Current drug management of BPH in primary care Claire Taylor MRCS, Charlotte Foley MRCS and Roger Kirby MA, MD, FRCS Urol
|
|
- Hilda Clark
- 5 years ago
- Views:
Transcription
1 Drug review BPH Current drug management of BPH in primary care Claire Taylor MRCS, Charlotte Foley MRCS and Roger Kirby MA, MD, FRCS Urol Skyline Imaging Ltd The range of drug treatments for BPH, alone and in combination, allow many patients to be managed in primary care and delay the need for referral. Our Drug review considers their efficacy and side-effects, followed by sources of further information, an analysis of prescription data and the Datafile. Benign prostatic hyperplasia (BPH) is one of the most prevalent diseases to afflict older men. Data from a number of autopsy studies have shown histological evidence of BPH in 50 per cent of 51 to 60 year olds, increasing to 90 per cent of 85 year olds. 1 This trend is mirrored by lower urinary tract symptoms (LUTS), suggestive of BPH. Analysis of the UK General Practice Research Database (UK GPRD) reveals LUTS in 3.5 per cent of men in their late 40s and in 35 per cent in their late 80s. 2 Development of safe and effective medical therapies and evidence-based prescribing has meant the role of GPs in BPH treatment has become increasingly important. As a result the British Association of Urological Surgeons (BAUS) has revised guidelines originally devised in 1997 to make them more applicable to the primary care setting (see Figure 1). 3 Presentation and evaluation of the patient Currently, patients will generally consult their GP only when their LUTS are sufficiently bothersome to reduce Prescriber 19 July
2 LUTS patient GP: history including symptoms assessment (IPSS) examination and DRE urinalysis/msu PSA PSA elevated for age DRE abrmal/of concern haematuria elevated urea/ creatinine palpable bladder recurrent UTI abrmal cytology severe symptoms urinary tract infection treat unresponsive or recurrent UTI cturia? bothersome LUTS? urological referral cturnal polyuria? prostatic obstruction? cturnal polyuria overactive bladder risk factors for progression? large prostate (>30cc) or high PSA (>1.4ng/ml) risk factors for progression? large prostate (>30cc) or high PSA (>1.4ng/ml) lifestyle advice alpha-blocker lifestyle advice 5-alpha reductase inhibitor, alphablocker or combination lifestyle advice 5-alpha reductase inhibitor lifestyle advice LUTS = lower urinary tract symptoms IPSS = International Prostate Symptom Score review at 6-12 weeks review at 3-6 months Figure 1. British Association of Urological Surgeons (BAUS) guidelines for the treatment of BPH in primary care 3 32 Prescriber 19 July
3 their quality of life (QOL); many men tolerate a high degree of symptoms and impact on daily activities before seeking help. 4 Symptoms of BPH reflect the secondary effects of the disease on the urethra and bladder and are classed into storage or obstructive symptoms (see Table 1). Initial consultation should include assessment of these symptoms; the International Prostate Symptom Score (IPSS) form is a useful tool to quantify symptoms and QOL. Digital rectal examination (DRE) gives an estimation of the prostate gland size and can reveal malignant features such as a palpable dule. Prostate-specific antigen (PSA) measurement, following an explanation of the pros and cons, gives an indication of the size of the gland. Gland size and PSA are among the risk factors for progression to an adverse event such as retention, recurrent infection or stone formation, or the need for surgery for symptom relief (see Table 2). Although obstructive symptoms are often associated with a reduced urinary flow rate, correlation was found between objective flow studies and subjective, patient-reported obstructive symptoms in one study. 5 However, there was a correlation between QOL measures and patient-reported storage symptoms, particularly urgency, frequency and cturia. 5 BPH can present in other ways including sexual dysfunction or recurrent urinary tract infections secondary to a significant postvoid volume. A recent survey, which enrolled men aged between 50 and 80 years from seven countries, reported a high prevalence of LUTS associated with sexual problems. Of the men who completed a questionnaire, 90 per cent had LUTS, 49 per cent reported erection difficulties, 46 per cent experienced ejaculatory disturbance and 7 per cent felt pain during intercourse. Despite this, 82 per cent of the respondents were sexually active. LUTS was severe in 6 per cent of men, moderate in 25 per cent and mild in 59 per cent, and this was proportional to the severity of their sexual problems; however, only 11 per cent of these men were medically treated for their prostate problems. 6 When to treat and when to refer Patients visiting their GP with BPH symptoms are frequently seeking to improve their QOL through a reduction in symptoms, rather than improving flow rates. They are also keen to avoid hospitalisation and surgery. With this in mind, clinicians have shifted away from immediate surgical approaches, despite their superior efficacy in reducing IPSS scores and improving flow rates, to the use of pharmacotherapy as the first-line treatment in BPH. Storage symptoms filling frequency urgency cturia Obstructive symptoms voiding difficulty initiating urination (hesitancy) poor flow terminal dribbling sensation of incomplete emptying Table 1. Storage and obstructive symptoms of BPH Table 3 highlights the circumstances when patients should be referred to a urologist for surgical treatment of their BPH transurethral resection of the prostate (TURP) still being the gold standard or for investigation and treatment of a urological malignancy. Choosing the correct medication Drugs available for the treatment of BPH fall into two main categories: selective alpha-blockers such as terazosin, doxazosin, tamsulosin and alfuzosin (Xatral), and the 5-alpha reductase inhibitors finasteride (Proscar) and dutasteride (Avodart). The choice of the most suitable medication for each patient is further increased by combination therapies. As with any condition, therapeutic goals include long-lasting symptom relief as well as prevention of complications from BPH using a medication the patient can tolerate. There is certainly a place for active surveillance for men with a smaller-volume prostate and few bothersome symptoms. Surveillance should include annual review, lifestyle advice and possibly a PSA test. If the symptoms become bothersome for the patient or the PSA increases by 25 per cent over one year, the possibility of treatment should be reassessed and referral considered. Alpha-blockers The first alpha-blocker to be studied in the treatment of BPH was phexybenzamine, a nselective alpha 1 /alpha 2 adrenergic antagonist. Despite evidence that it improved the symptoms of BPH, the cardiovascular side-effects, mediated predominantly by alpha 2 adrenergic antagonism, led to the development of a number of alpha 1 -selective agents. Although prostate tissue contains both alpha 1 and alpha 2 receptors, prostatic smooth muscle contraction is largely a function of alpha 1. Further work has sub-classified the alpha 1 -receptor into three subtypes: alpha 1A, alpha 1B and alpha 1D. Prostates with BPH have a predominance of alpha 1A and, to a lesser extent, alpha 1D - Prescriber 19 July
