Benign Prostatic Hyperplasia (BPH)

LUTS/Retentio
n
BACK
Treatment options
Watchful waiting
Medical management
Surgical approaches
Minimal invasive
TURP

Invasive open procedures

watchful waiting
n For mild symptoms. follow up 1 to 2
times yearly

n Offer suggestions that help

reduce symptoms
n Avoid caffeine and alcohol
n Alteration of timing,volume of fluid
intake
 Medical Management
2 major types:

Option 1: 1 adrenergic blockers

Relax the smooth muscle of prostate and
provide a larger urethral opening

Option 2: 5- reductase inhibitors

Shrink the prostate glandOption
Growing Market Option
Combination of 1 adrenergic
blockers and 5- reductase
inhibitors
Relax and Shrink the prostate
gland
 Option 1 : Alpha ()
Blockers(relaxants)
Prazosin, Terazosin, Tamsulosin
Relax the smooth muscle of the
prostate,
Early- acting
 Classifation of -Blockers
Nonselective
Phenoxybenzamine
Short-acting selective 1-blocker
Prazosin, Alfuzosin
Long-acting selective 1-blockers
Terazosin
Doxazosin
Long-acting selective 1A-subtype
Tamsulosin
Alfuzosin-SR
 Option 2: 5- Reductase
Inhibitors(shrinkers)(5ARI)
Finasteride
Slow-acting
Taken orally as once daily for at least 6
months
Option 3: Combination Separate or 2-in-1
Tablet
FinMax (Finarid + Pimax)

Duodart (Dutasteride + Tamsulosin)

Tamplus (Finasteride + Tamsulosin)

Combination therapy gives better outcome.

- Medical treatment of prostate symptoms study
Surgical TURP (transurethral resection of
Management: the prostate)

n Gold Standard of care for BPH

n Uses an electrical knife to surgically cut and remove excess

prostate tissue

n
Effective in relieving symptoms and restoring urine flow
FINASTERIDE
is an antiandrogen which acts by
inhibiting type II 5-alpha reductase, the
enzyme that converts testosterone to
dihydrotestosterone (DHT).

It is used as a treatment in
benign prostatic hyperplasia (BPH) in
low doses, and prostate cancer in
higher doses.
Benign Prostatic Hyperplasia
(BPH)

Testosterone Dihydrotestoste
5-Alpha reductase rone
Enzyme

Synthetic 4-azasteroid compound

Specific inhibitor of 5-alpha reductase
 FINARID (Finasteride)

Mechanism of Action (SHRINKS

the PROSTATE)

Testosterone Dihydrotestoste
rone

Synthetic 4-azasteroid compound

Specific inhibitor of 5-alpha reductase
How Tamsulosin Works
Smooth muscle tone is mediated by the sympathetic
nervous stimulation of 1 adrenoreceptors, which are
abundant in the prostate, prostatic capsule, prostatic
urethra, and bladder neck.

Blocking these adrenoceptors can cause smooth muscles in

the bladder neck and prostate to relax, resulting in an
improvement in urine flow rate and reduction in symptoms
in BPH.

Tamsulosin is a selective 1 receptor antagonist

(blocking agent) that has preferential selectivity for the 1A
receptor in the prostate versus the 1B receptor in the
blood vessels.
 Mechanism of Action

TAMSULOSIN

RELAXES

the PROSTATE
by blocking 1A receptors in the
prostate.
Peripheral zone

Transition zone

Urethra
INDICATION
Tamsulosin is primarily used for
benign prostatic hyperplasia,

But is sometimes used for the

passage of kidney stones by the
same mechanism of smooth muscle
relaxation via alpha antagonism.
(off-label indication)
Efficacy of Tamsulosin
Tamsulosin has been reported to
significantly improve BPH symptom
scores and quality-of-life measures
after 1 week
and peak urinary flow within 4 to 8 hours of
administration.
DOSAGE and ADMINISTRATION
Orally 200mcg or 400mcg or 1 tablet
to be taken 30 minutes after the
same meal each day

Or as prescribed by the physician

 Drug Combinations for the
Treatment of Benign Prostatic
Hyperplasia (BPH)
Alpha-Blocker and 5-
reductase Inhibitors
Sound drug combinations:

1. Alpha-blocker, PIMAX, for rapid symptom

improvement and

2. 5-reductase inhibitor, FINARID, for long-term

shrinkage of the prostate.

The efficiency of the combination was demonstrated in

randomized trials.

In the further course of the treatment, the alpha-

blocker could often be discontinued after 35 months