Benign prostatic hyperplasia severity

Surgical intervention should be reserved for patients with severe lower urinary tract symptoms of benign prostatic hyperplasia or those with complications of disease (such as recurrent urinary tract infections, renal failure, and bladder calculi). 

FIGURE 49-1. Algorithm for selection of treatment of BPH based on symptom severity. (From Lee M. Benign prostatic hyperplasia. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 

Wessells H, Roy J, Bannow J, Grayhack J, Matsumoto AM, Tenover L, Herlihy R, Fitch W, Labasky R, Auerbach S, Parra R, Rajfer J, Culbertson J, Lee M, Bach MA, Waldstreicher J. Incidence and severity of sexual adverse experiences in finasteride and placebo-treated men with benign prostatic hyperplasia. Urology 2003 61 579-84. 

A recent survey demonstrated that one third of men choosing nonsurgical therapy for benign prostatic hyperplasia were using herbal preparations alone or in combination with prescription medications. There is emerging evidence that several plant extracts are well tolerated and provide at least short-term improvement in urologic symptoms and flow. 

Benign prostatic hyperplasia. There are about 34 million sufferers, mosf with a severely compromised quality of life. 

Terazosin hydrochloride is a drug developed by Abbott Laboratories for the treatment of hypertension and benign prostatic hyperplasia, and marketed as the dihydrate under the trade name Hytrin since 1987. The patent of interest here is U.S. Patent No. 5,504,207 (the 207 patent), tiled in October, 1994 for which the fourth claim is a particular anhydrous crystalline form of terazosin hydrochloride, designated by Abbott as Form IV , a form not marketed by Abbott. In the 207 patent. Form IV is defined by reference to the X-ray powder diffraction pattern, listing the peak positions of several of the peaks. To be within the scope of claim 4 of the 207 patent, a product must be anhydrous terazosin hydrochloride and must exhibit a powder X-ray diffraction pattern having each of the principal peaks identified in claim 4. 

A woman, who was a neighbor, had a champion show dog with severe benign prostatic hyperplasia. Her veterinarian suggested a prostatectomy for this chronic condition. This was unacceptable, as the dog s owner received substantial income from the dog s stud fee. The dog was given saw palmetto and vitamin E, which reduced the symptoms and the need for surgery. Over the next few years the dog sired many more puppies."... 

In men, SUI is most commonly the result of prior lower urinary tract surgery or injury, with resulting compromise of the sphincter mechanism within and external to the urethra. Radical prostatectomy for treatment of adenocarcinoma of the prostate is probably the most common setting in which surgical manipulation leads to UI. Overall, SUI in the male is uncommon, and in the absence of prior prostate surgery, severe trauma, or neurologic illness, is extraordinarily rare. Transurethral resection of the prostate for benign prostatic hyperplasia (see Chap. 82) may also lead to SUI in men. 

Two recently developed classes of drug show promise, and these act by inhibiting the production of testosterone from cholesterol or its metabolism by the enzyme 5-cc-reductase. Attempts to control benign prostatic hyperplasia provided the incentive for the development of 5-a-reductase inhibitors. It has been known for some time that there is a genetic condition that is manifested by a deficiency of this enzyme. Men who have this gene defect have normal external genitalia but only a very small prostate and additionally, they do not develop acne or exhibit the typical male pattern of hair loss. All of these processes are under the control of 5- -reductase, which controls the conversion of testosterone to another steroid, dihydrotestosterone, and it is an imbalance in the ratio of these two steroids that leads to acne, male-pattern baldness, prostatic hyperplasia and probably prostatic cancer. Several... 

A 70-year-old man has severe urinary hesitancy associated with benign prostatic hyperplasia. He has tried alpha blockers with little relief. His physician recommends a drug that blocks 5a-reductase in tbe prostate and writes a prescription for (A) Cyproterone... 

Inhibition of aromatase may have therapeutic implications in diseases that are estrogen-dependent, such as some types of breast and endometrial cancer in women " " and possibly in benign prostatic hyperplasia in men Several steroidal and nonsteroidal com-... 

Terazosin hydrochloride is an alpha-1-selective adrenoceptor blocking agent marketed by Abbott Labs under the name Hytrin. The molecular structure of this compound is shown in Figure 4.10. This pharmaceutical is used to treat benign prostatic hyperplasia and high blood pressure. Like many modern pharmaceuticals, the compound is found to exist in several polymorphic forms as well as solvates. Four solvent-free polymorphs have been isolated directly and one solvent-free form has been isolated indirectly by desolvation of a methanol solvate. In addition to the methanol solvate, a dihydrate has also been found.These forms all exist at room temperature and their relative stabilities have been determined experimentally. 

Sexual function There was a clear association between a-adrenoceptor antagonists and ejaculatory dysfunction (pain/discom-fort) in an observational study in Spanish men with benign prostatic hyperplasia and/or lower urinary tract symptoms [106 ]. The presence and severity of symptoms were assessed using the male sexual health questionnaire there was an 83% prevalence of ejaculatory dysfunction in patients taking a-adrenoceptor antagonists. Most cases of ejaculatory dysfunction were mild and severe dysfunction occurred in only 4% of cases. Although the adverse effects on sexual function were seen with all of the a-adrenoceptor antagonists, alfuzosin was associated with better ejaculatory function than tamsulosin, terazosin, or doxazosin. 

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