Reviews for Primary Care - Fall 2007 - (Page 9) Alpha Blockers for BPH Treatment blockers. This knowledge will pave the way for the development of novel pharmacologic strategies for improving LUTS, which will substantively advance the field. It is likely that maximal reduction of LUTS will ultimately be achieved by combining different classes of drugs such as alpha blockers, phosphodiesterase inhibitors, and anticholinergic agents. The challenge will be to define criteria for prescribing the most effective pharmacological regimen. Overlapping Syndromes With LUTS/BPH Recent epidemiologic and demographic evidence has demonstrated the overlap among LUTS/BPH and other symptom-complexes such as erectile impotence, ejaculatory dysfunction, and overactive bladder.57 New data presented at the annual AUA meeting in 2007 suggests an overlap between LUTS/BPH and abdominal obesity, diabetes, and the metabolic syndrome (Table 8).58,59 The biological plausibility of these associations is currently being explored. Primary care physicians treating diabetes, obesity, and other metabolic conditions should recognize that these patients may have co-existing and latent symptoms of LUTS/BPH.60 The primary care physician is in the ideal position to identify and treat these symptoms, if clinically indicated. References 1. 2. McNeal JG. The prostate gland: morphology and pathobiology. Monogr Urol. 1983;4:3-33. Berry SJ, Coffey DS, Walsh PC, et al. The development of human prostatic hyperplasia with age. J Urol. 1984;132:474-479. Girman CJ, Jacobsen SJ, Guess HA, et al. Natural history of prostatism: relationship among symptoms, prostate volume and peak urinary flow rate. J Urol. 1995;153:1510-1515. Lepor H. The pathophysiology of lower urinary tract symptoms in the aging male population. In: Lepor H, ed. Prostatic Diseases. Philadelphia, PA: WB Saunders; 2000:163-196. Jepsen JB, Bruskewitz RC. Clinical manifestations and indications for treatment. In: Lepor H, ed. Prostatic Diseases. Philadelphia, PA: WB Saunders; 2000:127-142. McConnell JD, Roehrborn CG, Bautista OM, et al for the Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The long-term effects of doxazosin, finasteride and the combination on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349:2387-2398. Kaplan SA, McConnell JD, Roehrborn CG, et al for the MTOPS Research Group. Relationship between prostate size and the effect of combination therapy with doxazosin and finasteride versus either drug alone on the clinical progression of benign prostatic hyperplasia. J Urol. 2006;75:217-221. Roehrborn CG. Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2-year placebo-controlled study. BJU International. 2006;97:734-741. Barry MJ, Fowler FJ, Jr., O’Leary MP, et al. The American Urological Association Symptom Index for benign prostatic hyperplasia. J Urol. 1992;148:1549-1557. Barry MJ, Williford WO, Chang Y, et al. Benign prostatic hyperplasia specific health status measures in clinical research: how much change in the American Urological Association Symptom Index and the benign prostatic hyperplasia impact index is perceptible to patients? J Urol. 1995;154:1770-1774. Barry MJ, Cockett ATK, Holtgrewe HL, et al. Relationship of symptoms of prostatism to commonly used physiological and anatomical measures of the severity of benign prostatic hyperplasia. J Urol. 1993;150:351-358. 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. Lepor H, Williford WO, Barry MJ, et al. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. N Engl J Med. 1996;335:533-539. Lepor H. a-Adrenergic blockers for the treatment of benign prostatic hyperplasia. In: Lepor H, ed. Prostatic Diseases. Philadelphia, PA: WB Saunders; 2000:297-307. 15. 16. 17. 3. 18. 4. 19. 5. 20. 6. 21. 7. 22. 23. 8. 24. 25. 9. 26. 10. 27. Table 8 Overlapping Syndromes With Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia • Overactive bladder syndrome • Obesity • Diabetes • Erectile dysfunction • Ejaculatory dysfunction • Metabolic syndrome 28. 11. 29. 12. 13. 30. 14. 31. Kaplan SA, Gonzalez RR. Phosphodiesterase type 5 inhibitors for the treatment of male lower urinary tract symptoms. Rev Urol. 2007;9:73-77. Kaplan SA, Roehrborn CG, Rovner ES, et al. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. JAMA. 2006;296:2319-2328. Lepor H, Williford WO, Barry MJ, et al. The impact of medical therapy on bother due to symptom, quality of life and global outcome, and factors predicting response. J Urol. 1998;160:1358-1367. Roehrborn CG, Van Kerrebroeck P, Nordling J. Safety and efficacy of alfuzosin 10 mg oncedaily in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a pooled analysis of three double-blind, placebo-controlled studies. BJU International. 2003;92:257-261. Lepor H, Rigaud G. The efficacy of transurethral resection of the prostate in men with moderate symptoms of prostatism. J Urol. 1990;143:533537. Bartsch G, Muller HR, Oberholzer M, et al. Light microscopic stereological analysis of the normal human prostate and of benign prostatic hyperplasia. J Urol. 1979;122:487-489. Shapiro E, Becich MJ, Hartanto V, Lepor H. The relative proportion of stromal and epithelial hyperplasia as related to the development of clinical BPH. J Urol. 1992;147:1293-1297. Lepor H. Nonoperative management of benign prostatic hyperplasia. J Urol. 1989;141:12831289. Caine M, Raz S, Zeigler M. Adrenergic and cholinergic receptors in the human prostate, prostatic capsule and bladder neck. Br J Urol. 1975;27:193-202. Lepor H, Shapiro E. Characterization of the alpha1 adrenergic receptor in human benign prostatic hyperplasia. J Urol. 1984;132:1226-1229. Shapiro E, Lepor H. Alpha2 adrenergic receptors in hyperplastic human prostate: identification and characterization using [3H] rauwolscine. J Urol. 1986;135:1038-1042. Lepor H, Gup DI, Baumann M, Shapiro E. Laboratory assessment of terazosin and alpha1 blockade in prostatic hyperplasia. Urol. 1988;32:21-26. Lepor H, Tang R, Meretyk S, Shapiro E. Alpha 1 adrenoceptor subtypes in the human prostate. J Urol. 1993;149:640-642. Kobayashi S, Tang R, Shapiro E, Lepor H. Characterization and localization of prostatic alpha 1 adrenoceptors using radioligand receptor binding on slide-mounted tissue section. J Urol. 1993;150:2002-2006. Walden P, Gerardi C, Lepor H. Localization and expression of the alpha1A-1, alpha1B and alpha1D-adrenoceptors in hyperplastic and nonhyperplastic human prostate. J Urol. 1999;161(2): 635-640. Forray C, Bard JA, Wetzel JM, et al. The alpha1 adrenergic receptor that mediates smooth muscle contraction in human prostate has the pharmacologic properties of the cloned human alpha 1c subtype. Mol Pharmacol. 1994;45:703-708. Caine M, Pfau A, Perlberg S. The use of alpha adrenergic blockers in benign prostatic obstruction. Br J Urol. 1976;48:255-263. VOL. 1 NO. 1 2007 REVIEWS FOR PRIMARY CARE 9
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