Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Reviews
Year : 2007 | Month : October | Volume : 1 | Issue : 5 | Page : 416 - 425

Review of Medical Management of BPH

SINGH I Correspondence Address :
Dr. (Prof.) Iqbal Singh, M.Ch(Urology)[AIIMS],D.N.B.(Urology), M.S.(Surgery), D.N.B. (Surgery) Professor and Senior Consultant Urologist Division of Urology, Department of Surgery University College of Medical Sciences (University of Delhi) & GTB Hospital, F-14 South Extension Part-2, New Delhi-110049, India Fax: 91-11-22590495, 26257693®, 9810499222(M), Email: iqbalsinghp@yahoo.co.uk

Abstract

Aim: The aim of this study is to review the literature regarding the medical management of benign prostatic hyperplasia (BPH), with emphasis on the current mechanistic insights and drugs, so as to provide an update and present recent data to the urologists, surgeons, and clinicians involved in managing the BPH disease.
Methods: The National Library of Medicine and PubMed were searched for major published data and trials on the medical management of BPH using the key words benign prostatic hyperplasia, medical management, lower urinary tract symptoms (LUTS), α-blockers, 5-α reductase inhibitors, phytotherapy, and evidence-based medicine. Important landmark trials published in the last 15 years were analysed and tracked for recent changes, newer drugs, and medical therapies currently being used to manage BPH.
Results: Major randomised, placebo-controlled landmark trials involving the three major prescriptions, namely α-adrenergic blockers, 5-α reductase inhibitors, and phytotherapeutic agents, were reviewed and discussed.
Conclusions: Medical management of LUTS due to BPH is undoubtedly the first choice of BPH therapy, and it has drastically reduced the number of patients that were initially treated by surgery. Combination drug therapy is currently the most efficacious means to prevent BPH progression in terms of patient quality of life and morbidity. Successful medical management of BPH needs an integrated approach tailored to the patient’s symptoms so as to achieve a durable and sustained realistic goal.
Key words: Benign prostatic hyperplasia, LUTS, α-adrenergic blockers, 5-α-reductase inhibitors, phytotherapy, evidence-based medicine

Keywords

Benign prostatic hyperplasia, LUTS, α-adrenergic blockers, 5-α-reductase inhibitors, phytotherapy, evidence-based medicine

How to cite this article :

SINGH I. REVIEW OF MEDICAL MANAGEMENT OF BPH. Journal of Clinical and Diagnostic Research [serial online] 2007 October [cited: 2018 Nov 17 ]; 1:416-425. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2007&month=October&volume=1&issue=5&page=416-425&id=112

Introduction
Benign prostatic hyperplasia (BPH) is the non-malignant enlargement of prostate gland owing to stromal and epithelial proliferation. Hyperplasia of the prostate begins at 45 years, with the incidence increasing with age, viz. 8% of men being symptomatic at 40 years, 50% of men at 50–60 years, 70% of men at 70 years, and 100% of men at 80 years (1),(2). It is also the commonest benign neoplasm of men (3), significantly affecting the quality of lives of many men world over. Advances in the understanding of the receptors and various growth mechanisms involving the prostate and lower urinary tract symptoms (LUTS) have resulted in the emergence of medical management as a preferred initial modality to treat this condition and a consequent reduction in the need for surgery in the management of symptomatic BPH. The present manuscript attempts to holistically review and discuss the current literature, mechanistic insights, and drugs being used to medically manage the BPH disease.

MECHANISTIC INSIGHTS AND NEWER DEVELOPMENTS IN THE α-ADRENERGIC RECEPTORS
All α-adrenergic receptors (α-ARs) are G-protein-coupled trans-membrane glycoprotein receptors that mediate catecholaminergic actions in the sympathetic nervous system (act by binding to norepinephrine) (4). Based on their binding sites (prazosin ~high-affinity sites), these were initially divided into a and b subtypes; later these a-receptors were further subdivided into α1 and α2 receptors, and finally the α1-ARs were sub-classed into α1a, α1d, and α1b (current terminology). According to the International Union of Pharmacology (IUPHAR), three native α1-ARs (α1a, α1b, and α1c exist – based on their prazosin high-affinity sites – older terminology] and their cloned counterparts (α1a, α1b, α1d – new terminology) with their genomes exist on chromosomes number 8, 5, and 20.

