Another option for BPH management

13 May
2004

Perhaps we have another option for improving quality of life for men with BPH – Anticholinergics Effective for BPH Urinary Symptoms

Of the 43 patients, 39 (91%) completed the six-month trial. At baseline the patents’ mean symptoms score was 17.3; by the study’s end it was 11.2. The peak flow rate averaged 9.8 mL/sec at baseline and it increased to an average of 11.7 mL/sec at six months. At baseline patients had an average postvoid residual urine volume of 97 mL; by the study’s end it was an average of 75 mL. In addition, urination frequency decreased from an average of 9.8 voiding episodes daily to 6.3 episodes. Their nocturnal voiding episodes also decreased, from an average of 4.1 episodes per night to 2.9 nightly episodes.

Four men (9%) discontinued therapy because of intolerable dry mouth, a known adverse effect of muscarinic receptor antagonists, Dr. Kaplan said. No patients developed urinary retention, and one patient had a urinary tract infection. In this patient group, 27 (63%) had normal erectile function at baseline, as did 29 patients (67%) six months after starting treatment.

“Historically we have been told not to use anticholinergics in BPH for fear of obstruction-induced urinary retention,” E. Darracott Vaughan, Jr., MD, told Medscape in an interview seeking outside comment. “However, men with BPH also have overactive bladder. Therefore, it may be that some men’s urinary symptoms would respond to anticholinergics.” In those cases, he recommends using anticholinergics in combination with an alpha-blocker or a 5-alpha-reductase inhibitor. Dr. Vaughan is chairman emeritus and James J. Colt professor of urology at Weill Medical College of Cornell in New York, and he is also a former president of the American Urological Association.

“The current data suggest that urinary retention with anticholinergics is not common. Therefore it is not detrimental, and is often helpful, to use the combination,” Dr. Vaughan said. “There aren’t a lot of randomized trials, but the proof of principle is there. Anticholinergics for BPH-related urinary frequency is safe for many patients.”

I view these data as preliminary. However, I do hope to see some randomized controlled trials in the near future.

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1 Response to Another option for BPH management

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Doc

May 14th, 2004 at 7:54 pm

Great idea — except for all the elderly men who will develop impaired cognition and fall down while taking anticholinergics. But then, we can just put them on Aricept.

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