4 receptors. The alpha 1 -selective agents have a similar efficacy in relieving the symptoms of BPH. Their side-effect profiles, related to systemic alpha blockade, include dizziness, asthenia, somlence and rarely syncope. 7 The clinical utility of these agents may be limited by the need for multiple titration steps; however, the development of modified-release formulations of some of the drugs minimises the need for titration and may improve tolerability. For example, the controlledrelease gastrointestinal therapeutic system (GITS) formulation of doxazosin (Cardura XL) enhances the drug delivery rate and minimises the need for titration. 8 Doxazosin GITS significantly improves LUTS with adverse effect on sexual function and appears to be better tolerated than the standard formulation. 8 Tamsulosin is an alpha 1A and alpha 1D selective antagonist whose efficacy and tolerability have been established in a number of short-term randomised, placebo-controlled trials in both Europe and the USA. In all trials, tamsulosin was well tolerated and associated with significant improvements in symptoms and urinary peak flow rate compared to placebo. 9 Reported frequencies of ejaculation abrmalities, including ejaculatory failure/diminution and retrograde ejaculation, were similar to those in the placebo group. However, two US trials had incidences of ejaculation abrmalities in 8 per cent of men receiving 400µg per day (n=502) and 18 per cent receiving 400µg per day (n=492), indicating that this side-effect is dose dependent. 10 Ejaculation disorders in men treated with tamsulosin are thought to be secondary to impairment of the bladder neck and/or seminal-vesicle contraction. Despite alpha 1A and alpha 1D selectivity, cardiovascular effects are still sometimes seen with tamsulosin. Incidence of orthostatic hypotension and dizziness of 14 per cent on 400µg per day and 17 per cent on 400µg per day, compared to 10 per cent for placebo, have been reported. In addition rhinitis, probably secondary to local vasodilatory effects, was ted. Alfuzosin The efficacy of immediate-release alfuzosin has been established in several trials of up to six months duration in Europe, showing significant improvement in symptom scores and peak urinary flow rates over placebo. There was significant increase in side-effects in those taking alfuzosin vs placebo. A recent large-scale study within the primary-care setting has confirmed the efficacy of immediate-release alfuzosin in maintaining improved LUTS for up to three years. 11 In addition to the original immediate-release formulation of the drug, a modified-release formulation administered as 10mg once daily (Xatral XL) has been developed with similar efficacy to the immediaterelease formulation. large gland poor flow large postvoid residual volume increasing age high PSA Table 2. Risk factors for disease progression history of haematuria or haematuria on testing recurrent UTI positive urinary cytology acute or chronic retention suspicious DRE or PSA above age-adjusted range Table 3. Indications for referral to a urologist Orthostatic events and blood-pressure changes with alfuzosin were only slightly greater than those seen with placebo, even in elderly patients and those on other antihypertensive treatments, while dizziness was reported in only 5.7 per cent of patients receiving 10mg daily of alfuzosin compared to 2.8 per cent of the placebo patients. The incidence of abrmal ejaculation in alfuzosin recipients was comparable to that observed in placebo patients. 9,12 5-alpha reductase inhibitors The observation that men castrated before puberty or those with metabolic disorders affecting androgen pathways such as 5-alpha reductase deficiency do t develop BPH has led to the conclusion that there is an androgen-dependent mechanism within this multifactorial process. Dihydrotestosterone (DHT) is the primary prostatic androgen and is derived from testosterone by the action of 5-alpha reductase. Two isoenzymes have been identified: type 1 is found in most 5-alpha reductase producing tissues, including liver, skin and hair, and type 2 is predominant in genital tissues, including the prostate. DHT is more potent than testosterone, with a higher affinity for the receptor, explaining the paradox of high prostatic DHT levels despite falling serum testosterone levels in ageing men. Finasteride The link between prostatic DHT levels and prostate enlargement led to the development of 5- alpha reductase inhibitors. Early human studies using finasteride, which selectively targets the prostate-predominant type-2 enzyme, were found to reduce plasma DHT levels without a significant effect on plasma testosterone levels. Studies have shown that at 12 weeks finasteride confers an 18 per cent decrease in prostate volume, 13 and in a four-year placebo-controlled study a 32 per cent decrease was observed over placebo. 14 Meta-analysis has shown that the efficacy of finasteride is related to prostate size, with particular bene- 34 Prescriber 19 July
5 5-alpha reductase inhibitors reduced libido decreased ejaculatory volume impotence (reports between 3 and 19 per cent) Alpha 1 -blockers headache postural hypotension asthenia dizziness finasteride gradual shrinkage of the prostate alpha 1 -blockers relaxation of smooth muscle in prostate and bladder neck reduced bladder outflow obstruction Table 4. Common side-effects of drug treatments fit, in terms of symptom control, seen in those patients with prostate volumes of 40mg or above. Clinically, this means men presenting with LUTS with a prostate larger than a golf ball on DRE are likely to benefit from significant reduction in symptoms and improved flow. Furthermore, it was ted that finasteride can reduce PSA by around 50 per cent; this is thought to be a consequence of a reduction in prostate volume. There is also apoptosis in the glandular cells that produce PSA, 15 but by the simple strategy of doubling the PSA measurement, the utility for prostate cancer screening is maintained. 16 Both two- and four-year studies of finasteride have shown a significantly higher rate of reduced libido (4.8 per cent), ejaculation problems (3.5 per cent) and sexual dysfunction (5.0 per cent) compared to placebo during the first year; 17 however, for the remainder of the study period there was almost difference in the number of new cases in either group. The long-term four- to five-year studies have demonstrated a significant reduction in progression to surgery of 55 to 64 per cent and incidence of acute urinary retention of 57 to 67 per cent. 14,18 Dutasteride was developed on the basis that suppression of both isoforms of 5-alpha reductase will result in better and more consistent suppression of serum DHT. In a phase-ii study in men with BPH, dutasteride 0.5, 2.5 or 5mg per day for 24 weeks was associated with a significantly greater percentage reduction in serum DHT than finasteride 5mg per day or placebo, but the clinical impact of this is still uncertain as inhibition of intraprostatic DHT levels is similar for both drugs. 15 Probably both dutasteride and finasteride have similar efficacy and side-effect profiles. Dutasteride, like finasteride, reduces acute urinary retention and the need for surgery and has primarily sexual side-effects. 