Our experience with the treatment of benign prostatic hyperplasia (BPH) with tamsulosin

Abstract

Background: Alpha 1-blockers decrease the tension, ease the tonus of smooth muscles and thus alleviate the voiding and storage symptoms of the lower urogenital tract.

Objectives: The goal of this study was to assess objectively the improvement of the voidings and storage difficulties in 72 randomly chosen patients suffering from Benign Prostatic Hyperplasia (BPH) prior to, and in the course of 15 months of treatment with this alpha 1-blocker in a dose of one capsule of tamsulosin daily after meal.

Methods: During the period of three years (1997-1999), we have treated and studied 72 patients suffering from lower urinary tract symptoms (LUTS). The age of the patients ranged from 55 to 80 years with the median age of 71 years. The patients were examined physically, by laboratory methods, by ultrasonography (USG) and by uroflowmetry. Anamnestic data were justified by the application of the IPSS questionnaire and blood pressure tests (BP). The eventual volume of residual urine, as well as the condition of the kidneys were checked by USG. The Qmax values were measured by uroflowmetry prior to, and during treatment (0-3 weeks--6 months). We have continued with this treatment even after 6 months, but we have discontinued the biochemical, haematological and uroflowmetrical assessments. On the other hand, we have continued with quarterly examinations of urine, digital rectal examinations (DRE), measuring of BP and IPSS evaluation. PSA was checked at least once a year. Our patients were checked in this way for 12 to 18 months (median of 15 months). One capsule of tamsulosin was administered daily after meal.

Results: The prostatoselective alpha 1-blocker tamsulosin is a well-tolerated medication applied in the treatment of BPH. We did not have to discontinue the treatment with any of the patients during the 15 months of assessment. It is equally well tolerated at a dose of one capsule of tamsulosin daily, administered after the morning or evening meal without any orthostatic defect symptomatology. The quality of life has improved by three symptomatic units; the blood pressure remained practically unchanged, the IPSS score for BPH decreased by 6.8 score and the Qmax was upgraded from 10.1 ml/s to 14.9 ml/s. This finding remained practically unchanged during the 15 months of assessment and later.

Conclusion: In the course of the recent years, the conservative treatment of BPH by phytotherapeutics but mainly by alpha 1-blockers have resulted in a considerable reduction of transurethral resections of the prostate (TURP), and of the transvesical "open" prostatectomy (PE open). This reduction down to 50% can be observed nearly all over the world. The presence of alpha 1-a, alpha 1-b, alpha 1-d receptors in the lower urinary tract is a good prerequisite for successful treatment of voiding and storage symptoms. In the assessment of the effects of a 15-month continuous treatment by tamsulosin, we have registered a considerable improvement in the quality of life (QOL), an increase in the Qmax, and decrease in the IPSS score. The age of patients under or over 60 years as well as their weight did not play significant roles. We have not registered any interaction with other medications generally used by older patients. (Ref. 30.)