Lower urinary tract symptoms/benign prostatic hyperplasia: fast control of the patient's quality of life

doi:10.1016/S0090-4295(03)00589-2

Urology

Volume 62, Issue 3, Supplement 1, September 2003, Pages 6-14

https://doi.org/10.1016/S0090-4295(03)00589-2 Get rights and content

Abstract

Fast control of bothersome symptoms and improvement in the patient's quality of life (QOL) are important treatment goals in lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia. Although voiding symptoms are most common, storage symptoms are most bothersome, interfere the most with daily life activities, and have a major effect on QOL. α₁-Adrenoceptor antagonists, such as tamsulosin, improve the most bothersome storage symptoms to roughly the same extent as transurethral resection of the prostate (TURP), whereas the effect on voiding symptoms is slightly less. This may be because tamsulosin relieves storage symptoms as quickly and to the same extent as voiding symptoms, whereas TURP improves storage symptoms to a lesser extent and/or more slowly than voiding symptoms. In addition, α₁-adrenoceptor antagonists have a more rapid onset of action and seem to be slightly more effective in improving LUTS, its bothersomeness, and QOL than 5α-reductase inhibitors, such as finasteride. It also seems that α₁-adrenoceptor antagonists have a more rapid onset of action than the plant extract Serenoa repens. Because the α_1A/α_1D-adrenoceptor antagonist tamsulosin has a low risk for symptomatic orthostatic hypotension, it can be initiated at its full therapeutic dose immediately at the start of therapy. This enables faster relief of bothersome LUTS than non–subtype-selective α₁-adrenoceptor antagonists that require dose titration to their full therapeutic dose. In the long term, adding finasteride to an α₁-adrenoceptor antagonist may be beneficial in high-risk patients, but adding S repens does not seem to provide any additional benefit (up to 1 year). In conclusion, monotherapy with an α_1A/α_1D-adrenoceptor antagonist, such as tamsulosin, provides very effective and rapid relief of bothersome LUTS and so enables a rapid improvement of the patient's QOL.

Section snippets

α₁-adrenoceptor antagonists versus transurethral resection of the prostate

TURP is among the most effective treatment options in relieving symptoms and improving flow rate. It is generally assumed that TURP provides a better increase in flow rate and symptom relief than α₁-adrenoceptor antagonists (which all have comparable efficacy when administered at their full therapeutic dose10). When indirectly comparing the short-term effects of TURP and tamsulosin, the most frequently used α₁-adrenoceptor antagonist, in patients with comparable baseline disease severity

α₁-adrenoceptor antagonists versus 5α-reductase inhibitors

Up to 2002, findings from 3 direct comparative trials between α₁-adrenoceptor antagonists and 5α-reductase inhibitors (such as finasteride) lasting for up to 1 year were available.17, 18, 19 They all came to the conclusion that α₁-adrenoceptor antagonists provide more rapid and statistically significantly more effective improvement of LUTS/BPH than finasteride in the patient with LUTS/BPH with a mean prostate volume from 36 to 41 mL. More recently, the Multicentre Investigation to Characterise

α₁ -adrenoceptor antagonist versus phytotherapy

Phytotherapy is often used for the treatment of LUTS/BPH, although its use has not been justified because of the lack of well-designed, long-term, multicenter, randomized, placebo-controlled trials demonstrating its superiority to placebo.11 Similarly, few long-term, placebo-controlled, randomized trials have compared α₁-adrenoceptor antagonists and phytotherapy. Recently, the results of a direct comparative 1-year trial of the extract of S repens 320 mg (n = 350) or tamsulosin 0.4 mg once

Subtype-selective α_1A/α_1D-adrenoceptor antagonist tamsulosin versus non–subtype-selective α₁-adrenoceptor antagonists

From the data presented above, it seems that, among the medical therapies, α₁-adrenoceptor antagonists provide the most rapid and efficacious relief of LUTS and its associated bother, which may explain why they are the most frequently used medical therapy. However, the question remains as to which α₁-adrenoceptor antagonist should be selected to effectively relieve LUTS and to improve QOL as rapidly as possible. The α₁-adrenoceptor antagonist tamsulosin has been shown to be selective for the α_1A

α₁-adrenoceptor antagonist monotherapy versus combination therapy

Because α₁-adrenoceptor antagonists reduce the dynamic component of obstruction and 5α-reductase inhibitors (such as finasteride) reduce the static component of obstruction, it seems logical to combine both in the treatment of LUTS/BPH. Several trials have investigated whether adding finasteride to an α₁-adrenoceptor antagonist will result in enhanced symptom relief or an increase in Q_max. A trial comparing 1-year terazosin versus combined terazosin and finasteride treatment in men with

Conclusions

The main reasons for patients seeking treatment are the presence of bothersome symptoms and their negative effect on their QOL and the QOL of their partners. To improve the overall QOL or general well-being of patients, it is essential to rapidly and effectively relieve bothersome LUTS. Therapy for LUTS/BPH should therefore provide a rapid improvement of the bothersome symptoms and rapidly improve or restore QOL. This article has compared several treatment options for LUTS/BPH with α₁

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aunque el tratamiento de la vejiga hiperactiva (VH) es eficaz, muchos pacientes no responden, por lo que interesa estudiar los motivos de cambio de tratamiento y la satisfacción del paciente con el nuevo tratamiento.
estudio epidemiológico, transversal, no intervencionista para determinar los motivos del cambio de tratamiento en VH y la satisfacción con dicho cambio. Se reclutaron pacientes con VH (OAB-V8 ≥ 8), de ambos sexos, mayores de 18 años, que habían modificado su tratamiento en los 3-4 meses previos. Se recogieron datos demográficos, síntomas, tratamiento previo, actual y concomitante, motivo del cambio, impresión clínica global (ICG) de gravedad y de mejoría, cuestionario Morinsky Green, satisfacción con el tratamiento, preferencia del mismo y la escala del beneficio del tratamiento (TBS).
de 3.365 pacientes reclutados, 2.038 (61%) fueron evaluables (61,1 ± 11,2 años; 77% mujeres). El médico solicitó el cambio de tratamiento en un 69% y el paciente en un 31% por motivos de falta de beneficio clínico (60%), efectos secundarios (24%), petición del paciente (8%), incumplimiento terapéutico (6%) y otros (2%). El 52% de los pacientes cumplió con el nuevo tratamiento. Según ICG, el 65,4% presentó mejoría respecto al tratamiento anterior. Un 60% de los pacientes se mostró bastante/muy satisfecho con el tratamiento actual, un 91% lo prefirió al previo y un 93% opinó que sus síntomas habían mejorado.
la falta de beneficio clínico es el principal motivo del cambio de tratamiento de la VH. La mayoría de los pacientes prefieren el nuevo tratamiento.
although efficacious, some patients do not respond optimally to overactive bladder (OAB) treatment. The objective of this study was to identify the reasons why some patients do not respond and to look for reasons for changes in treatment and patient satisfaction with the new treatment.
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out of 3,365 successive patients, 2,038 (61%) were eligible (61.1 ± 11.2 years; 77% women). The physician decided to switch in 69% of the cases and 31% of patients asked for a change in treatment. Reasons for switching were lack of clinical benefit (60%), side effects (24%), patients’ request (8%), non-compliance (6%) and other (2%). 52% of patients complied with new treatment. According to the CGI, 65.4% showed improvement with respect to their previous treatment. 60% were quite/very satisfied with current treatment, 91% preferred it to their previous treatment and 93% reported that their symptoms had improved.
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Lower urinary tract symptoms/benign prostatic hyperplasia: fast control of the patient's quality of life

Abstract

Section snippets

α1-adrenoceptor antagonists versus transurethral resection of the prostate

α1-adrenoceptor antagonists versus 5α-reductase inhibitors

α1 -adrenoceptor antagonist versus phytotherapy

Subtype-selective α1A/α1D-adrenoceptor antagonist tamsulosin versus non–subtype-selective α1-adrenoceptor antagonists

α1-adrenoceptor antagonist monotherapy versus combination therapy

Conclusions

Urology

J Urol

J Urol

J Urol

J Urol

J Urol

Urology

Eur Urol Suppl

J Urol

Eur Urol

Urology

J Urol

Eur J Pharmacol

J Urol

The standardisation of terminology of lower urinary tract functionreport from the Standardisation Sub-Committee of the International Continence Society

Neurourol Urodyn

Implications of the most bothersome prostatism symptom for clinical care and outcomes research

J Am Geriatr Soc

Relative importance of sexuality and quality of life in patients with prostatic symptomsresults of an international study

Eur Urol

The development and validation of a quality-of-life measure to assess partner morbidity in benign prostatic enlargement

BJU Int

Benign prostatic hyperplasia

Clinical Evidence

Introduction and concluding remarks

Eur Urol

A meta-analysis on the efficacy and tolerability of α1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction

Eur Urol

α₁-adrenoceptor antagonists versus transurethral resection of the prostate

α₁-adrenoceptor antagonists versus 5α-reductase inhibitors

α₁ -adrenoceptor antagonist versus phytotherapy

Subtype-selective α_1A/α_1D-adrenoceptor antagonist tamsulosin versus non–subtype-selective α₁-adrenoceptor antagonists

α₁-adrenoceptor antagonist monotherapy versus combination therapy

A meta-analysis on the efficacy and tolerability of α₁-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction