Lower urinary tract symptoms/benign prostatic hyperplasia: fast control of the patient's quality of life

Fast control of bothersome symptoms and improvement in the patient's quality of life (QOL) are important treatment goals in lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia. Although voiding symptoms are most common, storage symptoms are most bothersome, interfere the most with daily life activities, and have a major effect on QOL. alpha(1)-Adrenoceptor antagonists, such as tamsulosin, improve the most bothersome storage symptoms to roughly the same extent as transurethral resection of the prostate (TURP), whereas the effect on voiding symptoms is slightly less. This may be because tamsulosin relieves storage symptoms as quickly and to the same extent as voiding symptoms, whereas TURP improves storage symptoms to a lesser extent and/or more slowly than voiding symptoms. In addition, alpha(1)-adrenoceptor antagonists have a more rapid onset of action and seem to be slightly more effective in improving LUTS, its bothersomeness, and QOL than 5alpha-reductase inhibitors, such as finasteride. It also seems that alpha(1)-adrenoceptor antagonists have a more rapid onset of action than the plant extract Serenoa repens. Because the alpha(1A)/alpha(1D)-adrenoceptor antagonist tamsulosin has a low risk for symptomatic orthostatic hypotension, it can be initiated at its full therapeutic dose immediately at the start of therapy. This enables faster relief of bothersome LUTS than non-subtype-selective alpha(1)-adrenoceptor antagonists that require dose titration to their full therapeutic dose. In the long term, adding finasteride to an alpha(1)-adrenoceptor antagonist may be beneficial in high-risk patients, but adding S repens does not seem to provide any additional benefit (up to 1 year). In conclusion, monotherapy with an alpha(1A)/alpha(1D)-adrenoceptor antagonist, such as tamsulosin, provides very effective and rapid relief of bothersome LUTS and so enables a rapid improvement of the patient's QOL.