Medical and Surgical Treatment Modalities for Lower Urinary Tract Symptoms in the Male Patient Secondary to Benign Prostatic Hyperplasia: A Review

Abstract

Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) is one of the most common ailments affecting aging men. Symptoms typically associated with BPH include weak stream, hesitancy, urgency, frequency, and nocturia. More serious complications of BPH include urinary retention, gross hematuria, bladder calculi, recurrent urinary tract infection, obstructive uropathy, and renal failure. Evaluation of BPH includes a detailed history, objective assessment of urinary symptoms with validated questionnaires, and measurement of bladder function parameters, including uroflowmetry and postvoid residual. In general, treatment of LUTS associated with BPH is based on the effect of the symptoms on quality of life (QOL) and include medical therapy aimed at reducing outlet obstruction or decreasing the size of the prostate. If medical therapy fails or is contraindicated, various surgical options exist. As the elderly population continues to grow, the management of BPH will become more common and important in maintaining patient's QOL.

Keywords

benign prostatic hyperplasia - lower urinary tract symptoms - transurethral resection of the prostate - interventional radiology

• References

• 1 Lee C, Kozlowski JM, Grayhack JT. Intrinsic and extrinsic factors controlling benign prostatic growth. Prostate 1997; 31 (2) 131-138
• 2 Auffenberg GB, Helfand BT, McVary KT. Established medical therapy for benign prostatic hyperplasia. Urol Clin North Am 2009; 36 (4) 443-459 , v–vi
• 3 Reynard JM. Does anticholinergic medication have a role for men with lower urinary tract symptoms/benign prostatic hyperplasia either alone or in combination with other agents?. Curr Opin Urol 2004; 14 (1) 13-16
• 4 Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol 2005; 173 (4) 1256-1261
• 5 McVary K. BPH: epidemiology and comorbidities. Am J Manag Care 2006; 12 (5 Suppl): S122-S128
• 6 McConnell JD, Roehrborn CG, Bautista OM , et al; Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003; 349 (25) 2387-2398
• 7 Di Silverio F, Gentile V, Pastore AL, Voria G, Mariotti G, Sciarra A. Benign prostatic hyperplasia: what about a campaign for prevention?. Urol Int 2004; 72 (3) 179-188
• 8 O'Leary MP. Lower urinary tract symptoms/benign prostatic hyperplasia: maintaining symptom control and reducing complications. Urology 2003; 62 (3) (Suppl. 01) 15-23
• 9 Barry MJ, Fowler Jr FJ, O'Leary MP , et al; The Measurement Committee of the American Urological Association. The American Urological Association symptom index for benign prostatic hyperplasia. J Urol 1992; 148 (5) 1549-1557 , discussion 1564
• 10 Barry M, Fowler Jr F, O'Leary M , et al. Measurement Committee of the American Urological Association. Med Care 1995; 22: AS145
• 11 Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J ; International Scientific Committee. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol 2009; 181 (4) 1779-1787
• 12 Bent S, Kane C, Shinohara K , et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med 2006; 354 (6) 557-566
• 13 Shi R, Xie Q, Gang X , et al. Effect of saw palmetto soft gel capsule on lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized trial in Shanghai, China. J Urol 2008; 179 (2) 610-615
• 14 Caine M, Raz S, Zeigler M. Adrenergic and cholinergic receptors in the human prostate, prostatic capsule and bladder neck. Br J Urol 1975; 47 (2) 193-202
• 15 Kobayashi S, Tang R, Shapiro E, Lepor H. Characterization and localization of prostatic alpha 1 adrenoceptors using radioligand receptor binding on slide-mounted tissue section. J Urol 1993; 150 (6) 2002-2006
• 16 Roehrborn CG, Siami P, Barkin J , et al; CombAT Study Group. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol 2008; 179 (2) 616-621 , discussion 621
• 17 Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 2005; 31 (4) 664-673
• 18 Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab 2004; 89 (5) 2179-2184
• 19 Andriole G, Bruchovsky N, Chung LW , et al. Dihydrotestosterone and the prostate: the scientific rationale for 5alpha-reductase inhibitors in the treatment of benign prostatic hyperplasia. J Urol 2004; 172 (4, Pt 1): 1399-1403
• 20 McConnell JD, Wilson JD, George FW, Geller J, Pappas F, Stoner E. Finasteride, an inhibitor of 5 alpha-reductase, suppresses prostatic dihydrotestosterone in men with benign prostatic hyperplasia. J Clin Endocrinol Metab 1992; 74 (3) 505-508
• 21 Wurzel R, Ray P, Major-Walker K, Shannon J, Rittmaster R. The effect of dutasteride on intraprostatic dihydrotestosterone concentrations in men with benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 2007; 10 (2) 149-154
• 22 Bruskewitz R, Girman CJ, Fowler J , et al. Effect of finasteride on bother and other health-related quality of life aspects associated with benign prostatic hyperplasia. PLESS Study Group. Proscar Long-term Efficacy and Safety Study. Urology 1999; 54 (4) 670-678
• 23 McConnell JD, Bruskewitz R, Walsh P , et al; Finasteride Long-Term Efficacy and Safety Study Group. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. N Engl J Med 1998; 338 (9) 557-563
