A 69-year-old man is started on tamsulosin for benign prostatic hyperplasia. Which one of the following best describes the side-effects he may experience?
A. Urgency + insomnia
B. Dizziness + postural hypotension
C. Urinary retention + nausea
D. Urgency + erectile dysfunction
E. Erectile dysfunction + reduced libido
Answer:
B. Dizziness + postural hypotension
Discussion:
Benign prostatic hyperplasia:
Benign prostatic hyperplasia (BPH) is a common condition seen in older men.
Risk factors include:
- Age: around 50% of 50-year-old men will have evidence of BPH and 30% will have symptoms. Around 80% of 80-year-old men have evidence of BPH.
- Ethnicity: black > white > Asian
Clinical Features: BPH typically presents with lower urinary tract symptoms (LUTS), which may be categorised into:
- voiding symptoms (obstructive): weak or intermittent urinary flow, straining, hesitancy, terminal dribbling and incomplete emptying
- storage symptoms (irritative) urgency, frequency, urgency incontinence and nocturia
- post-micturition: dribbling
- complications: urinary tract infection, retention, obstructive uropathy
Management:
1. Watchful waiting and symptommatic treatment.
2. Medication: alpha-1 antagonists, 5 alpha-reductase inhibitors. The use of combination therapy was supported by the Medical Therapy Of Prostatic Symptoms (MTOPS) trial
3.Surgery: transurethral resection of prostate (TURP)
Alpha-1 antagonists e.g. tamsulosin, alfuzosin
decrease smooth muscle tone (prostate and bladder)
considered first-line, improve symptoms in around 70% of men
adverse effects: dizziness, postural hypotension, dry mouth, depression
5 alpha-reductase inhibitors e.g. finasteride
block the conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH unlike alpha-1 antagonists causes a reduction in prostate volume and hence may slow disease progression. This however takes time and symptoms may not improve for 6 months. They may also decrease PSA concentrations by up to 50%
adverse effects: erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
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