What Is the Most Common Benign Prostatic Hyperplasia Treatment?

Benign prostatic hyperplasia (BPH) is a common and frequently-occurring disease in elderly men. BPH mainly occurs in the periurethral or transitional region of the prostate. The pathogenesis is not fully understood. Testosterone, dihydrotestosterone, and estrogen may participate in the formation of BPH. . BPH is mainly manifested by the proliferation of interstitial and glandular components of the prostate, enlarged prostate, lower urinary tract symptom (LUTS), and obstruction of bladder outlet. BPH is one of the most common benign diseases that causes dysuria in middle-aged and older men. It progresses slowly. The disease progresses mainly as comorbidities such as exacerbation of lower urinary tract symptoms, acute urinary retention and renal impairment. At present, there are three main categories of drugs for treating benign prostatic hyperplasia: 5-reductase inhibitors, such as finasteride; -receptor blockers, such as terazosin hydrochloride and doxazosin mesylate. Etc .; plant preparations and traditional Chinese medicines, such as Pu Shi Tai.

Benign prostatic hyperplasia (BPH) is a common and frequently-occurring disease in elderly men. It is mainly manifested by the proliferation of interstitial and glandular components of the prostate, enlarged prostate, lower urinary tract symptom (LUTS), and Obstruction of bladder outlet. BPH is the most common benign disease that causes dysuria in middle-aged and older men. BPH is a benign disease that progresses slowly. The progress of the disease is mainly manifested by complications such as exacerbation of lower urinary tract symptoms, acute urinary retention and renal impairment.

Patients with mild lower urinary tract symptoms and moderate symptoms and quality of life that have not been clearly affected can observe the progress of the disease, and the disease will eventually require surgical treatment. The short-term goal of BPH drug therapy is to alleviate lower urinary tract symptoms, and the long-term goal is to delay disease progression and prevent comorbidities. The overall goal is to reduce the side effects of drugs while maintaining a high quality of life. ^[1]

Drugs for benign prostatic hyperplasia

At present, there are three main categories of drugs for treating benign prostatic hyperplasia: 5-reductase inhibitors, such as finasteride; -receptor blockers, such as terazosin hydrochloride and doxazosin mesylate. Etc .; plant preparations and traditional Chinese medicines, such as Pu Shi Tai. 5-reductase inhibitors and -receptor blockers are commonly used clinically, either alone or in combination.

1.5 - Benign Prostatic Hyperplasia 1.5 Alpha-reductase inhibitor

5-reductase inhibitors can inhibit the 5-reductase required for the conversion of testosterone into dihydrotestosterone, inhibit the production of dihydrotestosterone, thereby reducing the content of dihydrotestosterone in the prostate, and reduce the volume of the prostate and improve dysuria. . 5-reductase has two types of isoenzymes: Type I is mainly distributed in tissues outside the prostate (such as skin and liver), and type II plays a major role in the prostate. 5-reductase inhibitors can be divided into two categories, competitive and non-competitive. Finasteride is a competitive type II 5-reductase-specific inhibitor, elistigide is a non-competitive type II reductase inhibitor, and dutasteride is a competitive dual blocker (inhibits type I and type II ).

5-reductase inhibitors are suitable for patients with BPH who have a large prostate and / or elevated serum prostate specific antigen (PSA) levels in patients with moderate to severe and high risk of progression. The advantage is that long-term use can reduce the risk of acute urinary retention and the need for surgical treatment in BPH patients, and delay the disease progression. 5-reductase inhibitors have a relatively slow onset of time, and need to be continuously used for 6-12 months to obtain the maximum effect. Symptoms recur after discontinuation, and long-term medication is required to maintain the effect. Common adverse reactions of 5-reductase inhibitors include erectile dysfunction, abnormal ejaculation, and low libido. Other adverse reactions include feminization of male breasts, breast pain, and rash. Current studies have shown that finasteride and dutasteride are similar in clinical efficacy, with dutasteride causing higher sexual function-related adverse reactions and breast pain than finasteride. ^[2]

2. Drugs for benign prostatic hyperplasia 2. Alpha adrenergic blockers

Alpha-adrenergic blockers, by blocking the adrenergic receptors (mainly 1-receptors) distributed on the surface of the prostate and bladder neck smooth muscle, relax the smooth muscles, and alleviate the dynamic obstruction of bladder outlet. The currently used drug is a selective 1-receptor blocker, which is suitable for BPH patients with lower urinary tract symptoms. 1-receptors include three subtypes of 1A, 1B, and 1D. The prostate and urethra are predominantly 1A. Blocking 1A receptors can improve symptoms of micturition and increase the rate of urinary flow. In the bladder detrusor, 1D is predominant. Blocking 1D receptors can improve symptoms during storage.

The first generation was a non-selective alpha blocker, and the representative drug was phenoxybenzamine. The main feature is that it can increase the urine flow rate and reduce the residual urine volume. Most patients have improved symptoms after taking the drug, but because the 2 receptor in vascular smooth muscle is blocked at the same time, adverse reactions are mostly blocked by peripheral and brain receptors. Related, mainly showing symptoms of headache, dizziness, fatigue, orthostatic hypotension, etc., are now less commonly used.

The second generation is a selective 1 receptor blocker, the representative drugs are doxazosin, afurazosin, terazosin, prazosin. Selective 1 receptor blockers work quickly, can reduce symptoms within a short time after treatment, can effectively relax the smooth muscles of the bladder neck and prostate without affecting the function of detrusor muscles, and can quickly release BPH. Obstruction symptoms are the drug of choice for patients with benign prostatic hyperplasia who need to reduce their symptoms quickly. Secondly, whether or not there is obstruction of the bladder outlet, the application of 1 blockers can alleviate the symptoms. Doxazosin has a lower blood pressure effect than terazosin, and fatigue, dizziness, headache, drowsiness, orthostatic hypotension are slightly higher than terazosin. Prazosin has obvious side effects on the cardiovascular and central nervous system, short-acting, and has rarely been used clinically. Alfurazosin is also a short-acting preparation, which is inconvenient for patients, and its use is limited.

