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