Lower urinary tract symptoms/benign prostatic hyperplasia: minimizing morbidity caused by treatment

The beneficial effects of treatment for lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), or LUTS/BPH, have to be balanced against the morbidity associated with treatment. Invasive surgery, such as transurethral resection of the prostate, has been associated with irreversible complications (eg, impotence and retrograde ejaculation). Alpha(1)-adrenoceptor antagonists provide effective and fast relief of LUTS/BPH. In contrast to finasteride, they are not associated with sexual dysfunction (eg, decreased libido or impotence). Alpha(1)-adrenoceptor antagonists induce adverse events associated with interference with blood pressure regulation. The alpha(1A)/alpha(1D)-adrenoceptor antagonist tamsulosin has the lowest potential to interfere with blood pressure regulation and induce related adverse events. In addition, tamsulosin seems to be as well tolerated as phytotherapy, except for a higher incidence of abnormal ejaculation. Abnormal ejaculation occurs in 4% to 11% of patients receiving a alpha(1)-adrenoceptor antagonist, which is, however, well tolerated; <1% of patients discontinue because of this adverse event. In placebo-controlled trials, abnormal ejaculation has been predominantly reported for tamsulosin, but in most direct comparative studies, the incidence was comparable to that of other alpha(1)-adrenoceptor antagonists. Men with LUTS/BPH have an increased risk of impaired sexual function. However, alpha(1)-adrenoceptor antagonists, such as tamsulosin, may slightly improve sexual dysfunction together with LUTS problems. Combination therapy of an alpha(1)-adrenoceptor antagonist and finasteride has a similar adverse-event profile as each monotherapy, except for an increased risk of abnormal ejaculation. The discontinuation rate because of adverse events does not seem to be higher than with monotherapy. Medical therapies, and particularly alpha(1)-adrenoceptor antagonists such as tamsulosin, can be considered a first-line treatment option for LUTS/BPH because they provide effective relief of bothersome LUTS with excellent tolerability.