Pharmacological treatment of BPS

Abstract

Pharmacological treatment of BPS is often considered the first therapeutic approach for patients who experience progression in lower urinary tract symptoms (LUTS).α1-adrenoceptor antagonists are often chosen as the first line pharmacological treatment, due to their rapid onset of action, as well as their significant impact on LUTS and Qmax and post-void residual. Adverse effects appear to be low.With larger prostate volume and LUTS, long term treatment with 5α-reductase inhibitors (5ARIs) significantly improves LUTS and post-void residual. In addition, 5ARIs have a significant impact on the reduction in disease progression.Patients with LUTS who mainly suffer from bladder storage symptoms appear to respond to treatment with muscarinic receptor antagonists and beta-3 agonists. Both of these drug classes significantly improve LUTS, but beta-3 agonists seem to be superior with respect to adverse effects.Treatment with phosphodiesterase-5 inhibitors, which are well established in the treatment of erectile dysfunction (ED) gives significant improvement in LUTS and post-void residual and can therefore be recommended for patients with LUTS and ED.Phytotherapies have low rates of adverse effects, which has made them increasingly popular, but effects on LUTS, Qmax and post-void residual remain to be proven.New substances and therapeutic approaches are continuously expanding the options for pharmacological treatment of BPS. As regards adverse effects, therapeutic schemes can increasingly be customised to a patient profile.