Der Urologe

, Volume 51, Issue 8, pp 1125–1136 | Cite as

Medikamentöse Therapie des benignen Prostatasyndroms

  • F. Strittmatter
  • S. Madersbacher
  • C.G. Stief
  • C. Gratzke
CME Zertifizierte Fortbildung

Zusammenfassung

Die medikamentöse Behandlung eines Patienten mit benignem Prostatasyndrom (BPS) ist nach Ausschluss strenger Operationsindikationen bei mäßigen bis schweren Symptomen des unteren Harntrakts indiziert. Die Differenzierung von Speicher- und Entleerungsstörungen dient der Wahl der einzelnen Wirkstoffe, die an das individuelle Risikoprofil des Patienten angepasst werden sollte. Primäre Ziele sind die Verbesserung der subjektiven Beschwerden sowie eine Reduktion des Progressionsrisikos. Damit sollen die Lebensqualität gebessert und Komplikationen, wie das Eintreten eines akuten Harnverhalts, oder BPS-bedingte Operationen verhindert werden. Als Goldstandard werden α1-Adrenozeptor-Blocker und 5α-Reduktase-Inhibitoren sowie deren Kombination angesehen. Außerdem kommen bei Patienten mit vorwiegenden Speicherstörungen zunehmend Anticholinergika als Monotherapie oder in Kombination mit α-Blockern zum Einsatz, während Phosphodiesterase-5-Hemmer ihr primäres Einsatzgebiet wohl bei Patienten mit BPS und erektiler Dysfunktion finden werden.

Schlüsselwörter

Symptome des unteren Harntrakts Benigne Prostatahyperplasie α1-Blocker 5α-Reduktase-Inhibitoren Anticholinergika Phytotherapie 

Medicinal therapy of benign prostate syndrome

Abstract

Male lower urinary tract symptoms (LUTS) include storage and voiding disorders and should be carefully evaluated before the start of any treatment. Medical therapy is directed at improving symptoms and reducing the risk of progression in order to improve quality of life and prevent complications, such as acute urinary retention, or the need for surgical intervention. Careful assessment of the individual complaints helps to identify the best drug which should be adapted to each individual patient’s risk profile. At present, α1-adrenoreceptor inhibitors and 5-alpha reductase inhibitors and their combination form the gold standard for pharmacological treatment. In addition, anticholinergic agents are increasingly being used as monotherapy or in combination with α1-adrenocepetor inhibitors for patients with predominant storage disorders while phosphodiesterase 5 (PDE5) inhibitors may be suitable for patients suffering from LUTS and concomitant erectile dysfunction.

Keywords

Lower urinary tract symptoms Benign prostatic hyperplasia α1 blocker 5α reductase inhibitors Cholinergic antagonists Phytotherapy 

