Lower urinary tract symptoms/benign prostatic hyperplasia: maintaining symptom control and reducing complications

Because the average patient with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), or LUTS/BPH, has a remaining life expectancy of 15 to 20 years, both short-term and long-term outcomes matter in the management of LUTS/BPH. Sustained symptom control and improvement of quality of life (QOL), control of disease progression (ie, prevention or reduction of bladder wall hypertrophy [BWH]/increased bladder mass and reduction of the risk of serious complications), and minimization of the need to switch to other medical therapy or surgery are important. In this respect, alpha(1)-adrenoceptor antagonists, such as tamsulosin, have been shown to provide effective and rapid relief of symptoms and improvement in QOL, which is sustained in the long term (up to 6 years). Obstruction may, in the long term, induce changes in the bladder wall (eg, BWH), which may result in (irreversible) bladder damage and serious complications. Preliminary data suggest that alpha(1)-adrenoceptor antagonists prevent the development of BWH in rabbits and reduce existing BWH in obstructed LUTS/BPH patients. Pooled analyses and indirect comparisons of clinical studies up to 1 year have shown that alpha(1)-adrenoceptor antagonists, such as tamsulosin, reduce the risk of acute urinary retention and the need for surgery to at least the same extent as the 5alpha-reductase inhibitor finasteride. In addition, monotherapy with an alpha(1)-adrenoceptor antagonist reduces the risk of long-term clinical progression; the combination with finasteride may be more beneficial in patients at high risk (patients with large prostate volume, high level of prostate-specific antigen, high International Prostate Symptom Score, high postvoid residual amount, and low maximum flow rate). Therefore, alpha(1)-adrenoceptor antagonists, such as tamsulosin, are first-line therapy, not only in the short term but also in the long-term management of LUTS/BPH.