Medical Management of Benign Prostatic Hyperplasia - Beyond the Abstract
We detailed the effectiveness of alpha-blockers in quickly alleviating BPH symptoms by relaxing smooth muscles in the bladder neck and prostate, whereas 5-alpha reductase inhibitors are highlighted for their ability to reduce prostate size and improve symptoms over a longer period.
Additionally, we discussed the dual benefits of phosphodiesterase-5 inhibitors, such as tadalafil, which not only improve urinary symptoms but can also help maintain erectile function. This makes them particularly valuable for patients experiencing both conditions. Beta-3 agonists, including mirabegron and vibegron, are noted for their favorable side effect profile - ideal for patients at risk of cognitive side effects from traditional urological anticholinergic medications.
The review also covers the established role of combination therapies in BPH management, showing that drugs like alpha-blockers combined with 5-alpha reductase inhibitors can be more effective than monotherapy - especially for patients with larger prostates or severe symptoms. This approach significantly reduces the progression of symptoms and the need for surgical intervention.
We advocate for a personalized approach to BPH treatment, integrating patient preferences and specific symptoms into the decision-making process. Our comprehensive review aims to enhance the understanding and application of both current and emerging therapies in managing BPH for the urologist and the primary care provider, ultimately aiming to improve patient outcomes in clinical practice.
Written by: Eiftu S. Haile, MD, Researcher, Department of Urology, Cleveland Clinic, Cleveland, OH
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