Korean J Urol.  2006 Jan;47(1):7-12. 10.4111/kju.2006.47.1.7.

Comparison of the Long Term Effect of Alpha-Blocker Only and 5-Alpha Reductase Inhibitor Combination Treatment on Acute Urinary Retention and Prostatic Surgery for Patients with Benign Prostatic Hyperplasia

• Chang HS
• Park CH
• Kim CI

• KMID: 2294208
• DOI: http://doi.org/10.4111/kju.2006.47.1.7

Abstract

PURPOSE: The medical treatment for benign prostatic hyperplasia (BPH) had recently been directed at preventing the progression of BPH, which reduces the risk of acute urinary retention (AUR) and BPH-related surgery. This study compared the long-term effectiveness of administering alpha- adrenergic blocker (alpha-blocker) and finasteride, a 5-alpha reductase inhibitor (5ARI), for treating BPH to prevent AUR and BPH-related surgery in real-life clinical practice.
MATERIALS AND METHODS
This retrospective study enrolled 166 BPH patients who were treated at our hospital with the alpha-blockers doxazosin, terazosin, prazosin and alfuzosin, or tamsulosin and 5ARI as their first BPH treatment between January 1997 and December 1997, and these treatments lasted at least 12 months. Using follow-up data that was obtained at up to 7 years after treatment, we calculated the AUR and BPH-related surgery percentages in the alpha-blocker only group and in the combination group.
RESULTS
During the study period, 17 of 110 patients (15.5%) in the alpha- blocker only group and 4 of 56 patients (7.1%) in the combination group experienced AUR. BPH-related surgery was performed on 10 of 110 patients (9.1%) in the alpha-blocker only group and surgery was performed on 1 of 56 patients (1.8%) in the combination group. Among them, 5 patients in the alpha-blocker only group and 1 patient in the combination group received surgery for AUR, and another 5 patients in the alpha-blocker only group showed insufficient therapeutic response.
CONCLUSIONS
Real-life clinical practice showed that long-term combination treatment with alpha-blockers and 5ARI reduced the risk of the progression of BPH, such as AUR or BPH-related surgery, as compared with alpha-blocker-only treatment.

Keyword

Prostatic hyperplasia; Alpha-adrenergic blockers; Finasteride; Urinary retention; Surgery

MeSH Terms

Adrenergic alpha-Antagonists
Adrenergic Antagonists
Doxazosin
Finasteride
Follow-Up Studies
Humans
Oxidoreductases*
Prazosin
Prostatic Hyperplasia*
Retrospective Studies
Urinary Retention*
Adrenergic Antagonists
Adrenergic alpha-Antagonists
Doxazosin
Finasteride
Oxidoreductases
Prazosin

Figure

• 

  Fig. 1 Percentage of patients treated with either an alpha-blocker only or a combination treatment.

• 

  Fig. 2 Cumulative occurrence of acute urinary retention.

• 

  Fig. 3 Cumulative occurrence of benign prostate hyperplasia related surgery.

Reference

1. Welch G, Weinger K, Barry MJ. Quality-of-life impact of lower urinary tract symptom severity: results from the Health Professionals Follow-Up Study. Urology. 2002. 59:245–250.

2. Roehrborn CG, Bruskewitz R, Nickel GC, Glickman S, Cox C, Anderson R, et al. Urinary retention in patients with BPH treated with finasteride or placebo over 4 years. Characterization of patients and ultimate outcomes. Eur Urol. 2000. 37:528–523.

3. Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G, et al. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. N Engl J Med. 1996. 335:533–539.

4. Kirby RS, Roehrborn C, Boyle P, Bartsch G, Jardin A, Cary MM, et al. Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology. 2003. 61:119–126.

5. McConnell JD, Wilson JD, George FW, Geller J, Pappas F, Stoner E. Finasteride, an inhibitor of 5-alpha reductase suppresses prostatic dihydrotestosterone in men with benign prostatic hyperplasia. J Clin Endocrinol Metab. 1992. 74:505–508.

6. Roehrborn CG, McConnell J, Bonilla J, Rosenblatt S, Hudson PB, Malek GH, et al. Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. J Urol. 2000. 163:13–20.

7. McConnell JD, Bruskewitz R, Walsh P, Andriole G, Lieber M, Holtgrewe HL, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. N Engl J Med. 1998. 338:557–563.

8. McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, 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. 349:2387–2398.

9. Flanigan RC, Reda DJ, Wasson JH, Anderson RJ, Abdellatif M, Bruskewitz RC. 5-year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a Department of Veterans Affairs cooperative study. J Urol. 1998. 160:12–16.

10. Kaplan SA, Goluboff ET, Olsson CA, Deverka PA, Chmiel JJ. Effect of demographic factors, urinary peak flow rates, and Boyarsky symptom scores on patient treatment choice in benign prostatic hyperplasia. Urology. 1995. 45:398–405.

11. Roehrborn CG. Efficacy and safety of once-daily alfuzosin in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a randomized, placebo-controlled trial. Urology. 2001. 58:953–959.

12. Park CH, Chang HS, Oh BR, Kim HJ, Sul CK, Chung SK, et al. Efficacy of low-dose tamsulosin on lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Clin Drug Invest. 2004. 24:25–29.

13. Boyle P, Roehrborn C, Harkaway R, Logie J, de la Rosette J, Emberton M. 5-Alpha reductase inhibition provides superior benefits to alpha blockade by preventing AUR and BPH-related surgery. Eur Urol. 2004. 45:620–627.

14. Roehrborn CG. The clinical benefits of dutasteride treatment for LUTS and BPH. Rev Urol. 2004. 6:Suppl 9. S22–S30.

15. Berum L, Klarskov P, Munck LK, Nielsen TH, Nordestgaard AG. Significance of acute urinary retention due to intravesical obstruction. Scand J Urol Nephrol. 1982. 16:21–24.

16. Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol. 1997. 158:481–487.

17. Pickard R, Emberton M, Neal DE. The management of men with acute urinary retention. Br J Urol. 1998. 81:712–720.