[Combination therapy in benign prostatic hyperplasia (BPH)].

Abstract

Because of the constant progress in our understanding of the physiopathology of benign prostatic hyperplasia, it is now possible to propose a more rational use of combination therapy, which is often used empirically, though not recommended, in routine practice. This chronic disorder, which is in fact more complex than it appears, may benefit in theory from a combination of molecules with different complementary action mechanisms. Prostatic obstruction may be treated either by alphablockers with their peripheral muscle-relaxant action on the smooth muscle fibers of the prostate and bladder neck, or by 5-alpha-reductase inhibitors for their reducing effect on gland volume. Irritative bladder symptoms involving the detrusor may be treated by antimuscarinics and to a lesser extent by alphablockers. Currently available data from recent studies suggest that a combination of an alphablocker and a 5-alpha-reductase inhibitor may be useful in patients with symptomatic BPH and a prostate of more than 40 grams with PSA > 1.6 ng/ml. Combinations including an antimuscarinic are effective in patients with BPH with marked irritative symptoms. Finally, the combination of an alphablocker and a phosphodiesterase type 5 inhibitor may be useful in patients with lower urinary tract symptoms (LUTS) associated with erectile dysfunction.