The potential value of 5-alpha-reductase inhibition in the treatment of bladder outflow obstruction due to benign prostatic hyperplasia
✍ Scribed by Roger S. Kirby; Timothy Christmas
- Publisher
- Springer-Verlag
- Year
- 1991
- Tongue
- English
- Weight
- 419 KB
- Volume
- 9
- Category
- Article
- ISSN
- 0724-4983
No coin nor oath required. For personal study only.
✦ Synopsis
The development of treatment forms for bladder outflow obstruction resulting from benign prostatic hyperplasia is traced from the early surgical techniques to the present. The positive effects and the drawbacks of modern pharmacological treatment are weighed against each other.
John Hunter, the father of modern surgery, observed as early as the eighteenth century that the prostate underwent atrophy after castration. Almost certainly stimulated by this observation, Cabot [8] performed bilateral orchidectomy for the treatment of bladder outflow obstruction due to benign prostatic hyperplasia (BPH) in 79 patients and reported improvement in 80% of cases. The assessment of the improvement, however, was totally subjective and it is not entirely clear whether some of the patients in the study were in fact suffering from malignant rather than benign prostatic enlargement. In 1940, Huggins and Stevens [14] reported on three cases of BPH treated by castration. In case 1, whose prostate was removed 29 days after castration, there was no change, but in the other two patients, from whom the remaining gland was removed 86 and 91 days after castration, respectively, both microscopic and macroscopic evidence of glandular atrophy was seen. Following this, Peirson [17] reported shrinkage of the prostate using stilboestrol therapy in 10 of 13 patients and symptomatic improvement in 70% of cases. Subsequently, Kaufman and Goodwin [16] tried a combination of testosterone propionate and diethylstilboestrol in 42 patients with BPH and noted improvement in symptoms and uroflow in the majority of cases, as well as some evidence of histological changes. Geller et al. [12] used the progestational agent 17-alphahydroxy-progesterone caproate, which shows potent antiandrogenic effects mainly by inhibiting pituitary gonadotropin release, in six patients with BPH and claimed encouraging results; however, Wolf and Madson [28]