Benign prostatic hyperplasia obstructive symptoms

O The lower urinary tract symptoms and signs of benign prostatic hyperplasia are due to static, dynamic, or detrusor factors. The static factor refers to anatomic obstruction of the bladder neck caused by an enlarged prostate gland. The dynamic factor refers to excessive stimulation of a-adrenergic receptors in the smooth muscle of the prostate, urethra, and bladder neck. The detrusor factor refers to irritability of hypertrophied detrusor muscle as a result of long-standing bladder outlet obstruction. 

When monitoring efficacy of drug treatment for benign prostatic hyperplasia, subjective endpoints include relief of obstructive and irritative voiding symptoms. Objective endpoints include improvements of urinary flow rates, decreased post-void residual urinary volume, and decreased complications of disease. 

Geriatric Considerations - Summary Alpha-adrenergic blockers are modestly effective alone, and in combination with 5-alpha reductase inhibitors (e,g, finasteride) in the treatment of urinary obstructive symptoms related to benign prostatic hyperplasia. Alfuzosin is a "uroselective" alpha-blockerwhich appears to cause less orthostatic hypotension than nonselective alpha-blockers such as terazosin, prazosin, and doxazosin. 

Symptomatic benign prostatic hyperplasia (BPH) is a common medical problem in older men. As many as 40% of men aged 60 years or older have lower urinary tract symptoms consistent with bladder outlet obstruction. Treatment goals in the vast majority of men are to relieve bothersome symptoms that reduce quality of life. In the U.S., treatment for benign prostatic hyperplasia costs more than 2 billion per year and accounts for 1.7 million physician office visits annually (Ishani et al., 2000). 

Alpha blockers are also used to increase urinary flow-rate and improve obstructive symptoms in benign prostatic hyperplasia. In this setting, their effects on blood pressure are more of an adverse effect, and their additive hypotensive effect with other antihypertensives may not be beneficial. 

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