ISSN: 1300-0292
İndekslendiği Dizinler: SCIENCE CITATION INDEX EXPANDED
CINAHL, Index Copernicus,
Chemical Abstracts (CA),
Excerpta Medica / EMBASE
Dil: Türkçe, İngilizce
İçerik: Orijinal Araştırma, Derleme, Editöre Mektup, Olgu Sunumu, Tıp Eğitimi, Tıbbi Kitap İncelemeleri
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Medical Treatment Of Lower Urinary Tractsymptoms Due To Benign Prostatic Hyperplasia
İbrahim ÇEVİK*, Hakan ÖZVERİ*, Selçuk YÜCEL*, Levent TÜRKERİ*, Atıf AKDAŞ*
*Dr., Marmara Üniversitesi Tıp Fakültesi Üroloji AD, İSTANBUL
This review contains update information about the medical treatment of lower urinary tract symptoms (LUTS) due to BPH. Although, 80% of men over the age of 60 have histopathological BPH, only 40% have lower urinary tract symptoms. Currently, medical treatment is advised to patients who does not have any indication for surgery and/or can not be operated. The medical therapy alternatives in BPH are phytotherapy, alpha receptor blockers, 5-a-reductase inhibitors and antiandrogens. However, studies revealed that efficacy of phytotherapy agents were limited in the efficacy of placebo. Alpha receptor blockers decrease the urethral pressure by influencing the dynamic component of BPH. Phenoxybenzamin, nonselective alpha receptor blocker, is no longer prescribed due to adverse effects in the treatment of LUTS in BPH. Prazosin, selective alpha blocker, has minor adverse effects but also lesser afficacy than of phenoxybenzamine in irritative symptoms. Obligatory three times use in a day limits alfuzosin, short term selective alpha blocker. Besides, Indoramin has central nervous system side effects since it passes blood brain barrier. Long term selective alpha blockers, terazosin and doxazosin were found to be effective with less side effects and remarkable improvement in treatment of LUTS due to BPH. Nevertheless, both choices need dose tapering for 1-2 weeks. Long term specific a-1A receptor blocker, tamsulosin does not need dose tapering. Also the improvement rates in tamsulosin are not different than in other selective agents. Finasteride decreases the level dihydrotestosterone by inhibiting 5-a-reductase while remains the level of testosterone as the same. The finasteride therapy is found to change the natural progress of BPH and to cause the shrinkage in prostate. Besides, it improves and/or stabilizes the symptomatology and improvement continues in the fifth year. GnRH agonists, progesteron, androgen receptor blockers and aromatase inhibitors are used in antiandrogen therapy. Nevertheless, antiandrogen agents should be regarded as the last treatment option due to adverse effects and high costs. The aim of the medical treatment is to use a drug that has fewer side effects, effective and easy to use. However, there is no drug available currently that meet these criteria.Keywords: BPH, Medical treatment, Alpha-receptor blockers,
Finasteride, PhytotherapyTurkiye Klinikleri J Med Sci 2001, 21:223-228
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