Dutasteridebenign prostatic hyperplasia.

Prostate gland enlargement is a common condition as men get older. Also called benign prostatic hyperplasia (BPH), prostate gland enlargement can cause bothersome urinary symptoms.

1. Prostate Glands The prostate (or prostate gland) is part of a man’s reproductive and urinary systems lies below the urinary bladder and is located in front of the rectum. It is about the size of a walnut in younger men, but it starts to get larger when men reach their late 40s and early 50s.

2. Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.

3. Function Prostatic secretion   The main function of the prostate is to make prostatic fluid. Prostatic fluid is rich in enzymes, proteins and minerals that help protect and nourish sperm. When a man is sexually aroused, the prostate pushes prostatic fluid through the ducts and into the urethra. Prostatic fluid mixes with sperm and other fluids in the urethra and is ejaculated as semen.  

4. Control of urine or semen flow The prostate acts as a kind of valve, preventing urine flow during the ejaculation and or permitting urine flow in between.

5. BPH Prostate gland enlargement is a common condition as men get older. Also called benign prostatic hyperplasia (BPH), prostate gland enlargement can cause bothersome urinary symptoms. Untreated, prostate gland enlargement can block the flow of urine out of the bladder and cause bladder, urinary tract or kidney problems. There are several effective treatments for prostate gland enlargement, including medications, minimally invasive therapies and surgery. 

6. Symptoms The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time. Common signs and symptoms of BPH include: Frequent or urgent need to urinate Increased frequency of urination at night ( nocturia ) Difficulty starting urination Weak urine stream or a stream that stops and starts Straining while urinating Inability to completely empty the bladder Less common signs and symptoms include: Urinary tract infection Inability to urinate Blood in the urine

7. Risk factors for prostate gland enlargement include: Aging.  Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80. Family history.  Having a blood relative, such as a father or brother, with prostate problems means you're more likely to have problems. Ethnic background.  Prostate enlargement is less common in Asian men than in white and black men. Black men might experience symptoms at a younger age than white men. Diabetes and heart disease.  Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH. Lifestyle.  Obesity increases the risk of BPH, while exercise can lower your risk.

8. Complications Sudden inability to urinate (urinary retention).  need to have a tube (catheter) inserted into your bladder to drain the urine. Some men with an enlarged prostate need surgery to relieve urinary retention. Urinary tract infections (UTIs).  Inability to fully empty the bladder can increase the risk of infection in urinary tract. Bladder stones.  These are generally caused by an inability to completely empty the bladder. Bladder stones can cause infection, bladder irritation, blood in the urine and obstruction of urine flow. Bladder damage.  A bladder that hasn't emptied completely can stretch and weaken over time. As a result, the muscular wall of the bladder no longer contracts properly, making it harder to fully empty your bladder. Kidney damage.  Pressure in the bladder from urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys.

9. Medication Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include: Alpha blockers.  These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Alpha blockers — which include alfuzosin ( Uroxatral ), doxazosin ( Cardura ), tamsulosin ( Flomax ), and silodosin ( Rapaflo ) — usually work quickly in men with relatively small prostates. 5-alpha reductase inhibitors.  These medications shrink our prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride ( Proscar ) and dutasteride ( Avodart ) — might take up to six months to be effective. Side effects include retrograde ejaculation .

10. Combination drug therapy.  taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn't effective. Tadalafil ( Cialis ).  this medication, which is often used to treat erectile dysfunction, can also treat prostate enlargement. However, this medication is not routinely used for BPH and is generally prescribed only to men who also experience erectile dysfunction.

11. Alpha blockers Alfuzosin Doxazosin Prazosin Silodosin Tamsulosin Terazosin

12. ? Receptor a  receptor  is a  protein   molecule  that receives chemical signals from outside a cell a molecule on the cell surface  within a cell, that recognizes and binds with specific molecules, producing some effect in the cell.

13. α1-blockers relaxes both the bladder neck and prostatic smooth muscle, thus decreasing pressure in the bladder and urethra and improving urinary flow . These agents are more effective at improving obstructive symptoms than irritative symptoms

14. There are two commonly associated male physiological events that have a similar etiology .  Enlarged prostate or benign prostatic hyperplasia (BPH) and male pattern baldness are both related to the enzyme 5- reductase .  Hirsutism ( Hirsutism is the presence of excess hair in women.)in women is also related to this enzyme.  An excess in activity of 5- reductase has been shown to be responsible for enlarged prostate and male pattern baldness, as well as hirsutism in women

15. 5α-reductase, which is an enzyme responsible for conversion of testosterone to dihydrotestosterone .   Inhibition of such conversion maintains prostate health. 5- Reductase catalyzes the conversion of testosterone to 5 dihydrotestosterone (5 DHT).  5DHT:- Responsible for Prostate enlargement

16. Two isoenzymes of 5AR exist: Type 1 and Type 2 Type 1 is most abundant in the liver and skin, but is found, to a lesser degree, in the prostate as well. It is also the dominant isoform in sebaceous glands.

17. Type 2 Type 2 is the dominant isoenzyme in the prostate, and is minimally present in the liver and skin. Their primary function is to convert testosterone to DHT. Finasteride has proven to selectively inhibit the Type 2 isoenzyme whereas dutasteride competitively inhibits both forms of the enzyme.

18. The guidelines state that the 5α-reductase inhibitors finasteride and dutasteride are appropriate and effective treatments for patients with LUTS associated with demonstrable prostatic enlargement, but they are not appropriate treatments for men with LUTS who do not have evidence of prostatic enlargement.

19. patients exhibiting symptomatic prostatic enlargement but without an impact on their daily life 5α-reductase inhibitor could prevent progression of the disease.

20. SILOSIN Selectivity and Safety

21. Indications & Dosage Benign Prostatic Hyperplasia: Mg OD PO with meal Uretic Stone: 8mg OD PO for 4 weeks:

22. Anatomy of BPH Kirby RS et al. Benign prostatic hyperplasia. Health Press, 1995 . Normal BPH Hypertrophied detrusor muscle Obstructed urinary flow Prostate Bladder Urethra

23. α 1 -Blocker Selectivity Profiles Results based on in vitro studies Ratio expressed as the relative concentration. Tatemichi S, et al. Yakugaku Zasshi . 2006;12:209-216. Data on file, Watson Laboratories, Inc. KMD-0005 Study Report. IN VITRO DIFFERENCES IN ALPHA-BLOCKER SELECTIVITY MAY NOT CORRELATE TO DIFFERENCES IN ACTUAL CLINICAL OUTCOMES. α 1 -Blocker Receptor Selectivity α 1A : α 1B Silodosin 162:1 Tamsulosin 10:1 Alfuzosin 1:1

24. α 1A Adrenoreceptor Expression Increases in BPH vs Non-BPH Prostate Tissue Nasu K, et al. Br J Pharmacol. 1996;119:797-803. Non- BPH Tissue BPH Tissue α 1A 63% 85% α 1D 31 % 14% α 1B 6% 1%

25. more efficacious than tamsulosin in improving the triad of symptoms including incomplete emptying, frequency and nocturia