Pharmacotherapy of ____Benign Prostatic Hyperplasia
Pharmacotherapy of ____Benign Prostatic Hyperplasia_______________
Barry VanDenHeuvel, PharmD Candidate 2007
|Epidemiology |The prevalence of histopathologic BPH is age dependant. |
| |BPH is very rare in men younger than 50 |
| |By 60 years of age, its prevalence is greater than 50%, by the age of 85; its prevalence is as high as 90%. |
| |About one half of men who have a histological diagnosis have moderate to severe lower urinary tract symptoms (LUTS) |
| |BPH accounts for more than 400,000 hospital stays each year. |
| |In 2000, approximately 4.5 million visits to physicians’ offices were made for a primary diagnosis of BPH, and nearly 8 million doctor |
| |visits were made with either a primary or secondary diagnosis of BPH. |
| |BPH is an expensive disease, with treatments costing more than $4 billion USD per year. As the male population ages, the cost of BPH is |
| |expected to increase even further. |
| |BPH costs $1.1 billion annually in direct expenditures for medical services provided at hospital inpatient and outpatient settings, |
| |emergency departments, and physicians’ offices. |
|Disease State |Benign prostatic hyperplasia is defined histologically as a disease process characterized by stromal and epithelial cell hyperplasia |
|Definition |beginning in the periurethral zone of the prostate |
| |The chief complaint of the patient with BPH is usually bothersome LUTS typified by urinary frequency, urgency, nocturia, decreased and |
| |intermittent force of stream and the sensation of incomplete bladder emptying. |
| |The relationship between BPH and LUTS is complex, however, because not all men with histological evidence of BPH will develop LUTS. In |
| |addition, LUTS are neither specific to nor exclusive of BPH; other conditions in the lower urinary tract and elsewhere may be causative. |
| |Moreover, not all patients with BPH and LUTS will have prostate enlargement, and prostate enlargement may exist in the absence of LUTS. |
|Patho-physiology |While the precise pathophysiologic mechanisms that cause BPH remain unclear, the role of intraprostatic DHT and type II 5a-reductase in the|
| |development of BPH is evidenced by several observations: |
| |BPH does not develop in men who are castrated before puberty. |
| |Castration causes an enlarged prostate to shrink. |
| |Patients with type II 5a-reductase enzyme deficiency do not develop BPH. |
| |Administration of testosterone to orchiectomized dogs of advanced age produces BPH. |
| | |
| |The pathogenesis of BPH is often described as resulting from both static and dynamic factors. |
| |Static factors relate to anatomic enlargement of the prostate gland, which produces a physical block at the bladder neck and thereby |
| |obstructs urinary outflow. |
| |Dynamic factors relate to excessive a-adrenergic tone of the stromal component of the prostate gland, bladder neck, and posterior urethra, |
| |which results in contraction of the prostate gland around the urethra and narrowing of the urethral lumen. |
| | |
| |Symptoms of BPH disease may result from static and/or dynamic factors, and this must be recognized when drug therapy is considered. |
|Clinical Presentation |General |
| |Patient is in no acute distress unless he has severe complications of BPH |
| |Symptoms |
| |Urinary frequency, urgency, intermittency, nocturia, decreased force of stream, hesitancy, and straining. |
| |Signs |
| |Digital rectal examination reveals an enlarged prostate (>20g). |
| |Laboratory Tests |
| |Increased BUN and serum creatinine, elevated PSA. |
| |Other Diagnostic Tests |
| |Increased AUA Symptoms Score and decreased urinary flow rate ( ................
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