saito H, Yamada T, Oshima H et al. A comparative study of the efficacy and safety of tamsulosinhydrochloride (Harnal capsules) alone and in combination with propiverine hydrochloride (BUP-4 tablets) in patients with prostatic hypertrophy associated with pollakisuria and/or urinary incontinence. Jpn J Urol Surg 1999; 12: 525–536.

69. Maruyama O, Kawachi Y, Hanazawa K et al. Naftopidil monotherapy vs naftopidil and an anticholinergic agent combined therapy for storage symptoms associated with benign prostatic hyperplasia: A prospective randomised controlled study. Int J Urol 2006; 13(10): 1280–1285.

70. Kaplan SA, Roehrborn CG, Rovner ES et al. Tolte rodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. JAMA 2006; 296(19): 2319–2328.

71. Roehrborn CG, Kaplan SA, Kraus SR et al. Effects of serum PSA on efficacy of tolterodine extended release with or without tamsulosin in men with LUTS, including OAB. Urology 2008; 72(5): ­1061–1067.

Labels
Paediatric urologist Urology
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account