α₁-Blocker therapy in the nineties: focus on the disease

Abstract

Therapy for benign prostatic hyperplasia has evolved rapidly over the last decade, with the introduction in the early 1990s of new agents such as α₁-blockers and 5α-reductase inhibitors. The major advantage of α₁-blockers over 5α-reductase inhibitors is their rapid onset of action. Maximum flow rate is improved after first administration and optimal symptom relief is usually reached within 2–3 months. In addition, α₁-blockers are effective regardless of prostate size and they provide a similar degree of symptom relief in patients with or without bladder outlet obstruction. The main adverse events with the α₁-blockers relate to their effects on the cardiovascular system (postural hypotension) and central penetration (asthenia, somnolence). Newer uroselective α₁-blockers, such as alfuzosin and tamsulosin, have a better safety profile and, as such, do not require initial dose titration. Alfuzosin has also been shown in a six-month study to significantly reduce both residual urine and the incidence of acute urinary retention (AUR) compared with placebo. In addition, alfuzosin is effective in improving the success rate of a trial without catheter in patients with AUR.