19 Similarly, dutasteride can lower PSA concentrations, and this fact should be taken into account when patients are monitored for prostate cancer, again by doubling the PSA value in treated patients. reduced lower urinary tract symptoms Figure 2. Mode of action of finasteride and alpha 1 -blockers Combination therapy The Medical Therapy of Prostatic Symptoms (MTOPS) study was conducted to determine whether combined treatment with an alpha-blocker (doxazosin) and a selective 5-alpha reductase inhibitor (finasteride) would be more effective than either drug alone. 18 Men with BPH (n=3047) were randomised to treatment with doxazosin, finasteride, combination therapy or placebo and followed for an average of four years and six months. The results of this study revealed a greater delay in clinical progression of BPH with a combination of doxazosin and finasteride than with either drug alone (risk reduction relative to placebo: doxazosin 39 per cent, finasteride 34 per cent, combination therapy 67 per cent). Progression was defined as the occurrence of one of the following end-points: greater than 4-point increase in AUA (American Urological Association) symptom score, acute urinary retention, incontinence, renal insufficiency or recurrent urinary tract infection. In contrast to finasteride motherapy, doxazosin conferred benefit over placebo in terms of reducing the risk of acute urinary retention or surgery. The greatest benefit seen in combination therapy was in preventing the progression of symptoms. The use of two drugs rather than one, of course, increases the cost of treatment and also slightly increases the risk of side-effects. Conclusion The increasing availability of medical treatments for BPH has meant that this common condition is w frequently and safely managed in the primary-care setting in the long term. The most cost-effective selection of the most suitable medication for each patient is influenced by their symptom profile and prostate size Prescriber 19 July
6 The BAUS guidelines, 3 grounded in evidencebased medicine, indicate which treatment is most likely to improve patients QOL and prevent progression to surgery. Furthermore, the guidelines will help busy GPs to decide which patients to refer for specialist management and at what stage of their disease process. Resources Groups and organisations Men s Health Forum is a registered charity tackling men s health issues, including prostate disorders. The Men s Health Forum, Tavistock House, Tavistock Square, London, WC1H 9HR. Tel: ; fax: ; website: Men s Health Matters, Blythe Hall, 100 Blythe Road, London W14 0HB. The Adviceline ( ) is open from 7pm to 9pm on Mondays and is staffed by specialist nurses. Factsheets on health issues affecting men are also available. References 1. Guess HA, Arrighi HM, Metter EJ, et al. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate 1990;17: Logie JW, Clifford GM, Farmer RDT, et al. Lower urinary tract symptoms suggestive of benign prostatic obstruction - Triumph: the role of general practice databases. Eur Urol 2001;39: Speakman M, Kirby R, Joyce A, et al. BAUS guidelines. BJU International 2004;93: Medina JJ, Parra RO, Moore RG. Benign prostatic hyperplasia (the aging prostate). Med Clin North Am 1999;83: The Department of Veterans Affairs Cooperative Study of transurethral resection for benign prostatic hyperplasia. A comparison of quality of life with patient reported symptoms and objective findings in men with benign prostatic hyperplasia. J Urol 1993;150: Rosen R, Altwein J, Boyle P, et al. LUTS and male sexual dysfunction: the Multinational Survey of the Aging Male (MSAM-7). Eur Urol 2003;44: Roehrborn CG. Are all alpha-blockers created equal? An update. Urology 2002;59 (2 Suppl 1): Andersen M, Dahlstrand C, Høye K. Double-blind trial of the efficacy and tolerability of doxazosin in the gastrointestinal therapeutic system, doxazosin standard, and placebo in patients with benign prostatic hyperplasia. Eur Urol 2000;38: Michel MC, Flannery MT, Narayan P. Worldwide experience with alfuzosin and tamsulosin. Urology 2001;58: Physician s desk reference. Montvale, NJ: Medical Ecomics Co, 2002; Lukacs B, Grange JC, Comet D, et al. Prospective follow-up of 3228 patients suffering from clinical benign prostatic hyperplasia (BPH) treated for 3 years with alfuzosin in general practice. BPH Group in General Practice. Prog Urol 1999;9: Van Kerrebroeck PE. The efficacy and safety of a new once-a-day formulation of an alpha-blocker. Eur Urol 2001;39(suppl 6): Stoner E. The clinical development of a 5 alpha-reductase inhibitor, finasteride. J Steroid Biochem Mol Bio 1990; 37: McConnell JD, Bruskewitz R, Walsh P, et al. The effect on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 1998;338: Bartsch G, Rittmaster RS, Klocker H. Dihydrotestosterone and the concept of 5 alpha-reductase inhibition in human benign prostatic hyperplasia. Eur Urol 2000; 37: Andriole GL, Guess HA, Epstein JL, et al. Treatment with finasteride preserves usefulness of prostatic-specific antigen in the detection of prostate cancer: results of a randomised, double-blind, placebo-controlled clinical trial. PLESS study group. Urology 1998;52: Stoner E. Three-year safety and efficacy data on the use of finasteride in the treatment of benign prostatic hyperplasia. Urology 1994;43: McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003;349: Roehrborn CG, Boyle P, Nickel JC, et al. ARIA3001, ARIA3002 and ARIA3003 Study Investigators. Efficacy and safety of a dual inhibitor of 5 alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 2002;60: Foley CL, Taylor C, Kirby RS. Counting the cost of treating benign prostatic hyperplasia. BJU International 2004;93: Dr Taylor and Dr Foley are higher surgical trainees and Professor Kirby is director of the Prostate Centre, London, and visiting professor at St George s Hospital and the Institute of Urology, London Prostate Help Association (PHA), Langworth, Lincoln LN3 5DF. Provides an information service for all types of prostate disease. Prostate Research Campaign UK, 10 Northfields Prospect, Putney Bridge Road, London SW18 1PE. Tel: , fax , info@prostateresearch.org.uk; This is a registered charity researching prostate disorders. It also publishes patient information books and leaflets. 36 Prescriber 19 July
Recommended drug treatment of BPH in primary care Claire Taylor MRCS, Charlotte Foley MRCS and Roger Kirby MA, MD, FRCS Urol
Drug review BPH Recommended drug treatment of BPH in primary care Claire Taylor MRCS, Charlotte Foley MRCS and Roger Kirby MA, MD, FRCS Urol Skyline Imaging Ltd The development of safe and effective drugs
More informationThe Journal of International Medical Research 2012; 40:
The Journal of International Medical Research 2012; 40: 899 908 Comparison of α-blocker Monotherapy and α-blocker Plus 5α-Reductase Inhibitor Combination Therapy Based on Prostate Volume for Treatment
More informationDuring the past decade, numerous
Benign prostatic hyperplasia (BPH) is one of the most common diseases of aging men. It is estimated that by age 60 years, greater than 50% of men will have histologically documented evidence of the disease.
