alpha(1)-blocker therapy in the nineties: focus on the disease

Therapy for benign prostatic hyperplasia has evolved rapidly over the last decade, with the introduction in the early 1990s of new agents such as alph a(1)-blockers and 5 alpha-reductase inhibitors. The major advantage of alph a(1)-blockers over 5 alpha-reductase inhibitors is their rapid onset of act ion. Maximum now rate is improved after first administration and optimal sy mptom relief is usually reached within 2-3 months. In addition, alpha(1)-bl ockers are effective regardless of prostate size and they provide a similar degree of symptom relief in patients with or without bladder outlet obstru ction. The main adverse events with the alpha(1)-blockers relate to their e ffects on the cardiovascular system (postural hypotension) and central pene tration (asthenia, somnolence). Newer uroselective alpha(1)-blockers, such as alfuzosin and tamsulosin, have a better safety profile and, as such, do not require initial dose titration. Alfuzosin has also been shown in a six- month study to significantly reduce both residual urine and the incidence o f acute urinary retention (AUR) compared with placebo. In addition, alfuzos in is effective in improving the success rate of a trial without catheter i n patients with AUR.