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BPH Dual oral therapies: Mechanism and their side effects

BPH
FB Dr Soarawee
Soarawee Weerasopone, MD

Minimally Invasive Uro-Oncologist
Royal Phnom Penh hospital, Kingdom of Cambodia

As we all know that Benign Prostatic Hyperplasia (BPH) is a degenerative changed of prostate gland which all gentlemen cannot be escaped when we’re getting older. There was a report on BPH epidemiology as following.

  • 42% of gentlemen, ages from 51 to 60.
  • > 70% of gentlemen, ages from 61 to 70.
  • Almost 90% of gentlemen ages from 81 to 90.
Senior
Benign Prostatic Hyperplasia is the degenerative disease which every single elderly gentleman cannot avoid.

BPH commonly presented with a weak urinary streams and nighttime urination (I have made the article on all presentation of BPH which you can visit by clicking this link). I have always been emphasized the patients that BPH is not fetal but majority effect on quality of life.  Nowadays, the advancement in oral medications on BPH management has gone so far. Today we will discuss about “Dual oral therapies for BPH”

Pee
Weak urinary stream is usually be complaint among BPH patients.
Dual therapy
Dual therapy means Alpha-blocker in combination with 5 Alpha reductase inhibitors

Dual therapies are consisted of 2 medications, Alpha-blockers and 5-Alpha Reductase Inhibitors (5-ARIs)

  1. Alpha-blockers
    • Example of tablets – Silodosin, Alfuzosin, Tamsulosin, Doxazosin
    • Mechanism – Alpha-blockers act by rapidly relaxing the smooth muscle in the prostate and bladder neck resulting in widening urethra which makes smoother feeling of urine flow. There was a report that Alpha-Blockers can improve urinary symptoms within hours to days. That’s why both American and European Urological Association recommended the Alpha-blockers as #1-line treatment for BPH.
    • Side effects (incidence of each side effects depend on individual tablet)
      • Dizziness from the antihypertensive-like effect
      • Abnormal ejaculation
      • NOT effect with erectile dysfunction
Dizziness
Dizziness is the most commonly complaint when using Alpha blocker.
  1. 5-ARIs
    • Examples of tablets – Dutasteride, Finasteride
    • Mechanism – 5-ARIs act by blocking the conversion of testosterone to more active form, dihydrotestosterone (DHT). DHT plays major role in prostate gland enlargement so losing of DHT will gradually make shrink of prostate tissue. This mechanism needs 6 months of 5-ARIs regular using to lead up to 30% prostate size reduction and 50% decrease of PSA blood value. 5-ARIs are claimed that they can reduce long-term BPH complications for examples, risk of urinary retention and risk of surgery.
    • Side effects
      • Reduced libido due to interfering of DHT
      • Erectile dysfunction due to interfering of DHT

You can see that these 2 medications have their pros and cons on their own. Alpha-blockers, very rapid effect but couldn’t lower long-term BPH complications. On the other hand, 5-ARIs, very gradually effect but has claimed the efficacy on reduction of long-term complications.

Any questions, you can discuss with your trusted urologist or it would be my honor if you text me. Take care!

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