A 69-year-old man is started on tamsulosin for benign prostatic hyperplasia. Which one of the following best describes the side-effects he may experience?
Urgency + insomnia
Dizziness + postural hypotension
Urinary retention + nausea
Urgency + erectile dysfunction
Erectile dysfunction + reduced libido
Benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH) is a common condition seen in older men.
Risk factors
- age: around 50% of 50-year-old men will have evidence of BPH and 30% will have symptoms. Around 80% of 80-year-old men have evidence of BPH
- ethnicity: black > white > Asian
BPH typically presents with lower urinary tract symptoms (LUTS), which may be categorised into:
- voiding symptoms (obstructive): weak or intermittent urinary flow, straining, hesitancy, terminal dribbling and incomplete emptying
- storage symptoms (irritative) urgency, frequency, urgency incontinence and nocturia
- post-micturition: dribbling
- complications: urinary tract infection, retention, obstructive uropathy
Management options
- watchful waiting
- medication: alpha-1 antagonists, 5 alpha-reductase inhibitors. The use of combination therapy was supported by the Medical Therapy Of Prostatic Symptoms (MTOPS) trial
- surgery: transurethral resection of prostate (TURP)
Alpha-1 antagonists e.g. tamsulosin, alfuzosin
- decrease smooth muscle tone (prostate and bladder)
- considered first-line, improve symptoms in around 70% of men
- adverse effects: dizziness, postural hypotension, dry mouth, depression
5 alpha-reductase inhibitors e.g. finasteride
- block the conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH
- unlike alpha-1 antagonists causes a reduction in prostate volume and hence may slow disease progression. This however takes time and symptoms may not improve for 6 months. They may also decrease PSA concentrations by up to 50%
- adverse effects: erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia