Symptomatic benign prostatic hyperplasia: the role of 5-alpha-reductase inhibitors in the prevention of acute urinary retention and surgical therapy

Italian Journal of Medicine

Norma Marigliano¹  Domenico Galasso² 

[1] Dipartimento di Farmacologia, Università degli Studi Magna Graecia, Catanzaro;Direttore Emerito di Medicina Interna, Azienda Ospedaliera “Pugliese-Ciaccio”, Catanzaro;

关键词: Benign prostatic hyperplasia;    5-alpha-reductase inhibitors;    Finasteride;    Dutasteride;   

DOI  :  10.4081/itjm.2012.57

来源: DOAJ

【 摘 要 】

Benign prostatic hyperplasia (BPH) is a disease that affects over 50% ofmales aged 50 years or older. In men aged >80 years, the incidenceis 90%. BPH occurs in 9-25% of males aged 40 to 79 years. Fifty percentof patients with BPH are symptomatic. The symptoms include reducedurinary flow, nocturia, defective bladder emptying, urinary hesitancy,and dysuria. Disease progression can be associated with acute urinaryretention (AUR). Prostatic obstruction includes mechanical and dynamiccomponents, the latter mediated by alpha-muscarinic receptors. Treatmentwith alpha-1-blockers (alfuzosin, doxazosin, tamsulosin, and terazosin)leads to rapid amelioration of symptoms and urinary flow, usuallywithin one or two weeks. The 5-alpha reductase inhibitors (5-ARIs) are“disease-modifying drugs.” They control the growth of the prostate byblocking the conversion of testosterone into dihydrotestosterone (DHT).Finasteride is a 5–ARI that is selective for type 2 receptors.Dutasteride is a powerful inhibitor of both 5- alpha reductase isoforms(type 1 and 2) and produces more complete suppression of DHT synthesisthan finasteride. Dutasteride also has a much longer half-life thanfinasteride (five weeks versus five to six hours). The authors reviewthe results of clinical trials involving finasteride and dutasteride,with and without alpha-1-blockers, highlighting the important role ofdutasteride in improving acute urinary retention and eliminating theneed for surgical therapy.

【 授权许可】

Unknown