More informationThe Evolution of Combination Therapy. US men eligible for BPH treatment * with projected population changes
The Management of BPH & The Impact of Combination Therapy Results Combination of Avodart and Tamsulosin (CombAT) Medical Therapy of Prostate Symptoms (MTOPS) Dr. Jack Barkin, md, fics, facs, dabu, Mcert
More informationBenign Prostatic Hyperplasia. Jay Lee, MD, FRCSC Clinical Associate Professor University of Calgary
Benign Prostatic Hyperplasia Jay Lee, MD, FRCSC Clinical Associate Professor University of Calgary Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied,
More informationBenign Prostatic Hyperplasia (BPH):
Benign Prostatic Hyperplasia (BPH): Evidence Based Guidelines for Primary Care Providers Jeanne Martin, DNP, ANP-BC Objectives 1. Understand the pathophysiology and prevalence of BPH 2. Select the appropriate
More informationIncreasing Awareness, Diagnosis, and Treatment of BPH, LUTS, and EP
Introduction to Enlarged Prostate E. David Crawford, MD Professor of Surgery (Urology) and Radiation Oncology Head, Urologic Oncology E. David Crawford Endowed Chair in Urologic Oncology University of
More informationMANAGING BENIGN PROSTATIC HYPERTROPHY IN PRIMARY CARE DR GEORGE G MATHEW CONSULTANT FAMILY PHYSICIAN FELLOW IN SEXUAL & REPRODUCTIVE HEALTH
MANAGING BENIGN PROSTATIC HYPERTROPHY IN PRIMARY CARE DR GEORGE G MATHEW CONSULTANT FAMILY PHYSICIAN FELLOW IN SEXUAL & REPRODUCTIVE HEALTH INTRODUCTION (1) Part of male sexual reproductive organ Size
More informationManagement of LUTS. Simon Woodhams February 2012
Management of LUTS Simon Woodhams February 2012 The management of lower urinary tract symptoms (LUTS) in men Implementing NICE guidance May 2010 NICE clinical guideline 97 Background Lower urinary tract
More informationCombination Drug Therapy for Benign Prostatic Hyperplasia (BPH)
The Annals of African Surgery www.sskenya.org Combination Drug Therapy for Benign Prostatic Hyperplasia (BPH) Author: Oliech J.S. FRCS, Affiliation: Department of Surgery, University of Nairobi. P.O. Box
More informationOffice Management of Benign Prostatic Enlargement
Focus on CME at McGill University Office Management of Benign Prostatic Enlargement Symptomatic benign prostate enlargement is a common medical problem encountered in our aging society. Watchful waiting,
More informationBenign Prostatic Hyperplasia (BPH) Important Papers / Landmark. Vijayan Manogran
Benign Prostatic Hyperplasia (BPH) Important Papers / Landmark Studies Vijayan Manogran MTOPS & CombAT PLESS SMART ALTESS ALF-ONE VA PREDICT EPICS Landmark Studies MTOPS Medical Therapy of Prostatic Symptoms
More informationBenign Prostatic Hypertrophy (BPH) is the most
Medical treatment of benign prostatic hypertrophy There is little doubt that medical therapy has transformed the treatment of benign prostatic hypertrophy (BPH). The medical treatment of BPH continues
More informationBenign Prostatic Hyperplasia. Management of Benign Prostatic Hyperplasia. Goals of Therapy
Benign Prostatic Hyperplasia Management of Benign Prostatic Hyperplasia Goals of Therapy Improve or abolish lower urinary tract symptoms (LUTS) Prevent or delay clinical progression of benign prostatic
More informationGuideline for the primary care management of male lower urinary tract symptoms
review Article GUIDELINES FOR LUTS M.J. SPEAKMAN et al. As my Comment in the first section of the journal suggested, the MTOPS results have offered the possibility to general practitioners of reducing
More informationIndex. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Ablative therapies, transurethral needle ablation, Adverse events, sexual side effects of BPH Aging, and incidence of BPH associated with
More informationTherapeutic Strategies for Managing BPH Progression
european urology supplements 5 (2006) 997 1003 available at www.sciencedirect.com journal homepage: www.europeanurology.com Therapeutic Strategies for Managing BPH Progression John M. Fitzpatrick a, *,
More informationMEDICAL THERAPY. Endocrine Approaches. Página 1 de 5.
Página 1 de 5 MEDICAL THERAPY Part of "32 - BENIGN PROSTATIC HYPERPLASIA" Use of pharmacologically defined and a variety of so-called alternative medications to attempt to improve BPH voiding dysfunction
More informationManagement of male LUTS in general practice
17 Management of male LUTS in general practice MARK J. SPEAKMAN AND FAITH MCMEEKIN The initial management of lower urinary tract symptoms in men is usually carried out in primary care. The authors explain
More informationWill Medical Management of Benign Prostatic Hyperplasia Result in Better or Worse Sexual Function in Men?
Urol Sci 2011;22(1):14 18 MINI REVIEW Will Medical Management of Benign Prostatic Hyperplasia Result in Better or Worse Sexual Function in Men? Thomas I.S. Hwang 1,2,3 * 1 Shin Kong WHS Hospital, Taipei,
More informationAll about the Prostate
MEN S HEALTH Dr Nick Pendleton January 16 th 2018 All about the Prostate 1 What does it do? Functions of the Prostate 1. Secretes Prostatic Fluid slightly alkaline fluid, 30% of volume of seminal fluid,
More informationHow Do New Data from Clinical Trials Allow Us to Optimise the Assessment and Treatment of Patients with Benign Prostatic Hyperplasia?
available at www.sciencedirect.com journal homepage: www.europeanurology.com How Do New Data from Clinical Trials Allow Us to Optimise the Assessment and Treatment of Patients with Benign Prostatic Hyperplasia?
More informationα-blocker Monotherapy and α-blocker Plus 5-Alpha-Reductase Inhibitor Combination Treatment in Benign Prostatic Hyperplasia; 10 Years Long-Term Results
www.kjurology.org http://dx.doi.org/10.4111/kju.2012.53.4.248 Voiding Dysfunction α-blocker Monotherapy and α-blocker Plus 5-Alpha-Reductase Inhibitor Combination Treatment in Benign Prostatic Hyperplasia;
More informationPROSTATIC ARTERY EMBOLISATION (PAE) FOR BENIGN PROSTATIC HYPERPLASIA. A Minimally Invasive Innovative Treatment
PROSTATIC ARTERY EMBOLISATION (PAE) FOR BENIGN PROSTATIC HYPERPLASIA A Minimally Invasive Innovative Treatment What is the prostate? The prostate is an accessory organ of the male reproductive system.
More informationKey words: Lower Urinary Tract Symptoms (LUTS), Prostatic Hyperplasia, Alpha-1 Adrenoceptor Antagonists, Tamsulosin, Terazosin.
The Professional Medical Journal DOI: 10.17957/TPMJ/17.4102 ORIGINAL PROF-4102 PROSTATIC HYPERPLASIA; COMPARISON BETWEEN TAMSULOSIN AND TERAZOSIN FOR EFFICACY IN MEDICAL MANAGEMENT OF LOWER URINARY TRACT
More informationVictoria Sharp, MD, MBA, FAAFP. Clinical Professor of Urology and Family Medicine
Victoria Sharp, MD, MBA, FAAFP Clinical Professor of Urology and Family Medicine Victoria Sharp, MD, MBA, FAAFP Market Chief Medial Officer AmeriHealth Caritas Family of Companies Office phone: (515) 330-3740
More informationEvaluation of Sexual Dysfunction in Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Patients
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2018/10 Evaluation of Sexual Dysfunction in Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Patients N. Narayanamoorthy,
More informationDiagnostic approach to LUTS in men. Prof Dato Dr. Zulkifli Md Zainuddin Consultant Urologist / Head Of Urology Unit UKM Medical Center
Diagnostic approach to LUTS in men Prof Dato Dr. Zulkifli Md Zainuddin Consultant Urologist / Head Of Urology Unit UKM Medical Center Classification of LUTS Storage symptoms Voiding symptoms Post micturition
More informationProstate Disease. Chad Baxter, MD
Prostate Disease Chad Baxter, MD Managing BPH and LUTS Chad Baxter, MD Department of Urology cbaxter@mednet.ucla.edu 33 nd Annual UCLA Intensive Course in Geriatric Medicine & Board Review Prevalence of
More informationBenign Prostatic Hyperplasia (BPH) IPT VI Srikanth Kolluru, Ph.D
Benign Prostatic yperplasia (BP) IPT VI Srikanth Kolluru, Ph.D. kolluru@tamhsc.edu, 361 221 0741 verview 1. Introduction and background of BP 2. Causes and common symptoms 3. Treatment options Learning
More informationLONG-TERM SAFETY AND EFFICACY OF TAMSULOSIN FOR THE TREATMENT OF LOWER URINARY TRACT SYMPTOMS ASSOCIATED WITH BENIGN PROSTATIC HYPERPLASIA
0022-5347/03/1702-0498/0 Vol. 170, 498 502, August 2003 THE JOURNAL OF UROLOGY Printed in U.S.A. Copyright 2003 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000076140.68657.fd LONG-TERM SAFETY
More informationMMM. Topic The use of Tadalafil 5mg daily for the treatment of BPH-LUTS
Dr Tan & Partners MMM Vol. 1 No. 1 Morbidity & Mortality Meeting 14 th November 2014 Introduction Topic The use of Tadalafil 5mg daily for the treatment of BPH-LUTS Tadalafil 5mg daily is a well established
More informationDIAGNOSED WITH BENIGN PROSTATIC HYPERPLASIA
Acta Poloniae Pharmaceutica ñ Drug Research, Vol. 74 No. 4 pp. 1247ñ1253, 2017 ISSN 0001-6837 Polish Pharmaceutical Society PHARMACOLOGY CLINICAL EVALUATION OF α-1-adrenolytics IN PATIENTS DIAGNOSED WITH
More informationREPORTS. Clinical and Economic Outcomes in Patients Treated for Enlarged Prostate
Clinical and Economic Outcomes in Patients Treated for Enlarged Prostate Michael James Naslund, MD, MBA; Muta M. Issa, MD, MBA; Amy L. Grogg, PharmD; Michael T. Eaddy, PharmD, PhD; and Libby Black, PharmD
More informationAlpha antagonists from initial concept to routine clinical practice
european urology 50 (2006) 635 642 available at www.sciencedirect.com journal homepage: www.europeanurology.com Editorial 50th Anniversary Alpha antagonists from initial concept to routine clinical practice
More informationMODULE 3: BENIGN PROSTATIC HYPERTROPHY
MODULE 3: BENIGN PROSTATIC HYPERTROPHY KEYWORDS: Prostatic hypertrophy, prostatic hyperplasia, PSA, voiding dysfunction, lower urinary tract symptoms (LUTS) At the end of this clerkship, the medical student
More informationEjaculation. Emission. Ejection. Orgasm
Ejaculation Emission Ejection Orgasm Ejaculation sc T10-L2 S2-4 Emission: vas deferens, prostate, bladder neck Post. Urethra distention Ejection: Pelvic Floor / bulbocavernous muscle contraction Orgasm:
More information10/9/2015. Dana A. Brown, Pharm.D., BCPS Assistant Dean for Academics, Associate Professor of Pharmacy Practice Palm Beach Atlantic University
Dana A. Brown, Pharm.D., BCPS Assistant Dean for Academics, Associate Professor of Pharmacy Practice Palm Beach Atlantic University 1. Explain the pathophysiology of benign prostatic hyperplasia (BPH),
More informationEvaluation of Recent Trends in Treatment Patterns Among Men With Benign Prostatic Hyperplasia
469245JMHXXX10.1177/1557988312469245A merican Journal of Men s HealthKruep et al. Article Evaluation of Recent Trends in Treatment Patterns Among Men With Benign Prostatic Hyperplasia American Journal
More informationLower Urinary Tract Symptoms K Kuruvilla Zachariah Associate Specialist
Lower Urinary Tract Symptoms K Kuruvilla Zachariah Associate Specialist Lower Urinary Tract Symptoms Storage Symptoms Frequency, urgency, incontinence, Nocturia Voiding Symptoms Hesitancy, poor flow, intermittency,
More informationCanadian Undergraduate Urology Curriculum (CanUUC): Prostate Diseases
Canadian Undergraduate Urology Curriculum (CanUUC): Prostate Diseases LUTS/Benign Prostate Hyperplasia Objectives 1. List the lower urinary tract symptoms (LUTS) found in men with BPH. 2. List the differential
More informationMedical Therapy for Benign Prostatic Hyperplasia Present and Future Impact
REPORTS Medical Therapy for Benign Prostatic Hyperplasia Present and Future Impact Muta M. Issa, MD, MBA; Timothy S. Regan, BPharm, RPh, CPh Abstract The purpose of this manuscript is to provide clinicians,
More informationHyoung Woo Kim, Dae Geun Moon, Hyun Min Kim, Jong Ho Hwang, Soon Chan Kim, Sam Geuk Nam, Jun Tag Park
www.kjurology.org http://dx.doi.org/10.4111/kju.2011.52.10.681 Voiding Dysfunction Effect of Shifting from Combination Therapy to Monotherapy of α-blockers or 5α-Reductase Inhibitors on Prostate Volume
More informationTrans Urethral Resection of Prostate (TURP)
Trans Urethral Resection of Prostate (TURP) Patient Information Author ID: SF Leaflet Number: Urol 010 Version: 6 Name of Leaflet: Trans Urethral Resection of Prostate (TURP) Date Produced: March 2018
More information50% of men. 90% of men PATIENT FACTSHEET: BPH CONDITION AND TREATMENTS. Want more information? What are the symptoms?
