java android barcode library 6 -Blockade for benign prostatic hyperplasia in Objective-C

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Table 23 6 -Blockade for benign prostatic hyperplasia
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Agent Phenoxybenzamine Prazosin Terazosin Doxazosin Alfuzosin Tamsulosin Action 1- and 2Blockade 1-Blockade 1-Blockade 1-Blockade 1-Blockade 1a-Blockade Dose 5 10 mg twice daily 1 5 mg twice daily 1 10 mg daily 1 8 mg daily 10 mg daily 04 or 08 mg daily
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fication of appropriate patients for prophylactic therapy remains to be determined Dutasteride is a dual 5 -reductase inhibitor that appears to be similar to finasteride in its effectiveness; its dose is 05 mg orally daily 3 Combination therapy The four-arm Veterans Administration Cooperative Trial compared placebo, finasteride alone, terazosin alone, and combination of finasteride and terazosin Over 1200 patients participated, and significant decreases in symptom scores and increases in urinary flow rates were seen only in the arms containing terazosin However, enlarged prostates were not an entry criterion; in fact, prostate size in this study was much smaller than in previous controlled trials using finasteride (32 versus 52 mL) Other randomized, placebo-controlled trials comparing finasteride with placebo in men with lower urinary tract symptoms and large prostates showed finasteride to be beneficial for reducing symptoms, increasing urinary flow rate, and reducing the risk of complications due to benign prostatic hyperplasia as well as reducing the number of men who required surgery for benign prostatic hyperplasia The Medical Therapy of Prostatic Symptoms (MTOPs) trial is a large, randomized, placebo-controlled trial comparing finasteride, doxazosin, the combination of the two, and placebo in 3047 men observed for a mean of 45 years Longterm combination therapy with doxazosin and finasteride was safe and reduced the risk of overall clinical progression of benign prostatic hyperplasia significantly more than did treatment with either drug alone Combination therapy and finasteride alone reduced the long-term risk of acute urinary retention and the need for invasive therapy Combination therapy had the risks of additional side effects and the cost of two medications 4 Phytotherapy Phytotherapy is the use of plants or plant extracts for medicinal purposes Its use in benign prostatic hyperplasia has been popular in Europe for years, and its use in the United States is growing as a result of patient-driven enthusiasm Several plant extracts have been popularized, including the saw palmetto berry, the bark of Pygeum africanum, the roots of Echinacea purpurea and Hypoxis rooperi, pollen extract, and the leaves of the trembling poplar The mechanisms of action of these agents are unknown A recent, prospective, randomized, double-blind, placebo-controlled trial revealed no improvement in symptoms, urinary flow rate, or quality of life for men with benign prostatic hyperplasia with saw palmetto treatment compared with placebo
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in one study probably related to more significant comorbidities in the TURP patients compared with the patients who received open surgical treatment Several other studies could not confirm the difference in mortality when controlling for age and comorbidities The risks of TURP include retrograde ejaculation (75%), impotence (5 10%), and urinary incontinence (< 1%) Complications include bleeding, urethral stricture or bladder neck contracture, perforation of the prostate capsule with extravasation, and, if severe, transurethral resection syndrome, a hypervolemic, hyponatremic state resulting from absorption of the hypotonic irrigating solution Clinical manifestations of the syndrome include nausea, vomiting, confusion, hypertension, bradycardia, and visual disturbances The risk of transurethral resection syndrome increases with resection times over 90 minutes Treatment includes diuresis and, in severe cases, hypertonic saline administration 2 Transurethral incision of the prostate (TUIP) Men with moderate to severe symptoms and small prostates often have posterior commissure hyperplasia or an elevated bladder neck These patients will often benefit from incision of the prostate The procedure is more rapid and less morbid than TURP Outcomes in well-selected patients are comparable, though a lower rate of retrograde ejaculation has been reported (25%) 3 Open simple prostatectomy When the prostate is too large to remove endoscopically, open enucleation is necessary What size is too large depends upon the surgeon s experience with TURP Glands over 100 g are usually considered for open enucleation In addition to size, other relative indications for open prostatectomy include concomitant bladder diverticulum or bladder stone and whether dorsal lithotomy positioning is or is not possible Open prostatectomies can be performed with either a suprapubic or retropubic approach Simple suprapubic prostatectomy is performed transvesically and is the operation of choice if there is concomitant bladder pathology After the adenoma is removed, both a urethral and a suprapubic catheter are inserted prior to closure In simple retropubic prostatectomy, the bladder is not entered but rather a transverse incision is made in the surgical capsule of the prostate and the adenoma is enucleated as described above; only a urethral catheter is needed at the end of the case
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