Literatur

  1. 1.
    Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49(4):651–658PubMedCrossRefGoogle Scholar
  2. 2.
    McConnell JD, Roehrborn CG, Bautista OM et al (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349(25):2387–2398PubMedCrossRefGoogle Scholar
  3. 3.
    Berges R (2008) Epidemiology of benign prostatic syndrome. Associated risks and management data in German men over age 50. Urologe A 47(2):141–148PubMedCrossRefGoogle Scholar
  4. 4.
    Berges R, Dreikorn K, Höfner K et al (2009) Therapy of benign prostate syndrome (BPS): guidelines of the German Urologists (DGU). Urologe A 48(12):1503–1516PubMedCrossRefGoogle Scholar
  5. 5.
    Edwards JL (2008) Diagnosis and management of benign prostatic hyperplasia. Am Fam Physician 77(10):1403–1410PubMedGoogle Scholar
  6. 6.
    Madersbacher S, Alivizatos G, Nordling J et al (2004) EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol 46(5):547–54PubMedCrossRefGoogle Scholar
  7. 7.
    Wilt T, Ishani A, MacDonald R et al (2000) Beta-sitosterols for benign prostatic hyperplasia. Cochrane Database Syst Rev (2):CD001043Google Scholar
  8. 8.
    Wilt T, Mac Donald R, Ishani A et al (2000) Cernilton for benign prostatic hyperplasia. Cochrane Database Syst Rev (2):CD001042Google Scholar
  9. 9.
    Sokeland J, Albrecht J (1997) Combination of Sabal and Urtica extract vs. finasteride in benign prostatic hyperplasia (Aiken stages I to II). Comparison of therapeutic effectiveness in a one year double-blind study. Urologe A 36(4):327–333PubMedCrossRefGoogle Scholar
  10. 10.
    Barry MJ, Meleth S, Lee JY et al (2011) Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA 306(12):1344–1351PubMedCrossRefGoogle Scholar
  11. 11.
    Michel MC, Vrydag W (2006) Alpha1-, alpha2- and beta-adrenoceptors in the urinary bladder, urethra and prostate. Br J Pharmacol 147(Suppl 2):88–119CrossRefGoogle Scholar
  12. 12.
    Kortmann BB, Floratos DL, Kiemeney LA et al (2003) Urodynamic effects of alpha-adrenoceptor blockers: a review of clinical trials. Urology 62(1):1–9PubMedCrossRefGoogle Scholar
  13. 13.
    Murata S, Taniguchi T, Takahashi M et al (2000) Tissue selectivity of KMD-3213, an alpha(1)-adrenoreceptor antagonist, in human prostate and vasculature. J Urol 164(2):578–583PubMedCrossRefGoogle Scholar
  14. 14.
    Barendrecht MM, Abrams P, Schumacher H et al (2008) Do alpha1-adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance? Neurourol Urodyn 27(3):226–230PubMedCrossRefGoogle Scholar
  15. 15.
    Andersson KE, Gratzke C (2007) Pharmacology of alpha1-adrenoceptor antagonists in the lower urinary tract and central nervous system. Nat Clin Pract Urol 4(7):368–378PubMedCrossRefGoogle Scholar
  16. 16.
    Strittmatter F, Hedlund P (2011) Silodosin: pharmacological and clinical features. Aging Health 7(1):45–57CrossRefGoogle Scholar
  17. 17.
    Djavan B, Chapple C, Milani S et al (2004) State of the art on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology 64(6):1081–1088PubMedCrossRefGoogle Scholar
  18. 18.
    Kerrebroeck P van, Jardin A, Laval KU et al (2000) Efficacy and safety of a new prolonged release formulation of alfuzosin 10 mg once daily versus alfuzosin 2,5 mg thrice daily and placebo in patients with symptomatic benign prostatic hyperplasia. ALFORTI Study Group. Eur Urol 37(3):306–313PubMedCrossRefGoogle Scholar
  19. 19.
    MacDonald R, Wilt TJ (2005) Alfuzosin for treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia: a systematic review of efficacy and adverse effects. Urology 66(4):780–788PubMedCrossRefGoogle Scholar
  20. 20.
    Wilt TJ, Howe RW, Rutks IR, MacDonald R (2002) Terazosin for benign prostatic hyperplasia. Cochrane Database Syst Rev (4):CD003851Google Scholar
  21. 21.
    Wilt TJ, Mac Donald R, Rutks I (2003) Tamsulosin for benign prostatic hyperplasia. Cochrane Database Syst Rev (1):CD002081Google Scholar
  22. 22.
    Michel MC, Mehlburger L, Bressel HU, Goepel M (1998) Comparison of tamsulosin efficacy in subgroups of patients with lower urinary tract symptoms. Prostate Cancer Prostatic Dis 1(6):332–335PubMedCrossRefGoogle Scholar
  23. 23.
    Nickel JC, Sander S, Moon TD (2008) A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia. Int J Clin Pract 62(10):1547–1559PubMedCrossRefGoogle Scholar
  24. 24.
    Barendrecht MM, Koopmans RP, Rosette JJ de la, Michel MC (2005) Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: the cardiovascular system. BJU Int 95(Suppl 4):19–28PubMedCrossRefGoogle Scholar
  25. 25.
    Dijk MM van, Rosette JJ de la, Michel MC (2006) Effects of alpha(1)-adrenoceptor antagonists on male sexual function. Drugs 66(3):287–301PubMedCrossRefGoogle Scholar
  26. 26.
    Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 31(4):664–673PubMedCrossRefGoogle Scholar
  27. 27.
    Andriole G, Bruchovsky N, Chung LW et al (2004) Dihydrotestosterone and the prostate: the scientific rationale for 5alpha-reductase inhibitors in the treatment of benign prostatic hyperplasia. J Urol 172(4 Pt 1):1399–1403PubMedCrossRefGoogle Scholar
  28. 28.
    Naslund MJ, Miner M (2007) A review of the clinical efficacy and safety of 5alpha-reductase inhibitors for the enlarged prostate. Clin Ther 29(1):17–25PubMedCrossRefGoogle Scholar
  29. 29.
    Nickel JC, Gilling P, Tammela TL et al (2011) Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int 108(3):388–394PubMedCrossRefGoogle Scholar
  30. 30.