PATIENT FACTSHEET: BPH CONDITION AND TREATMENTS What is Benign Prostatic Hyperplasia (enlarged prostate)? Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate, the gland that
More informationAs man draws near the common goal Can anything be sadder Than he who, master of his soul Is servant to his bladder LUTS 2. Prevalence of BPH LUTS 5
BPH / LUTS Dr Jonny Coxon MA MD MRCS MRCGP DRCOG Beaconsfield Medical Practice, Brighton As man draws near the common goal Can anything be sadder Than he who, master of his soul Is servant to his bladder
More informationBenign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH) Definition Prostate gland enlargement is a common condition as men get older. Also called benign prostatic hyperplasia (BPH), prostate gland enlargement can cause bothersome
More informationMale Lower Urinary Tract Symptoms: Management in primary care and beyond. Daniel Cohen PhD FRCS(Urol) Consultant Urological Surgeon
Male Lower Urinary Tract Symptoms: Management in primary care and beyond Daniel Cohen PhD FRCS(Urol) Consultant Urological Surgeon 1 LUTS Very common: 1/3 men over age of 50 have moderate to severe LUTS
More informationEVALUATION OF THE EFFICACY OF TADALAFIL IN IMPROVING LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH SYMPTOMATIC BENIGN PROSTATIC ENLARGEMENT
Basrah Journal Of Surgery EVALUATION OF THE EFFICACY OF TADALAFIL IN IMPROVING LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH SYMPTOMATIC BENIGN PROSTATIC ENLARGEMENT MB, ChB, FIBMS, Assistant Professor
More informationElements for a Public Summary
VI.2 VI.2.1 Elements for a Public Summary Overview of disease epidemiology Benign prostatic hyperplasia (BPH), also called benign prostatic hypertrophy or benign prostatic obstruction, is a condition in
More informationBenign Prostatic Hyperplasia and Enlarged Prostate Guidelines: How They Can Be Useful to Primary Care
Volume 1, Number 1 Weill Medical College of Cornell University Reports on Men s Urologic Health 1 Editor: Steven A. Kaplan, MD, Professor of Urology, and Chief, Institute for Bladder and Prostate Health,
More informationBPH / LUTS. Prevalence. Prevalence of BPH. It is abnormal NOT to have benign growth of the prostate with increasing age. Prevalence.
BPH / LUTS Dr Jonny Coxon MA MD MRCS MRCGP DRCOG FECSM Beaconsfield Medical Practice, Brighton & Brighton & Sussex Universities NHS Trust As man draws near the common goal Can anything be sadder Than he
More informationLower Urinary Tract Symptoms (LUTS) and Nurse-Led Clinics. Sean Diver Urology Advanced Nurse Practitioner candidate Letterkenny University Hospital
Lower Urinary Tract Symptoms (LUTS) and Nurse-Led Clinics Sean Diver Urology Advanced Nurse Practitioner candidate Letterkenny University Hospital 01/02/2018 Lower Urinary Tract Symptoms LUTS - one of
More informationThe Enlarged Prostate Symptoms, Diagnosis and Treatment
The Enlarged Prostate Symptoms, Diagnosis and Treatment MAC00031-01 Rev G Financial support for this seminar has been provided by NeoTract, Inc., the manufacturer of the UroLift System. 1 Today s Agenda
More informationEAU GUIDELINES POCKET EDITION 3
EAU GUIDELINES POCKET EDITION 3 CONTENTS: BENIGN PROSTATIC HYPERPLASIA URINARY INCONTINENCE UROLITHIASIS 2 3 EAU POCKET GUIDELINES POCKET EDITION 3 This is one of a series of convenient pocket size books
More informationOverview. Urology Dine and Learn: Erectile Dysfunction & Benign Prostatic Hyperplasia. Iain McAuley September 15, 2014
Urology Dine and Learn: Erectile Dysfunction & Benign Prostatic Hyperplasia Iain McAuley September 15, 2014 Overview Review of the most recent guidelines for ED and BPH ED Guidelines CUA 2006 AUA 2011
More informationEfficacy and safety of tamsulosin OCAS
Original Article EFFICACY AND SAFETY OF TAMSULOSIN OCAS SPEAKMAN Efficacy and safety of tamsulosin OCAS MARK SPEAKMAN Taunton and Somerset Hospital, Taunton, UK The efficacy and safety of a new tablet
More informationProstate Health PHARMACIST VIEW
Prostate Health PHARMACIST VIEW Prostate Definition Prostate is a gland made of fibromuscular tissue. It is about 4 cm and surrounds the neck of the bladder and the urethra. It produces seminal fluid.
