A major concern with drug therapy for BPH (as well as incontinence) is the modest therapeutic index of the drugs used to treat these disorders, many of which are used chronically for disorders that are generally not life-threatening. In the field of a-adenoceptor antagonist new chemical entities (NCEs), the ability to design functionally selective (>100-fold) ligands among the six different types of receptor (a1A, a1B, and a1D; a2A, a2B, and a2C) has been challenging. The presence of synaptic and extrasynaptic receptors in the cardiovascular system additionally limits functional differences in separately modulating the urogential and vascular systems. Alternatives to prescription drugs in the treatment of BPH are herbal remedies or 'alternative medicines' that are thought to have fewer side effects than prescription medications and are hence 'safer.' One such agent is saw palmetto, a herbal medicine with an unknown mechanism of action, that is widely used to treat BPH, especially in Europe. While small clinical studies reported saw palmetto to be efficacious in BPH, a recent double-blind trial showed no difference between saw palmetto and placebo in terms of efficacy.4
If drug therapy fails to provide adequate symptom relief surgery is an option to help correct prostate hypertrophy. Surgical options for BPH include TURP and transurethral incision of the prostate (TUIP). TURP involves removal of the inner portion of the prostate while TUIP involves making one to two incisions into the prostate to reduce pressure. While TUIP is less invasive than TURP, the latter is the procedure of choice because of its effectiveness. Less invasive procedures for the treatment of BPH include transurethral needle ablation (TUNA), transurethral microwave hyperthermia (TUMT), and high-intensity focused ultrasound (HIFU). These procedures use heat in enlarged areas of the prostate to remove excessive growth. TUNA, TUMT, and HIFU are not as effective as TURP and only used in individuals who are unable to undergo surgery.
18.104.22.168 Bladder Outlet Obstruction (BOO)
Bladder outlet obstruction (BOO) is a disorder of the pelvic floor in females that is reflected as hesitancy in voiding, poor urine stream, and stop-start voiding.5 BOO can be caused by prolapse of the large-anterior vaginal wall or by pelvic-floor dysfunction, and secondarily, may be due to surgical procedures for stress urinary incontinence (SUI). It is usually treated by catheterization.
Prostatitis is an inflammation of the prostate gland that can be divided into: acute bacterial prostatitis, an acute bacterial infection of the prostate gland; chronic bacterial prostatitis, a recurrent infection of the prostate that is associated with chronic urinary infection; and nonbacterial prostatitis, inflammation in the absence of infection. Prostatitis is treated with quinolone antibiotics, anti-inflammatory agents, and a-adenoceptor blockers.
22.214.171.124 Urinary Incontinence/Overactive Bladder
Urinary incontinence (UI) is an involuntary loss of urine due to weakened bladder control (detrussor muscle function). This may be the result of: a loss of bladder tone; a lack of neural control over bladder function (as in Alzheimer's or Parkinson's diseases); or involuntary bladder muscle spasms, the latter being known as overactive bladder (OAB). Incontinence affects men and women equally with approximately 13 million individuals in the USA suffering from incontinence. Symptoms of incontinence include: frequency - urinating eight or more times in a 24-h period; night-time frequency or nocturia - urinating two or more times a night; urgency - sudden urges to urinate; urge incontinence - an urgent need to urinate followed by leakage or wetting incidents; and stress incontinence - loss of urine due to increased pressure on the bladder, caused by coughing, sneezing, laughing, or physical activity.6
Incontinence can be treated with antimuscarinics like oxybutynin (7), tolterodine, and darifenacin (8), which block contraction of the bladder by relaxing the bladder muscles. While oxybutynin is efficacious, its side effects, especially dry mouth, result in 80-85% of individuals discontinuing treatment. The latter is to some extent overcome by once a day, controlled-release oxybutynin (DitropanXL). Tolterodine is another antimuscarinic developed for OAB has a lesser incidence of dry mouth. Darifenacin is a muscarinic M3-receptor-selective antagonist that is also selective for bladder smooth muscle and may avoid dry mouth.
Was this article helpful?