New medical treatments for lower urinary tract symptoms due to benign prostatic hyperplasia and future perspectives

Abstract

BackgroundLower Urinary Tract Symptoms (LUTS) in men are a common clinical problem in urology and have been historically strictly linked to benign prostatic hyperplasia (BPH), which may lead to bladder outlet obstruction (BOO). New molecules have been approved and have entered the urologists’ armamentarium, targeting new signaling pathways and tackling specific aspects of LUTS. Objective of this review is to summarize the evidence regarding the new medical therapies currently available for male non-neurogenic LUTS, including superselective α1-antagonists, PDE-5 inhibitors, anticholinergic drugs and intraprostatic onabotulinum toxin injections.MethodsThe National Library of Medicine Database was searched for relevant articles published between January 2006 and December 2015, including the combination of “BPH”, “LUTS”, “medical” and “new”. Each article’s title, abstract and text were reviewed for their appropriateness and their relevance. One hundred forty eight articles were reviewed.ResultsOf the 148 articles reviewed, 92 were excluded. Silodosin may be considered a valid alternative to non-selective α1-antagonists, especially in the older patients where blood pressure alterations may determine major clinical problems and ejaculatory alterations may be not truly bothersome. Tadalafil 5 mg causes a significant decrease of IPSS score with an amelioration of patients’ QoL, although with no significant increase in Qmax. Antimuscarinic drugs are effective on storage symptoms but should be used with caution in patients with elevated post-void residual. Intraprostatic injections of botulinum toxin are well-tolerated and effective, with a low rate of adverse events; however profound ameliorations were seen also in the sham arms of RCTs evaluating intraprostatic injections.ConclusionNew drugs have been approved in the last years in the medical treatment of BPH-related LUTS. Practicing urologists should be familair with their pharmacodynamics and pharmacokinetics.

Novel intraprostatic injectable agents in the treatment of BPH

“…Fexapotide Triflutate (NX-1207) is a protein that reduces prostate volume by inducing selective apoptosis [24,25] . A single administration of the drug is injected into the transition zone of the prostate leading to non-regressive prostate shrinkage and symptomatic relief [10] .…”

The BPSC: A prospective study investigating the clinical effect of interventional therapy and the risk factors for bladder cancer and benign prostatic hyperplasia in Chinese population

“…The morbidity and mortality of BC and BPH cause heavy social and economic burden to the human beings, especially to the patients and their families. Nowadays, conservative, pharmacological and surgical treatments are the main management methods for BPH patients . Counseling of smoking cessation, adjuvant treatment, and radical cystectomy are the three major management methods for the patients with superficial BC, which is also named nonmuscle‐invasive bladder cancer (NMIBC), including TaT1 and carcinoma in situ (CIS) .…”

“…Nowadays, conservative, pharmacological and surgical treatments are the main management methods for BPH patients. [32][33][34][35][36][37] Counseling of smoking cessation, adjuvant treatment, and radical cystectomy are the three major management methods for the patients with superficial BC, which is also named nonmuscle-invasive bladder cancer (NMIBC), including TaT1 and carcinoma in situ (CIS). [38][39][40] Transurethral resection of the prostate (TURP) and transurethral resection of the bladder (TURB) are the transurethral minimally invasive surgeries for BPH and NMIBC, respectively.…”

Efficacy of Holmium Laser Transurethral Incision of the Prostate in Symptomatic Mild‐to‐Moderate Benign Prostate Enlargement Based on Preoperative Characteristics

“…The substantial burden of LUTS and the negative effects on quality of life have been demonstrated in men aged ≥40 years . Bladder outlet obstruction (BOO) as a consequence of benign prostate enlargement (BPE) is one of the most important aspects of male LUTS …”

“…2 Bladder outlet obstruction (BOO) as a consequence of benign prostate enlargement (BPE) is one of the most important aspects of male LUTS. 3 Transurethral incision of the prostate (TUIP) is an acceptable treatment for men who have LUTS secondary to BOO. 4 The TUIP procedure has shown comparable efficiency to transurethral resection of the prostate in terms of symptomatic improvement for men with small prostates, with lesser bleeding, morbidity, and sexual dysfunction than transurethral resection of the prostate.…”