Treatment for BPH obstruction
Treatment strategies depend on the severity of symptoms of the patient, and these can be divided into three groups:
- Regular monitoring ("watchful waiting") is recommended for those patients with mild symptoms that do not affect their quality of life. The specialist will advise a regular check-up to make sure that there are no additional complications due to BPH.
- Medication: There are two main pharmacological groups, the alpha-blockers and inhibitors of the enzyme 5-alpha-reductase.
- Alpha-blockers: These drugs were initially used to treat arterial hypertension because they relax the muscle surrounding the arteries. This same action occurs around the muscles that surround the neck of the bladder and the prostatic urethra, improving urine flow. Alpha-blockers do not reduce the size of the prostate or affect PSA levels. The most frequently used drugs are tamsulosin and alfuzosin, which are also the most uro-selective. These drugs are given orally once per day and maintain their effect for 24 hours. Also, less frequently, terazosin and doxazosin are used. Patients begin to notice improvement of symptoms by 2-4 weeks after treatment has begun, and maximal effect is reached after 3 months. Side effects may include nasal congestion, orthostatic or postural hypotension, fatigue, and retrograde ejaculation (semen goes to the bladder during ejaculation due to relaxation of the muscles of the bladder neck).
- 5-alpha-reductaseinhibitors are drugs that inhibit the conversion of testosterone to dihydrotestosterone, thereby suppressing the growth of the prostate and diminishing its size by 25-30%. These are the most beneficial in prostates of greater than 40 grams, and symptoms begin to improve after the sixth month of treatment. These drugs reduce the risk of urine retention and the necessity of undergoing future surgery. There are two drugs on the market (finasteride and dutasteride) that are given orally once per day. The most common side effects are reduced sexual desire (4%), erectile dysfunction (7%), diminished volume of semen (2%) and reduction in breast size (2%). Since these drugs can lower PSA levels, a correction factor should be applied to determine an accurate level.
- Combined treatment of both alpha-blockers and 5-alpha-reductase inhibitors can be used if symptoms are severe; a greater effect has been seen in improving urinary function when two drugs are used.
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