α-AR DISTRIBUTION AND QUANTIFICATION
α1a-ARs overwhelmingly predominate in the prostatic stroma, whereas α1d-ARs are present to a lesser extent. α1b-ARs are chiefly involved in peripheral vasoconstriction. α1d-ARs are restricted to the liver, spleen, lungs, urinary bladder, spinal cord, ganglia (sacral ventral motor nucleus), and nerve terminals. Normally in the human vessels, in patients <55 years, α1a-ARs predominate, while in patients >65 years, α1b-ARs predominate. In the human urinary bladder tissue, hypertrophy after prolonged bladder outlet obstruction leads to an enhanced bladder α1d-ARs expression. Based on the RNase protection assays of the prostatic tissue, Nasu et al. has shown that the α1-ARs (α1a:α1b:α1d) in the normal human prostate exist in the ratio of 70:3:27%, which in patients of BPH changes to 85:1:14% (5).

CLINICO-PATHOLOGICAL CORRELATION OF α1-ARS WITH LUTS
Receptor distribution studies (6) reveal that 70% of the α1a-ARs are located in the bladder neck, prostate, and urethra; the α1d-receptors predominate in the bladder and sacral spinal cord and the α1b-ARs predominate in the glandular epithelium. Thus, in the human bladder (α1d > α1a) predominates, while in the prostate (α1a > α1b) prevail. This pattern of receptor distribution is in conformity with the embryology, as the bladder trigone + prostate + urethra develops from the same embryologic tissue where it mediates smooth muscle contraction, while the bladder (mesodermal derivative) has mainly α1d-ARs, which also predominate in the spinal cord (6). (Table/Fig 1) shows the distribution of α-ARs in the human bladder and prostate tissues.

(Table/Fig 3) shows a summary of the salient features of some of the clinically important landmark trials that have been carried out with α-blockers and 5-ARI drugs for the management of symptomatic BPH till date (13),(15),(37),(38), (39), (40), (41).

The MTOPS study (medical therapy of prostatic symptoms) (37) had a shortcoming in that it was not possible to conclude whether combination therapy could (i) actually prevent hospitalisation on account of AUR and (ii) whether it could be justified as a viable option for long-term therapy in patients with moderately severe LUTS. SMART-1 (symptom management after reducing therapy) (38) trial too had its lacunae: (i) it was a short-term study of a small number of patients and (ii) it lacked a placebo arm. Nevertheless, it showed that combination therapy was quite effective, and symptom deterioration following tamsulosin withdrawal was seen only in patients with prior severe symptoms.

The α-blockers currently recommended by the American Urological Association for the treatment of symptomatic BPH include doxazosin, terazosin, tamsulosin, and alfuzosin (42),(43). A recent re-analysis of the MTOPS by Roehrborn et al. concluded that medical therapy ought to be tailored to the risk status of the patient (44). They concluded that combination therapy of an α-adrenergic blocker with 5-ARI is more beneficial and effective for the therapy of patients of LUTS with demonstrable enlargement of the prostate (45) than with α-blockers alone in the long run. Patients with a prostate volume >40 ml, transition zone volume >20 ml, and serum PSA >4.0 ng/dl could be the right group of patients who could be ideally subjected to a combination therapy. Recent clinical experience with tamsulosin has also shown that it is one of the safest α-blockers capable of producing a rapid and lasting symptomatic relief of LUTS, while finasteride and dutasteride reduce the risk of AUR and BPH-related surgery (46),(47). Phase III double-blind studies have also confirmed that daily tamsulosin (0.4–0.8 mg) is effective and safe for the long-term therapy of BPH, and it is a good therapeutic alternative to surgical intervention (48). The combination of dutasteride and tamsulosin has been shown to be well tolerated, with the additional advantage of a rapid and sustained efficacy with symptomatic relief when administered over a period of time (48),(49). Further dutasteride has also been shown to hold an in vitro tumour regression property, and its role in chemoprevention of prostate cancer is being currently evaluated by an ongoing trial “Reduction by Dutasteride of Prostate Cancer Events” (REDUCE) (50). This may translate into a superior advantage of using the dual inhibitor dutasteride in place of finasteride for the management of BPH in preventing the onset of possible high-grade prostate cancer, suggesting a possible chemopreventive role in future (50),(51).