The third generation is a highly selective 1 receptor blocker, which represents the drugs tamsulosin and nefidil. When treating BPH, it has less effect on alpha receptors in other parts of the body, and has a longer half-life. Adverse reactions are similar to placebo and have a small effect on blood pressure. Its advantages are small doses, good symptoms relief, and body tolerance better.

Alpha 1-blockers have the advantage that symptoms can be improved within hours to days after treatment without affecting prostate volume and serum PSA levels. The selectivity of 1-receptor subtypes and pharmacokinetic factors influence the incidence of adverse reactions. Common adverse reactions include dizziness, headache, fatigue, orthostatic hypotension. Orthostatic hypotension is more likely to occur in older people, patients with cardiovascular disease, or colleagues taking vasoactive drugs. Orthostatic hypotension can be prevented by starting with small doses, slowly increasing doses, and avoiding sudden changes in position. Patients taking alpha1-blockers may experience iris relaxation syndrome when undergoing cataract surgery, so discontinuation is recommended.

3.M Benign prostate hyperplasia medication 3.M receptor antagonist

M receptor antagonists selectively affect the bladder, block the binding of acetylcholine to the M receptor that mediates detrusor contraction, and inhibit the involuntary contraction of detrusor muscles, thereby improving the bladder's urine storage function. There are five known M receptor subtypes in humans, of which M2 and M3 are expressed in detrusor muscles. M receptor antagonists are divided into non-selective and selective. Commonly used in China are tolterodine (non-selective M receptor antagonist) and solinacin (selective M3 receptor antagonist).

BPH patients with urinary urgency and frequent urinary storage symptoms, M receptor antagonists can be used alone. Due to the risk of acute urinary retention, it is necessary to closely follow up the changes in residual urine volume.

The main adverse reactions of M-receptor antagonists include dry mouth, dizziness, constipation, dysuria, and blurred vision, which mostly occur within 2 weeks of treatment and in patients> 66 years of age. M-receptor antagonists should be used with caution in patients with high risk of acute urinary retention; they should be disabled when the detrusor is weak. Urinary retention, gastric retention, narrow-angle glaucoma, and those allergic to M receptor antagonists are contraindicated.

3. Drugs for benign prostatic hyperplasia 3. Plant preparations and Chinese medicine

3.1 Medications for Benign Prostatic Hyperplasia 3.1 Plant-Based Preparations

It mainly refers to pollen preparations and plant extracts, which have non-specific anti-inflammatory, anti-edema, promotion of bladder detrusor contraction and urethral smooth muscle relaxation. ^{[3] The} most widely used in clinical applications are alprox (Pulean), Seneton and so on. Plant preparations are suitable for the treatment of BPH, but the mechanism of action of plant preparations is complex, and it is difficult to judge the correlation between the biological activity and efficacy of specific ingredients. Large-scale randomized controlled clinical research based on evidence-based medicine is of positive significance to further promote the clinical application of plant preparations in BPH treatment. ^[2]

3.2 Benign Prostatic Hyperplasia 3.2 Traditional Chinese Medicine

BPH syndromes are relatively concentrated, with kidney yang failure, kidney deficiency, blood stasis, lung heat, and midair depression as the main syndromes. Tonic medicines, tonifying blood and relieving symptoms, and tonic medicines ranked the top three. Buyang medicine ranks first, accounting for 12.19%. Epimedium and Morinda officinalis are commonly used medicines, and the more frequently used drugs for spleen and blood relieving are Xizhu, Sanling, and Pangolin. It can be seen that yang deficiency and blood stasis are the main pathogenesis of BPH. Yang deficiency and coldness are endogenous, and cold coagulation and stagnation lead to poor blood flow and blood stasis. The preferred treatment for disease. Qi-enhancing drugs are in the second place. Usually, Qi-deficiency pathology is ahead, and qi-deficiency causes yang deficiency for a long time, which promotes blood circulation weakness and leads to internal resistance of bruises, which can lead to the occurrence of BPH ^[4] . Guizhi Fuling Capsule is composed of Guizhi, Poria, Paeonia lactiflora, Moutan bark, and peach kernel.Prostatic hyperplasia belongs to the category of traditional Chinese medicine. Mostly due to the dysfunction of the lungs, spleen and kidneys, the bladder and the triple coke are unfavorable, resulting in urine excretion. Difficulties or even inaccessibility are the main clinical manifestations.

Benign benign prostatic hyperplasia medication II. Adverse reactions to benign prostatic hyperplasia medication

Treatment of benign prostatic hyperplasia requires the simultaneous application of an alpha-blocker (such as terazosin hydrochloride or doxazosin mesylate) and a 5 alpha-reductase inhibitor (finasteride). This study found that the incidence of adverse drug reactions and first-dose effects of -receptor blockers was higher than that of 5-reductase inhibitors, with terazosin hydrochloride having the highest incidence of adverse reactions. 5-reductase inhibitors have a lower incidence of adverse drug reactions ^[5] . The new dual 5ARI dutasteride can significantly and long-term inhibit the production of DHT in the blood and prostate, and is effectively used to treat benign prostatic hyperplasia, and has shown good safety and tolerance. In terms of adverse reactions, it is worth paying full attention to: impotence, decreased sexual desire, male breast development and ejaculation disorders, etc. ^[6] . If adverse drug reactions occur, the medication regimen should be adjusted in a timely manner.