    Lepor H, Williford WO, Barry MJ et al (1996) The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N Engl J Med 335(8):533–539PubMedCrossRefGoogle Scholar
  31. 31.
    Kirby RS, Roehrborn C, Boyle P et al (2003) 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 61(1):119–126PubMedCrossRefGoogle Scholar
  32. 32.
    Roehrborn CG, Lukkarinen O, Mark S et al (2005) Long-term sustained improvement in symptoms of benign prostatic hyperplasia with the dual 5alpha-reductase inhibitor dutasteride: results of 4-year studies. BJU Int 96(4):572–577PubMedCrossRefGoogle Scholar
  33. 33.
    Roehrborn CG (2008) BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int 101(Suppl 3):17–21PubMedCrossRefGoogle Scholar
  34. 34.
    Thompson IM, Goodman PJ, Tangen CM et al (2003) The influence of finasteride on the development of prostate cancer. N Engl J Med 349(3):215–224PubMedCrossRefGoogle Scholar
  35. 35.
    Andriole GL, Bostwick DG, Brawley OW et al (2010) Effect of dutasteride on the risk of prostate cancer. N Engl J Med 362(13):1192–1202PubMedCrossRefGoogle Scholar
  36. 36.
    Chess-Williams R, Chapple CR, Yamanishi T et al (2001) The minor population of M3-receptors mediate contraction of human detrusor muscle in vitro. J Auton Pharmacol 21(5–6):243–248Google Scholar
  37. 37.
    Höfner K, Burkart M, Jacob G, Jonas U (2007) Safety and efficacy of tolterodine extended release in men with overactive bladder symptoms and presumed non-obstructive benign prostatic hyperplasia. World J Urol 25(6):627–633PubMedCrossRefGoogle Scholar
  38. 38.
    Roehrborn CG, Kaplan SA, Kraus SR et al (2008) Effects of serum PSA on efficacy of tolterodine extended release with or without tamsulosin in men with LUTS, including OAB. Urology 72(5):1061–1067PubMedCrossRefGoogle Scholar
  39. 39.
    Kaplan SA, Walmsley K, Te AE (2008) Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol 179(5 Suppl):82–85CrossRefGoogle Scholar
  40. 40.
    Abrams P, Kaplan S, De Koning Gans HJ, Millard R (2006) Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 175(3 Pt 1):999–1004PubMedCrossRefGoogle Scholar
  41. 41.
    Herschorn S, Jones JS, Oelke M et al (2010) Efficacy and tolerability of fesoterodine in men with overactive bladder: a pooled analysis of 2 phase III studies. Urology 75(5):1149–1155PubMedCrossRefGoogle Scholar
  42. 42.
    Roehrborn CG, Siami P, Barkin J et al (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol 57(1):123–131PubMedCrossRefGoogle Scholar
  43. 43.
    Nickel JC, Barkin J, Koch C et al (2008) Finasteride monotherapy maintains stable lower urinary tract symptoms in men with benign prostatic hyperplasia following cessation of alpha blockers. Can Urol Assoc J 2(1):16–21PubMedGoogle Scholar
  44. 44.
    Kaplan SA, Roehrborn CG, Rovner ES et al (2006) Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 296(19):2319–2328PubMedCrossRefGoogle Scholar
  45. 45.
    Kaplan SA, Walmsley K, Te AE (2005) Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol 174(6):2273–2275PubMedCrossRefGoogle Scholar
  46. 46.
    Athanasopoulos A, Gyftopoulos K, Giannitsas K et al (2003) Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol 169(6):2253–2256PubMedCrossRefGoogle Scholar
  47. 47.
    Kedia GT, Uckert S, Jonas U et al (2008) The nitric oxide pathway in the human prostate: clinical implications in men with lower urinary tract symptoms. World J Urol 26(6):603–609PubMedCrossRefGoogle Scholar
  48. 48.
    Uckert S, Oelke M, Stief CG et al (2006) Immunohistochemical distribution of cAMP- and cGMP-phosphodiesterase (PDE) isoenzymes in the human prostate. Eur Urol 49(4):740–745PubMedCrossRefGoogle Scholar
  49. 49.
    Oelke M, Giuliano F, Mirone V et al (2012) Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Eur Urol 61(5):917–925PubMedCrossRefGoogle Scholar
  50. 50.
    Gacci M, Corona G, Salvi M et al (2012) A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with α-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 61(5):994–1003PubMedCrossRefGoogle Scholar
  51. 51.
    Kaplan SA, Gonzalez RR, Te AE (2007) Combination of alfuzosin and sildenafil is superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. Eur Urol 51(6):1717–1723PubMedCrossRefGoogle Scholar
  52. 52.
    Bechara A, Romano S, Casabé A et al (2008) Comparative efficacy assessment of tamsulosin vs. tamsulosin plus tadalafil in the treatment of LUTS/BPH. Pilot study. J Sex Med 5(9):2170–2178PubMedCrossRefGoogle Scholar
  53. 53.
    Liguori G, Trombetta C, De Giorgi G et al (2009) Efficacy and safety of combined oral therapy with tadalafil and alfuzosin: an integrated approach to the management of patients with lower urinary tract symptoms and erectile dysfunction. Preliminary report. J Sex Med 6(2):544–552PubMedCrossRefGoogle Scholar
  54. 54.
    Tuncel A, Nalcacioglu V, Ener K et al (2010) Sildenafil citrate and tamsulosin combination is not superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. World J Urol 28(1):17–22PubMedCrossRefGoogle Scholar
  55. 55.
    Kerrebroeck P van, Rezapour M, Cortesse A et al (2007) Desmopressin in the treatment of nocturia: a double-blind, placebo-controlled study. Eur Urol 52(1):221–229PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • F. Strittmatter
    • 1
  • S. Madersbacher
    • 2
  • C.G. Stief
    • 1
  • C. Gratzke
    • 1
  1. 1.Urologische Klinik und PoliklinikKlinikum der Universität München-Großhadern MünchenDeutschland
  2. 2.Donauspital WienWienÖsterreich

Personalised recommendations