More informationBenign Prostatic Hyperplasia. Shahideh Amini Pharm.D clinical pharmacy resident Tehran university of medical science Department of pharmacotherapy
Benign Prostatic Hyperplasia Shahideh Amini Pharm.D clinical pharmacy resident Tehran university of medical science Department of pharmacotherapy Definition BPH is a common disorder that increases in frequency
More informationWhat is Benign Prostatic Hyperplasia (BPH)?
What is Benign Prostatic Hyperplasia (BPH)? Benign prostatic hyperplasia (BPH) is an enlarged prostate. The prostate goes through two main growth periods as a man ages. The first occurs early in puberty,
More informationVOIDING DYSFUNCTION IN ELDERLY MALE CURRENT STATUS
VOIDING DYSFUNCTION IN ELDERLY MALE CURRENT STATUS DR. FRANCIS LEE Voiding dysfunction Storage Emptying Common voiding dysfunction in elderly male Emptying BPH Storage Incontinence Overactive bladder Post-prostatectomy
More informationAlpha-BlockerTherapy Can Be Withdrawn in the Majority of Men Following Initial CombinationTherapy with the Dual 5a-Reductase Inhibitor Dutasteride
European Urology European Urology 44 (2003) 461 466 Alpha-BlockerTherapy Can Be Withdrawn in the Majority of Men Following Initial CombinationTherapy with the Dual 5a-Reductase Inhibitor Dutasteride J.
More informationManaging lower urinary tract symptoms in men
Managing lower urinary tract symptoms in men MacKenzie KR, Aning JJ. Managing lower urinary tract symptoms in men. Practitioner 6; 6(79):-6 Mr Kenneth R MacKenzie MBChB MRCS (Ed) Core Trainee in Urology
More informationLiterature Scan: Drugs for BPH
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationCase studies: LUTS. Case 1 history. Case 1 - questions. Case 1 - outcome. Case 2 - history. Case 1 learning point 14/07/2015 DR JON REES
Case 1 history Case studies: LUTS DR JON REES A 49 year old male comes to see you he has had gradual deterioration of his flow over the last few years- he saw a colleague of yours 6 weeks ago who recorded
More informationBPH: a present and future perspective on health impact
BPH: a present and future perspective on health impact Burden of disease in men with moderate LUTS Dalibor Pacík This presentation is financially supported by GlaxoSmithKline. CZ/DUTT/0019/12 Men with
More informationNOTE: This policy is not effective until April 1, Transurethral Water Vapor Thermal Therapy of the Prostate
NOTE: This policy is not effective until April 1, 2019. Medical Policy Manual Surgery, Policy No. 210 Transurethral Water Vapor Thermal Therapy of the Prostate Next Review: December 2019 Last Review: December
More informationThe Risk of Fracture with Taking Alpha Blockers for Treating Benign Prostatic Hyperplasia
J Prev Med Public Health 2009;42(3):165-170 DOI: 103961/jpmph2009423165 The Risk of Fracture with Taking Alpha Blockers for Treating Benign Prostatic Hyperplasia Joongyub Lee 1) Nam-Kyoung Choi 13) Sun-Young
More informationWhat can the primary care physician do? Brian W. Ellis
What can the primary care physician do? Brian W. Ellis Consultant Urological Surgeon at Ashford & St Peter s 1983-2007 Currently Consultant Urological Surgeon at Cobham Hospital Visiting Professor at Middlesex
More informationPRABHAKAR SINGH*, MANOJ INDURKAR, AMITA SINGH, PALLAVI INDURKAR
Academic Sciences International Journal of Current Pharmaceutical Research ISSN- 0975-7066 Vol 5, Issue 1, 2013 Research Article COMPARISON OF THE EFFICACY AND SAFETY OF TAMSULOSIN (0.4 V/S (and) FINASTERIDE
More informationDepartment of Urology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX
NEW PERSPECTIVES ON BPH 5- -Reductase Inhibitors Prevent the Progression of Benign Prostatic Hyperplasia Claus G. Roehrborn, MD Department of Urology, The University of Texas Southwestern Medical Center
More informationPolicy for Prostatism/Lower Urinary Tract Symptoms in men
NHS Halton Clinical Commissioning Group NHS Liverpool Clinical Commissioning Group NHS St Helens Clinical Commissioning Group NHS South Sefton Clinical Commissioning Group NHS Southport and Formby Clinical
More informationCan men with prostates sized 80 ml or larger be managed conservatively?
Original Article - Lower Urinary Tract Dysfunction Investig Clin Urol 2017;58:359-364. pissn 2466-0493 eissn 2466-054X Can men with prostates sized 80 ml or larger be managed conservatively? Alvin Lee,
More informationPATIENT INFORMATION 2017 NeoTract, Inc. All rights reserved. Printed in the USA. MAC Rev A
PATIENT INFORMATION OVER 70% OF MEN IN THEIR 60s HAVE SYMPTOMS OF BPH 1 BPH affects more than 500 million men worldwide, with many men suffering from symptoms of enlarged prostate. 1 You no longer have
More informationVoiding Dysfunction Block lecture, 5 th year student. Choosak Pripatnanont, Department of Surgery, PSU.
Voiding Dysfunction 2009 Block lecture, 5 th year student. Choosak Pripatnanont, Department of Surgery, PSU. Objectives Understand and explain physiologic function and dysfunction of lower urinary tract.
