Medical Management for BPH-Present Concept

Abstract

Purpose of review: Benign prostatic hyperplasia(BPH) is one of the most common disease to affect men beyond middle age to cause lower urinary tract symptoms(LUTS). Medical therapy is now well established as the first option in the management of symptomatic BPH. Selective α1a blockers which relaxes the smooth muscle component of prostatic urethra and bladder neck and the 5αreductase enzyme inhibitors (5ARI) which inhibit or regresses the growth of adenomatous component of prostatic gland have proved quite efficacious when given as a monotherapy or in combination. Lately anticholinergic drugs like tolterodine or solifenacetin are given in combination with α blockers where irritative bladder symptoms like- urgency, frequency or urge incontinence predominates .Though these two drugs are physiologically antagonistic , each exerts its beneficial effect acting at different target sites eg.,- overactive detrusor muscle and spasmodic bladder neck sphincter area. More recently 5 phosphodieasterase inhibitors like Sildenefil citrate(Viagra) or the long acting variant Tadafil citrate(Tazzle) are prescribed in combination with α blockers to enhance the effect of smooth muscle relaxation at the bladder neck and also to take care of the erectile dysfunction(frequently experienced by many ageing men with BPH) Various phytotherapeutic products and food supplements used by traditional medical therapists failed to give a consistent favourable result. The present review gives a bird s eye view on recent advances in the medical management of BPH. Key Words: Benign prostatic hyperplasia, Medical therapy, 5α reductase inhibitors, Selective α blockers, Phosphodiesterase inhibitors