Uropharmacology for the primary care physician

Advances in the understanding of the pathophysiology of a variety of urological disorders have resulted in the development of novel medications to manage these diseases. While many disorders such as erectile dysfunction, overactive bladder, hypogonadism and benign prostatic hypertrophy have traditionally been managed primarily by urologists, the use of these newer medications has become commonplace in the primary care setting. For example, symptomatic benign prostatic hyperplasia therapy, while historically treated with primary surgical intervention, is now commonly initially managed with medical therapy. Prostate cancer patients are being treated with newer formulations of long term hormone therapy that range from monthly to yearly administration. Additionally, the open dialogue about erectile dysfunction can be directly traced to the development of oral therapy for this condition. Testosterone replacement therapy can be administered using a variety of oral, transdermal and intramuscular therapies in order to minimize side effects and provide a more consistent dosing pattern. Finally, overactive bladder, which is a significant problem socially, has many new medications available for its treatment. This article will review some of the newer classes of urological medications, provide an understanding of basic uropharmacology that may guide treatment recommendations, and provide insight into the potential adverse side effects and interactions of these useful medications.