[Therapy of benign prostatic hyperplasia with alpha receptor blockers]

Abstract

The therapeutic efficacy of alpha-blockers in disorders of bladder emptying has been known for 20 years. Substantial side effects initially prevented their wide use in benign prostatic hyperplasia. The situation has changed with the development of the very much better tolerated selective alpha 1-adrenoceptor antagonists. In numerous countries, alpha 1-blockers are also licensed for use in the treatment of benign prostatic hyperplasia in addition to the main indication, vascular hypertension. Of those available in Germany, the slow-acting antihypertensive agents terazosin and doxazosin are the most suitable for use in this condition. The modern alpha 1-blockers have proved their effectiveness in large-scale placebo-controlled studies. However, the effects consist solely in improvement of the subjective symptoms and a moderate increase of urinary flow and are not comparable to those achieved with transurethral resection. alpha 1-Blockers are indicated in patients with moderate to fairly severe symptomatic benign prostatic hyperplasia (as an alternative, for example, to phytotherapeutic agents) and in patients who have severe symptoms but for whom surgical treatment is not desired, needs to be postponed or is contraindicated. Side effects arise from the concomitant vasodilatation, so that contraindications for alpha-blockers are cardiac and renal failure, a prior history of cerebrovascular incidents and a tendency to hypotension. Further attenuation of these side effects appears possible with the future development of "uroselective" alpha 1-blockers.