More informationOriginal Article Japanese Urological Association. International Journal of Urology (2006) 13,
Blackwell Publishing AsiaMelbourne, AustraliaIJUInternational Journal of Urology0919-81722006 Blackwell Publishing Asia Pty Ltd2006130014051409Original ArticleTamsulosin vs doxazosin in BPH D Rahardjo
More informationTreating BPH: Comparing Rezum UroLift and HoLEP
Treating BPH: Comparing Rezum UroLift and HoLEP Scott M. Cheney MD Mayo Clinic Arizona 2018 MFMER slide-1 Welcome to AZ 2018 MFMER slide-2 Outline Background on BPH, Rezum, Urolift, HoLEP AUA Guideline
More informationComments concerning the real risk of sexual adverse events secondary to the use of 5-ARIs
ORIGINAL PAPER DOI: 10.4081/aiua.2015.4.312 Comments concerning the real risk of sexual adverse events secondary to the use of 5-ARIs Furio Pirozzi Farina, Antonella Pischedda Andrological Urology Unit,
More informationThe Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (6), Page
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (6), Page 1377-1386 Evaluation of Silodosin in Comparison to Tamuslosin in Treatment of Benign Prostatic Hyperplasia with lower Urinary
More informationMedical therapy options for aging men with benign prostatic hyperplasia: focus on alfuzosin 10 mg once daily
REVIEW Medical therapy options for aging men with benign prostatic hyperplasia: focus on alfuzosin 10 mg once daily Claus G Roehrborn 1 Raymond C Rosen 2 1 Department of Urology, University of Texas Southwestern
More informationBenign prostatic hyperplasia (BPH) is a term that
42Clinical Pharmacist February 2012 Vol 4 For older men, benign prostatic hyperplasia is a common cause of lower urinary tract symptoms such as polyuria, incomplete bladder emptying, urinary urgency and,
More informationImpact of 5-Alpha Reductase Inhibitors Treatment for Benign Prostatic Hyperplasia on Erectile Dysfunction: A Meta-Analysis
International Journal of Clinical Urology 2017; 1(1): 1-6 http://www.sciencepublishinggroup.com/j/ijcu doi: 10.11648/j. ijcu.20170101.11 Review Article Impact of 5-Alpha Reductase Inhibitors Treatment
More information(dutasteride/tamsulosin) For the treatment of Benign Prostatic Hyperplasia (BPH)
Combodart (dutasteride/tamsulosin) For the treatment of Benign Prostatic Hyperplasia (BPH) This leaflet is only for use by patients who have been prescribed Combodart. Please see Patient Information Leaflet
More informationImpact of Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Treatment with Tamsulosin and Solifenacin Combination Therapy on Erectile Function
www.kjurology.org DOI:10.4111/kju.2011.52.1.49 Sexual Dysfunction Impact of Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Treatment with Tamsulosin and Solifenacin Combination Therapy on Erectile
More informationOVER 70% OF MEN IN THEIR 60s HAVE SYMPTOMS OF BPH 1
PATIENT INFORMATION BPH affects more than 500 million men worldwide, with many men suffering from symptoms of enlarged prostate. 1 You no longer have to be one of them! OVER 70% OF MEN IN THEIR 60s HAVE
More informationMini-Invasive Treatment in Urological Diseases Dott. Alberto Saita Responsabile Endourologia Istituto Clinico Humanitas - Rozzano
Dipartimento di Urologia Direttore Prof. Giorgio Guazzoni Mini-Invasive Treatment in Urological Diseases Dott. Alberto Saita Responsabile Endourologia Istituto Clinico Humanitas - Rozzano alberto.saita@humanitas.it
More informationEuropean Healthcare Innovation Leadership Network
MAY 2008 The Value Proposition of Medicines to Treat Benign Prostatic Hyperplasia: Introduction The following case study examines the evolution of Avodart, a drug manufactured by GSK that is currently
More informationNational Institute for Health and Care Excellence. Lower Urinary Tract Symptoms Update Addendum Consultation Table 3 rd February 5 pm 3 rd March 2015
British Association of Urological Surgeons British Association of Urological Surgeons National Institute for Health and Care Excellence Lower Urinary Tract Symptoms Update Addendum Consultation Table 3
More informationH6D-MC-LVHR Clinical Study Report Synopsis Page LVHR Synopsis (LY450190)
H6D-MC-LVHR Clinical Study Report Synopsis Page 1 2. LVHR Synopsis H6D-MC-LVHR Clinical Study Report Synopsis Page 2 Clinical Study Report Synopsis: Study H6D-MC-LVHR Title of Study: A Randomized, Double-Blind,
More informationChapter 3: Results of the Treatment Outcomes Analyses
Chapter 3: Results of the Treatment Outcomes Analyses Introduction To determine the appropriateness of individual therapies, as well as to develop practice recommendations, the American Urological Association
More informationThe Journal of International Medical Research 2005; 33:
The Journal of International Medical Research 2005; 33: 562 573 A Comparative Study on the Safety and Efficacy of Tamsulosin and Alfuzosin in the Management of Symptomatic Benign Prostatic Hyperplasia:
More informationA Comparative Study of Efficacy and Safety Between Tamsulosin and Terazosin in the Treatment of Symptomatic Benign Prostatic Hyperplasia
Chattagram Maa-O-Shishu Hospital Medical College Journal Original Article A Comparative Study of Efficacy and Safety Between Tamsulosin and Terazosin in the Treatment of Symptomatic Benign Prostatic Hyperplasia
More informationJMSCR Vol 05 Issue 07 Page July 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i7.47 Original Research Article Tadalafil therapy
More informationRole of herbal drugs in the management of benign prostatic hyperplasia: Clinical trial to evaluate the efficacy and safety of Himplasia
[Medicine Update (2003): 11(2), 55-58] Role of herbal drugs in the management of benign prostatic hyperplasia: Clinical trial to evaluate the efficacy and safety of Himplasia Arora, R.P., CMO, Rajiba L.
More informationTransurethral Resection of Prostate (TURP)
Transurethral Resection of Prostate (TURP) Department of Urology Patient Information What What and and where where is the is prostate? the prostate? The prostate is a small gland, about the size of a walnut,
More informationPROSTATIC EMBOLIZATION FOR BENIGN HYPERPLASIA
St. Louis Hospital PROSTATIC EMBOLIZATION FOR BENIGN HYPERPLASIA INITIAL CLINICAL RESULTS Faculty of Medical Sciences New University of Lisbon JOÃO PISCO LUÍS CAMPOS PINHEIRO TIAGO BILHIM HUGO RIO TINTO
More informationChapter 3: Results of the Treatment Outcomes Analyses
Chapter 3: Results of the Treatment Outcomes Analyses TABLE OF CONTENTS INTRODUCTION... 3 WATCHFUL WAITING... 11 STUDY OUTCOMES... 11 MEDICAL THERAPIES... 13 ALPHA-ADRENERGIC ANTAGONISTS (ALPHA-BLOCKERS)...
More informationThe potential for NX-1207 in benign prostatic hyperplasia: an update for clinicians
Therapeutic Advances in Chronic Disease Review The potential for NX-1207 in benign prostatic hyperplasia: an update for clinicians Neal Shore and Barrett Cowan Ther Adv Chronic Dis (2011) 2(6) 377 383
More information