scholarly journals Symptomatic benign prostatic hyperplasia: the role of 5-alpha-reductase inhibitors in the prevention of acute urinary retention and surgical therapy

2012 ◽  
pp. 57-62
Author(s):  
Norma Marigliano ◽  
Domenico Galasso
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Urinary Retention ◽  
Surgical Therapy ◽  
Acute Urinary Retention ◽  
Prostatic Hyperplasia ◽  
Complete Suppression ◽  
Urinary Flow ◽  
Reductase Inhibitors ◽  
5 Alpha Reductase Inhibitors

Benign prostatic hyperplasia (BPH) is a disease that affects over 50% of males aged 50 years or older. In men aged >80 years, the incidence is 90%. BPH occurs in 9-25% of males aged 40 to 79 years. Fifty percent of patients with BPH are symptomatic. The symptoms include reduced urinary flow, nocturia, defective bladder emptying, urinary hesitancy, and dysuria. Disease progression can be associated with acute urinary retention (AUR). Prostatic obstruction includes mechanical and dynamic components, the latter mediated by alpha-muscarinic receptors. Treatment with alpha-1-blockers (alfuzosin, doxazosin, tamsulosin, and terazosin) leads to rapid amelioration of symptoms and urinary flow, usually within one or two weeks. The 5-alpha reductase inhibitors (5-ARIs) are “disease-modifying drugs.” They control the growth of the prostate by blocking the conversion of testosterone into dihydrotestosterone (DHT). Finasteride is a 5–ARI that is selective for type 2 receptors. Dutasteride is a powerful inhibitor of both 5- alpha reductase isoforms (type 1 and 2) and produces more complete suppression of DHT synthesis than finasteride. Dutasteride also has a much longer half-life than finasteride (five weeks versus five to six hours). The authors review the results of clinical trials involving finasteride and dutasteride, with and without alpha-1-blockers, highlighting the important role of dutasteride in improving acute urinary retention and eliminating the need for surgical therapy.

scholarly journals Role of alpha blockers and 7-days catheterization in enhancing the success of trial void in acute urinary retention due to benign prostatic hyperplasia: a double-blind randomized control trial

2018 ◽  
Vol 5 (10) ◽  
pp. 3256
Author(s):  
Rohit Garagadahalli Rangaiah ◽  
Vilvapathy Senguttuvan Karthikeyan
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Primary Outcome Measure ◽  
Prostatic Hyperplasia ◽  
Double Blind ◽  
Alpha Blockers ◽  
Treatment Groups ◽  
First Time

Background: Acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH) is common. This study evaluated the efficacy of three alpha-blockers with urethral catheterization for 7 days in trial without catheter (TWOC).Methods: This was a prospective, randomized, double-blind, active-control study conducted between November 2013 and May 2016. Patients aged more than 50 years, presenting with first-time painful AUR due to BPH were enrolled in this study. Eligible patients were randomized (1:1:1) to one of the three treatment groups to receive tamsulosin 0.4 mg, alfuzosin 10 mg or silodosin 8 mg for one week. The primary outcome measure was successful TWOC at 7 days.Results: A total of 118 patients were included in the study (tamsulosin, n=40; alfuzosin, n=38; and silodosin, n=40). The baseline parameters were comparable between the three groups. A total of 84 (71.2%) patients had successful TWOC at the end of 7 days (tamsulosin, n=30 (75%); alfuzosin, n=32 (84%); and silodosin, n=22 (55%)) and was significantly (p=0.015) different between three groups. Higher age, larger volume at retention and higher prostate volume were significantly (p<0.05) associated with the failure of TWOC.Conclusions: Results from this study demonstrate that there is a definite role of 7-day catheterization with alpha blockers in improving the rates of success of TWOC in men presenting with AUR due to BPH. The success of TWOC is multifactorial.

scholarly journals Efficacy and Safety of Silodosin and Dutasteride Combination Therapy in Acute Urinary Retention due to Benign Prostatic Hyperplasia: A Single-Arm Prospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kazuhisa Hagiwara ◽  
Takuya Koie ◽  
Hiromichi Iwamura ◽  
Atsushi Imai ◽  
Shingo Hatakeyama ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Combination Therapy ◽  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Prostatic Hyperplasia ◽  
First Episode ◽  
Urinary Flow ◽  
Daily Trial ◽  
Postvoid Residual Urine

This study aimed to assess the efficacy of combination therapy with dutasteride and silodosin in patients with acute urinary retention (AUR) caused by benign prostatic hyperplasia (BPH). Eighty consecutive patients with a first episode of AUR were enrolled in this study. All patients received silodosin 8 mg and dutasteride 0.5 mg daily. Trial without catheter (TWOC) was attempted every 2 weeks until 12 weeks after the initiation of medication. The primary endpoint was the rate of catheter-free status at 12 weeks. Voided volume (VV), postvoid residual urine (PVR), uroflowmetry, International Prostatic Symptoms Score (IPSS), and quality of life due to urinary symptoms (IPSS-QOL) were also measured. All patients were followed up for more than 12 weeks and were included in this analysis. The success rate of TWOC at 12 weeks was 88.8%. VV and maximum urinary flow rate were significantly higher at 2, 4, 8, and 12 weeks compared with the time of AUR (P<0.001). IPSS and IPSS-QOL were significantly lower at 2, 4, 8, and 12 weeks compared with the time of AUR (P<0.001). In conclusion, a combination of dutasteride and silodosin therapy may be effective and safe for patients with AUR due to BPH.

MODELING AN APPROACH TO THE TREATMENT OF ACUTE URINARY RETENTION IN BENIGN PROSTATIC HYPERPLASIA

2020 ◽  
Vol 22 (4) ◽  
pp. 82-87
Author(s):  
S.M. Pikalov ◽  
A.A. Zimichev ◽  
D.O. Gusev ◽  
P.V. Sumsky ◽  
A.D. Adilov ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Prostatic Hyperplasia

scholarly journals Sexual Dysfunctions Related to Drugs Used in the Management of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Narrative Review on α-Blockers and 5-Alpha Reductase Inhibitors

Uro ◽  
2021 ◽  
Vol 1 (3) ◽  
pp. 82-98
Author(s):  
Antonio La Torre ◽  
Caterina Palleria ◽  
Irene Tamanini ◽  
Andrea Scardigli ◽  
Tommaso Cai ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Benign Prostatic Hyperplasia ◽  
Sexual Dysfunction ◽  
Lower Urinary Tract ◽  
Prostatic Hyperplasia ◽  
Sexual Dysfunctions ◽  
Reductase Inhibitors ◽  
Urinary Tract Symptoms ◽  
5 Alpha Reductase Inhibitors ◽  
Lower Urinary

This is a critical review of the current literature data about sexual dysfunction as a potential side effect related to drugs commonly used for the treatment of Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. In this narrative review, we analyzed data from the literature related to the development of sexual dysfunctions during the treatment of BPH or LUTS. Both α-blockers and 5-alpha reductase inhibitors (5-ARIs) can induce erectile dysfunction, ejaculatory disorders and a reduction in sexual desire. The sexual side effect profile of these drugs is different. Among the α-blockers, silodosin appears to have the highest incidence of ejaculatory disorders. Persistent sexual side effects after the discontinuation of finasteride have been recently reported; however, further studies are needed to clarify the true incidence and the significance of this finding. However, most of the published studies are affected by a weak methodology and other important limitations, with only a few RCTs available. Therefore, it is desirable that future studies will include validated tools to assess and diagnose the sexual dysfunction induced by these medications, especially for ejaculation and sexual desire disorders.

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