Bladder Dysfunction

Disorders involving bladder dysfunction are captured under the acronym LUTS: lower urinary tract symptoms. These disorders include benign prostatic hyperplasia or hypertrophy (hyperplasia being an increase in the number of the prostate cells and hypertrophy an increase in cell size), incontinence or overactive bladder, and bladder outlet obstruction.1'2

6.23.2.1 Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a progressive disease characterized by prostate stromal and epithelial cell 'thickening' or enlargement that may lead in time to prostate cancer, although this remains a controversial viewpoint. BPH can be asymptomatic or be associated with LUTS, the latter including urinary frequency and urgency, nocturia, decreased and/or intermittent force of stream, and incomplete bladder voiding (see 6.24 Incontinence (Benign Prostatic Hyperplasia/ Prostate Dysfunction)).

BPH is an age-related condition with the prevalence of symptomatic BPH being 2.7% in males aged 45-49 years and 24% in males over 80 years of age. BPH is thought to be initiated by hormone-related changes (primarily testosterone) associated with aging, coupled with a redifferentiation of prostate mesenchymal cells. This leads to excessive cell proliferation, inflammatory cell infiltration and inhibition of apoptosis, leading to a loss of normal prostate function. Prostate hyperplasia can result in bladder outlet obstruction (BOO), the latter an increase in urethral resistance to urine flow, acute bladder distension, and the development of LUTS.

Treatment options for BPH that lead to improvements in urinary flow include lifestyle changes, 'watchful waiting,' drug therapy, nonsurgical procedures, and major surgery. If the BPH symptoms are mild and do not affect quality of life, 'watchful waiting' is often recommended. Individuals undergo regular checkups; when the symptoms cause discomfort, affect activities of daily living, or endanger the health, drug treatment is recommended. Drugs can relieve the common urinary symptoms associated with BPH by either reducing the size of the prostate gland or slowing prostate growth.1'2 Drug classes used to treat BPH include: the nonselective a-adenoceptor blockers, e.g., terazosin (2), doxazosin (1), and tamsulosin (3), which relax both prostate smooth muscle and the urethra, leading to an increase in urinary flow; 5-a-reductase inhibitors, e.g., finasteride (5) and dutasteride (6), which block testosterone production; or a combination of the two.1,3 Alfuzosin (4) is a more uroselective a1-adrenoceptor antagonist. As a general rule, a1-adrenoceptor antagonists fail to fully relieve BPH symptoms.

NH2 1 Doxazosin

NH2 2 Terazosin

NH2 1 Doxazosin

NH2 2 Terazosin

S Tamsulosin
Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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