Notes for: Drugs For Urinary RetentionLast edited [04/07/2012 09:42:05]
Algorithm
Guidelines for the management of lower urinary tract symptoms in men have been issued by the British Association of Urological Surgeons (BAUS). There are differences in interpretation around the identification of men at high risk of progression. Some reflect that the greatest benefit was seen in men with prostatic volume > 40 mL or PSA > 4 nanograms / mL whereas BAUS guidelines reflect the inclusion criteria of the MTOPS trial of prostatic volume > 30 mL or PSA > 1.4 nanograms / mL.
Last edited [21/08/2013 15:42:37]
1. Alpha-blockers are particularly suitable when rapid relief of symptoms is required and for patients with a smaller prostate. There is a high placebo effect with alpha blockers and it is suggested that the drug is stopped after 3 - 4 months to see if therapy needs to continue.
2. Finasteride often requires six months therapy before maximal symptomatic improvement is observed. Finasteride, which is included in section 6.4.2, is particularly suitable for those patients with a larger prostate as it causes shrinkage of prostatic glandular tissue.
3. The Medical Therapy for Prostatic Symptoms (MTOPS) study provides evidence that treating men with a combination of finasteride and doxazosin reduces their risk of disease progression. Whilst in most cases progression of disease is simply a worsening of symptoms over time, some men go on to suffer complications such as urinary retention or otherwise require surgical intervention. The reduction in risk to progression of these major events was reduced more in men with prostatic volumes > 40 mL or PSA > 4 nanograms / mL. Hence combination therapy with alpha blockers is appropriate in patients at high risk of clinical progression such as patients with prostatic volumes > 40 mL or PSA > 4 nanograms / mL. The incidence of side effects is greater when combination therapy is used but in these men these risks may be outweighed by the benefit gained. An attempt to withdraw the alpha blocker may be made at 6 - 12 months and finasteride continued as monotherapy. If symptoms recur the alpha blocker can be restarted. One further attempt to withdraw the alpha blocker 6 months later would be appropriate.
4. Xatral® XL (alfuzosin) and modfied release tamsulosin capsules are reserved for patients unable to tolerate the side-effects of the less selective agents.