• 24 Roehrborn CG, Bruskewitz R, Nickel JC , et al; Proscar Long-Term Efficacy and Safety Study Group. Sustained decrease in incidence of acute urinary retention and surgery with finasteride for 6 years in men with benign prostatic hyperplasia. J Urol 2004; 171 (3) 1194-1198
• 25 Roehrborn CG, Boyle P, Bergner D , et al; PLESS Study Group. Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a four-year, randomized trial comparing finasteride versus placebo. Urology 1999; 54 (4) 662-669
• 26 Tempany CM, Partin AW, Zerhouni EA, Zinreich SJ, Walsh PC. The influence of finasteride on the volume of the peripheral and periurethral zones of the prostate in men with benign prostatic hyperplasia. Prostate 1993; 22 (1) 39-42
• 27 Foley SJ, Soloman LZ, Wedderburn AW , et al. A prospective study of the natural history of hematuria associated with benign prostatic hyperplasia and the effect of finasteride. J Urol 2000; 163 (2) 496-498
• 28 Häggström S, Tørring N, Møller K , et al. Effects of finasteride on vascular endothelial growth factor. Scand J Urol Nephrol 2002; 36 (3) 182-187
• 29 Pareek G, Shevchuk M, Armenakas NA , et al. The effect of finasteride on the expression of vascular endothelial growth factor and microvessel density: a possible mechanism for decreased prostatic bleeding in treated patients. J Urol 2003; 169 (1) 20-23
• 30 Canda AE, Mungan MU, Yilmaz O, Yorukoglu K, Tuzel E, Kirkali Z. Effects of finasteride on the vascular surface density, number of microvessels and vascular endothelial growth factor expression of the rat prostate. Int Urol Nephrol 2006; 38 (2) 275-280
• 31 Dong Y, Hao L, Shi Z, Wang G, Zhang Z, Han C. Efficacy and safety of tadalafil monotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a meta-analysis. Urol Int 2013; 91 (1) 10-18
• 32 Gacci M, Corona G, Salvi M , et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with α-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 2012; 61 (5) 994-1003
• 33 Oelke M, Giuliano F, Mirone V, Xu L, Cox D, Viktrup L. Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Eur Urol 2012; 61 (5) 917-925
• 34 American Urological Association Guideline. Management of Benign Prostatic Hyperplasia. AUA Education and Research, Inc. Published 2010. Reviewed and validity confirmed 2014. Available at: https://www.auanet.org/education/guidelines/benign-prostatic-hyperplasia.cfm . Accessed March 22, 2016
• 35 Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 2006; 296 (19) 2319-2328
• 36 Abrams P, Kaplan S, De Koning Gans HJ, Millard R. Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 2006; 175 (3, Pt 1): 999-1004 , discussion 1004
• 37 Athanasopoulos A, Gyftopoulos K, Giannitsas K, Fisfis J, Perimenis P, Barbalias G. Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol 2003; 169 (6) 2253-2256
• 38 Höfner K, Burkart M, Jacob G, Jonas U. Safety and efficacy of tolterodine extended release in men with overactive bladder symptoms and presumed non-obstructive benign prostatic hyperplasia. World J Urol 2007; 25 (6) 627-633
• 39 Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG ; The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. N Engl J Med 1995; 332 (2) 75-79
• 40 Orandi A. Transurethral incision of prostate (TUIP): 646 cases in 15 years—a chronological appraisal. Br J Urol 1985; 57 (6) 703-707
• 41 Saporta L, Aridogan IA, Erlich N, Yachia D. Objective and subjective comparison of transurethral resection, transurethral incision and balloon dilatation of the prostate. A prospective study. Eur Urol 1996; 29 (4) 439-445
• 42 Sparwasser C, Riehmann M, Knes J, Madsen PO. [Long-term results of transurethral prostate incision (TUIP) and transurethral prostate resection (TURP). A prospective randomized study]. Urologe A 1995; 34 (2) 153-157
• 43 Riehmann M, Knes JM, Heisey D, Madsen PO, Bruskewitz RC. Transurethral resection versus incision of the prostate: a randomized, prospective study. Urology 1995; 45 (5) 768-775
• 44 Carter A, Sells H, O'Boyle PJ. High-power KTP laser for the treatment of symptomatic benign prostatic enlargement. BJU Int 1999; 83 (7) 857-858
• 45 Malek RS, Kuntzman RS, Barrett DM. High power potassium-titanyl-phosphate laser vaporization prostatectomy. J Urol 2000; 163 (6) 1730-1733
• 46 Malek RS, Kuntzman RS, Barrett DM. Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol 2005; 174 (4 Pt 1): 1344-1348
• 47 Ruszat R, Wyler S, Forster T , et al. Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation. Eur Urol 2007; 51 (4) 1031-1038 , discussion 1038–1041
• 48 Hochreiter WW, Thalmann GN, Burkhard FC, Studer UE. Holmium laser enucleation of the prostate combined with electrocautery resection: the mushroom technique. J Urol 2002; 168 (4, Pt 1): 1470-1474
• 49 Hurle R, Vavassori I, Piccinelli A, Manzetti A, Valenti S, Vismara A. Holmium laser enucleation of the prostate combined with mechanical morcellation in 155 patients with benign prostatic hyperplasia. Urology 2002; 60 (3) 449-453
• 50 Kuntz RM, Lehrich K. Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm.: a randomized prospective trial of 120 patients. J Urol 2002; 168 (4, Pt 1): 1465-1469
• 51 Das A, Kennett K, Fraundorfer M, Gilling P. Holmium laser resection of the prostate (HoLRP): 2-year follow-up data. Tech Urol 2001; 7 (4) 252-255
• 52 Gilling PJ, Kennett KM, Fraundorfer MR. Holmium laser resection v transurethral resection of the prostate: results of a randomized trial with 2 years of follow-up. J Endourol 2000; 14 (9) 757-760