Drugs online research references
surgadmin.surgery.wisc.edu
OBJECTIVE: To review the contemporary management of symptomatic benign prostatic hyperplasia (BPH) in North America. METHODS: Information was obtained from published scientific articles, lay press articles, Medicare outcomes data, IMS market analysis data and surveys among primary care practitioners and urologists. RESULTS: A survey in Olmsted County in the US identified the number of men with an I-PSS score >7 and maximum urinary flow rate <15 ml/s. This survey found that 17% of men in the 50-59 year old age bracket, 27% of men in the 60-69 bracket and 37% of men in the 70-79 bracket meet this minimum criterion for discussions about treatment. Currently in the US, there are approximately 5.6 million men that fall in this category, and the number is expected to double by the year 2025. Primary care physicians in 25% of cases and internal medicine in 24% of cases provide initial management of BPH. Urologists provide initial management in 37% of cases. Improvement in urinary symptoms and quality of life is the most important health outcome in the management of symptomatic BPH in the US, particularly because serious complications from BPH are distinctly uncommon. A survey among urologists determined that for men with mild symptoms, watchful waiting was employed 77% of the time, alpha(1)-adrenoceptor antagonists 21% and finasteride 1%. For those with moderate symptoms and prostate volume </=40 ml, alpha(1)-adrenoceptor antagonists are employed 88% of the time, finasteride 1% and TURP 1%. When the prostate is in excess of 40 ml, alpha(1)-adrenoceptor antagonists are used 69% of the time, finasteride 10% and TURP 9%. alpha(1)-Adrenoceptor antagonists are also employed most of the time for patients with severe symptoms: 58% of the time for small and 45% of the time for large prostates. The respective data for TURP are 31% and 38%. Primary care physicians utilize predominantly watchful waiting and long-acting alpha(1)-adrenoceptor antagonists. Laser use in the management of BPH has fallen from 40% of urologists in 1994 to 26% in 1997. TUMT and TUNA are each employed by 3% of urologists. The use of transurethral vaporisation of the prostate has increased to 62% of urologists. For those patients being treated with medication, 36% are treated with terazosin, 31% with doxazosin, 15% with finasteride and 18% with tamsulosin, which was introduced only recently and is growing. CONCLUSIONS: In the future, the number of older men in the US will increase dramatically. Likely the percentage of patients undergoing surgical treatment such as TURP will decrease but the absolute number having surgery will increase. It is also likely that alpha(1)-adrenoceptor antagonists will be used with greater frequency in the future and finasteride will be used less frequently. Copyrightz1999S.KargerAG,Basel
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10559625&dopt=Abstract
Neurourol Urodyn. 1994;13(1):1-12.
Effect of terazosin on urine storage and voiding in the aging male with prostatism.
Gleason DM, Bottaccini MR.
Urodynamics Laboratory, Tucson Medical Center, Arizona 85712.
Patients in a private practice, evaluated for prostatism due to benign prostatic hypertrophy were offered the options of medical treatment with the alpha blocker terazosin, surgical treatment, or continued observation. Nineteen men accepted terazosin treatment and are the subjects of the present series. They were treated over a mean period of 8 months, the longest treatment lasting over 22 months. Dosage was started at 1 mg/d and increased as tolerated to 2, 5, and 10 mg/d over the test period. Extensive testing including invasive urodynamics, multiple voiding diaries, and symptoms scores at each dosage level was carried out. We found that flow rates increased moderately from baseline in a dose dependent fashion. At the 10 mg/d dosage some patients achieved flow rates in the low normal range. Patients on treatment documented a decrease in the number of voidings per day, a decrease in nocturia, an increase in bladder capacity and the volume of each voiding. On the other hand, patients frequently did not appreciate changes in their voiding patterns, as reflected in their responses to the symptom questionnaires. We could not demonstrate significant changes in bladder pressures on cystometry either during filling or voiding. Our data suggested that terazosin may well have a direct effect on the fundus of the aging bladder to increase capacity, and, through the well-known relationship between voided volume and flow rate, increase urinary flow rate.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7512401&dopt=Abstract
Acta Biomed Ateneo Parmense. 1994;65(1-2):23-8.
[Use of terazosin and alfuzosin in the treatment of benign prostatic hypertrophy (BPH): our experience]
[Article in Italian]
Larosa M, Ferretti S, Salsi P, Simonazzi M.
Divisione di Urologia, Ospedale Maggiore, Parma.
Dynamic and static factors cause infravesical obstruction in men with BPH. The dynamic component is determined by alpha 1-adrenoceptor-mediated contractions of the prostate smooth muscle and bladder neck. Using alpha-receptor-blockers will relieve bladder outlet obstruction, improving urinary flow rates and obstructive and irritative symptoms as well as the physician's global assessment. This study was performed to evaluate the efficacy and safety of alpha 1 blockers (terazosin and alfuzosin) in ambulatory patients (n = 20) with BPH. After 24 weeks of therapy, the peak flow rate increased 54% from a baseline average of 8.5 ml/s to 13.1 ml/s (p < 0.01). The mean flow rate increased 49%, from a baseline of 4.61 ml/s to 6.9 ml/s (p < 0.01); residual volume decreased 74% from 48.3 ml to 12.5 ml (p < 0.001). Mean systolic blood pressure decreased significantly (p < 0.05) from baseline, but this change wasn't clinically important. The clinical experience with alpha-blockers in BPH indicates that these drugs increase urinary flow rates, decrease obstructive and irritative symptoms, without serious side effects.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7528458&dopt=Abstract
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