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Lower Urinary Tract : Treatment Options for Men with Symptoms of BPH

Donald H. Andersen, M.D., Urologist
The Chester County Hospital

Published: September 1, 2008

In recent years, the medical treatment of benign prostatic hyperplasia (BPH) has advanced with the introduction of new drugs and new techniques of combining existing medications. BPH is a common condition men caused by the non-cancerous growth of the prostate, which can result in a condition known as Lower Urinary Tract Symptoms (LUTS).

The symptoms of LUTS are common and experienced by 20% of men in their 50's and 40% of men in their 70's. LUTS include slowing and hesitancy of the urinary stream; urgency and frequency of urination; awakening at night to urinate; the occasional leakage of urine; and the rare inability to void at all. These symptoms often are caused by enlargement of the prostate, but similar symptoms may result from other prostate problems or abnormalities of the bladder. A small prostate gland may also result in LUTS if the muscle fibers within the prostate are excessively tight or well developed. Abnormalities of the bladder may cause these symptoms as well in the absence of BPH.

Evaluation of a man with LUTS includes an assessment of prostate size and function, as well as bladder function to help guide the choice of drug therapy. A digital rectal exam and Prostate-Specific Antigen (PSA) blood test are used to rule out prostate cancer. A urinalysis screens for other diseases such as bladder tumors or diabetes, which can give similar symptoms. Often a doctor will measure the speed of the urine flow and use ultrasound to calculate how well the bladder empties in his assessment.

Three classes of drugs treat LUTS in men. These include muscle relaxants known as alpha blockers; prostate-shrinking drugs known as 5 alpha reductase inhibitors; and bladder-relaxing drugs known as anticholinergics.

Alpha blockers, including Flomax, Uroxatral and Terazosin, are medicines which relax the muscle fibers inside the prostate. Relaxation of the prostate allows urine to pass through the gland with greater ease. This class of drugs provides immediate and sustained relief for most men with LUTS and is usually chosen as first-line therapy. They can result in dizziness especially when initially taken. Alpha blockers work best in men who do not have very large prostates.

Avodart and Finasteride, which are 5 alpha reductase inhibitors, change the way hormones are processed within the prostate. This change causes the prostate to shrink again allowing urine to pass more easily through the prostate. This type of medication is most effective for men with very large prostates. Side effects are uncommon but may include sexual dysfunction in some men. Recent studies suggest that 5 alpha reductase inhibitors may prevent some men from developing prostate cancers.

Combining an alpha blocker and a 5 alpha reduction inhibitors is more effective for many men than taking either drug individually. Combination therapy is more costly and usually reserved for men who have failed single-drug therapy.

Anticholinergics, including Detrol, Vesicare, or Oxybutinin, relax the bladder. This action lessons the symptoms of urgency and frequency. Occasionally, relaxing the bladder can make it more difficult for a man to empty his bladder.

Most men with LUTS due to BPH or other causes can be treated easily and effectively with medical therapy. Choosing the right therapy relies on accurately assessing the cause of the symptoms.

This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.

Last Updated: 7/27/2009