Recent evidence-based medicine (EBM) reviews have shown that 5-ARI has a significantly higher efficacy in patients with larger prostates (>40 ml). Thus, patients most likely to benefit from 5-ARI therapy are those with a large prostate and serum PSA levels >1.4 ng/dl. The favourable changes in symptom scores and flow rates tend to be maintained for at least 5 years. By inducing prostate shrinkag

Conclusion

About 15 years ago watchful waiting and surgery were the only two commonly practised therapeutic options for LUTS and bladder outflow obstruction due to BPH. Today worldwide medication has emerged as the dominant frontrunner, and the rates of TURP/surgery for BPH have drastically declined. α-Blockers are here to stay, as they have persistently shown a rapid improvement in the BPH-related LUTS uro-flow rates with minor side effects. Currently, tamsulosin and alfuzosin remain the most popularly prescribed α-blockers. Prolonged therapy with 5-α reductase inhibitors produces a relatively delayed improvement in the flow rates and a reduction in the rate of BPH progression with a durable shrinkage of 20–30% in the prostate size. Dutasteride has emerged as a popular and well-tolerated, efficient dual 5-α reductase inhibitor drug both in combination with α-blockers and in monotherapy for the larger and symptomatic BPH (55). Long-term therapy (48 months) with 5-ARIs has not shown any statistically significant increase in the overall incidence of adverse events. Combination therapy is currently the most efficacious means to prevent BPH progression. As of date no evidence exists to suggest that combination therapy is associated with any serious side effects (56).

Successful medical management of LUTS due to BPH must involve paying greater attention in detail to the monitoring of medication-related sexual side effects and following an integrated management and a holistic approach dictated by the patient symptoms and outcome goals. Tailoring of the BPH/LUTS drug management should include co-prescribing anticholinergic drugs (tolterodine) and or phosphodiesterase inhibitors (tadalafil) for selected and deserving cases of BPH syndrome associated with a proven overactive bladder and sexual dysfunction.

References

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Boyle P, Robertson C, Mazetta C, Keech M, Hobbs R, Ur Epik Study Group. The prevalence of LUTS in men and women in four centers. BJU Int 2003;92:409–14.
2.
Beckman TJ, Myderse LA. Evaluation and medical management of BPH. Mayo Clin Proc 2005;80(10):1356–62.
3.
Shabbir M, Kirby RS. Fact or fiction: what do the BPH data tell us? Curr Urol Rep 2005;6(4):243–50.
4.
Michelotti G, Price D, Schwinn D. Alpha-1 adrenergic receptor regulation: basic science and clinical implications. Phamacol Ther 2000;83:281–309.
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Nasu K, Moriyama N, Kawabe K. Quantification and distribution of alpha 1-adrenoceptor subtype mRNAs in human prostate: comparison benign hypertrophied tissue and non-hypertrophied tissue. Br J Pharmacol 1996;119:797–803.
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Zderic SA, Wein A, Rohrman D. Mechanisms of bladder smooth-muscle hypertrophy and decompensation: lessons from normal development and response to outlet obstruction. World J Urol 1998;16:350–358.
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Roehrborn CG. Alfuzosin: overview of pharmacokinetics, safety, and efficacy of a clinically uroselective alpha-blocker. Urology 2001;58:55–64.
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Seaman E, Jacobs B, Blavais J, Kaplan S. Persistence or recurrence of symptoms after TURP: a urodynamic assessment. J Urol 1994;152:935–7.
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O’Leary MP. Lower urinary tract symptoms/BPH: maintaining symptom control and reducing complications. Urology 2003;62:15–23.
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Michel MC, Grubbel B, Taguchi K, Verfurth F, Otto T, Kropfl D. Drugs for the treatment of BPH: affinity comparison at cloned alpha-1 adrenoceptor subtypes and in human prostate. J Auton Pharmacol 1996;16:21–8.
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Nieminen T, Ylitalo R, Koobi T, Ylitalo P, Kahonen M. The vasodilatory effect of alfuzosin and tamsulosin in passive orthostasis: a randomized double blind placebo-controlled study. Eur Urol 2005;47:340–5.
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Jean JMCH, Rosette DE LA, Kortmann BBM, Rossi C, Sonke GS, Floratos DL, et al. Long-term risk of re-treatment of patients using -blockers for LUTS. J Urol 2001;167:1734–9.
13.<

Tables and Figures
[Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3]

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