Urology

Question 1

What lifestyle advice can you give men to reduce symptoms of BPH?

Answer 1

Limit fluids in the evening to reduce nocturia
Limit caffeine or alcohol which have diuretic effects
Limit diuretics if possible. Diuretics should be taken in the morning
Limit decongestants or antihistamines which can worsen obstructive symptoms
Take exercise
Keep warm - irritative symptoms are worse with cold

Question 2

How do alpha antagonists work?

Answer 2

Inhibiting these receptors causes relaxation of prostatic smooth muscle and decreases urinary outflow resistance.

Question 3

What are the side effects of blockade of alpha receptors?

Answer 3

Cardiovascular - postural hypotension and syncope, headaches, oedema
Genitourinary - failure of ejaculation (probably due to the effect on the vas deferens and seminal vesicles rather than relaxation of the bladder neck.
Nervous system - dizziness and drowsiness

Question 4

How do 5-alpha reductase inhibitors work?

Answer 4

Testosterone is converted to dihydrotestosterone by 5-alpha reductase. Dihydrotestosterone induces BPH by acting on the prostate tissue. Inhibiting this therefore reduces prostatic hyperplasia.

Question 5

How long do 5-alpha reductase inhibitors take to work?

Answer 5

In men with enlarged prostate they can reduce the volume by 20-30%. However, the patient will not notice symptomatic improvement in the first 6 months of treatment and treatment is needed long term.

Question 6

What are the adverse effects of 5-alpha reductase inhibitors?

Answer 6

Erectile dysfunction
Decreased libido
Ejaculatory disorders
Gynaecomastia
Breast tenderness
Reduced PSA levels, so adjustment may be needed when evaluating prostate cancer risk

Question 7

When would combination therapy of alpha blocker and 5-alpha reductase inhibitor be considered and what are the side effects?

Answer 7

Considered in patients whose symptoms progress with an alpha antagonist and for patients at particularly high risk of progression to obstruction (high prostate volume or high post void residual) who are also symptomatic.

The risk of progression or need for surgery was reduced, but there was an increased incidence of dyspnoea, peripheral oedema and erectile dysfunction.

Question 8

What alternative therapies have been reported to provide symptomatic relief for BPH?

Answer 8

Saw palmetto.