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Sunday, April 06, 2003
Dumaguing: Hytrin helps Prostate-related urination problems
By Dr. Victor Dumaguing
THE round-table discussions of prostate-related urination problems held at the John Hay clubhouse on Monday, March 31 was doubly significant to me.
For one, the guest speakers is a friend from way back 1977 when we were co-intern at the UP Philippine General Hospital, where his is now a shining gem among its roster of urologists.
Dr. Edward R. Gatchalian is a magna cum laude Pre-Med graduate of the University of Sto. Tomas and in the top 10 of UP Medicine class '77. For another, being in my mid-50's, I could relate very easily with the clinical issues he was talking about.
Dr. Ed titled his lecture as LUTS or lower urinary tract symptoms, which he clarified as having taken place of the old term "protatism" in which one of seven men in their 40s to 60s suffer from, one of two men in their 69s to 70s and all males in their 80s.
The underlying cause of LUTS is BHP or benign protatic hypertrophy or a physiologic (normal, expected, usual) enlargement of the prostate when men reaches 40 years, due to hormonal stimulation of testosterone and its metabolites.
The prostate is part of the urogenital tract of males, about the seize of a walnut or sineguelas near the base of the penis, which help form seminal fluid; so positioned that it surrounds the passageway of urine in the prostatic portion of the urethra, the tube that conveys urine from the bladder to the outside.
Except for eunuchs or males who were castrate before puberty, all members of the male gender of the human species, whether macho man or gay, a philandering Casanova or a celibate monk, are subject to enlargement of the prostate by the time reach 40. A worse probability would be the prostate undergoing malignant degeneration to cancer.
So as the male grows older, his prostate becomes bigger which lead to progressive narrowing and construction of the urethra at the prostate level. So the male starts having disturbing symptoms like frequent urination, urgency or uncontrollable urge to urinate, weak stream of urine, sensation of incomplete voiding or sensation of residual urine remaining in the bladder despite forceful effort, terminal dribbling or the unwanted drops of urine even after the male has finished urinating or at times efforts to rise at night just to go to the bathroom could lead to interruption of restful sleep resulting to grouchy, irritable man the next day.
Thus, whether the enlargement of the prostate has resulted to an irritative or obstructive urination becomes moot and academic. The fact remains that LUTS is an uncomfortable, disturbing and even embarrassing clinical condition.
The good doctor regaled the enthusiastic audience with colorful, well-prepared slides punctuated by adlibbing about his experience with interesting patients suffering from LUTS. To protect the prostate, Dr. Gatchalian warned about injuries or straddling a bike, horse or motorcycle for an extended period for fear of injuring the prostate.
He also cautioned males from taking decongestants or cold tablets. Aside from their potential or raising blood pressure, cold medicines having an alpha agonist or stimulant effect, may aggravate LUTS by making the prostate all the more constrict the urethal passage. The use of diuretics should be minimized, for obvious reasons.
Although Dr. Gatchalian was trained as a surgeon, his approach to LUTS is refreshingly conservative. Depending on the results of DRE (digital rectal exam), PSA or prostate specific antigen and possibly other sophisticated diagnostic work-ups, Dr. Ed was open to the use of herbals or plant extract to arrest the progressive growth of the prostate. Even the mention of lycopene in tomatoes as anti-prostate-cancer agent drew a wide smile from him.
The bulk of his lecture centered on medical treatment of LUTS, the so-called 5 alpha aromatize enzyme inhibitors and the alpha 1 receptor blockers. Finasteride is the prototype of the first type of medicines. In fact, 1 mg of Finasteride is being used also to treat premature baldness in young men. The so-called alpha 1 receptor blockers, whose high selectivity to the lower bladder portion or the critical trigone area improves urination without unduly affecting heart and blood vessel function, exhibited the more impressive reduction of LUTS.
There are four approved drugs of this family. Personally, I saw the encouraging potential of Terazosin or Hytrin in greatly alleviating the symptoms of LUTS. In a series of graphs, Terazosin exhibited significant advantage over placebo, over finasteride and mind you, even over a combination of finasteride and Terazosin. Hytrin is available in 1 mg, 2 mg, 5 mg and 10 mg tablets.
Men on alpha 1 receptor blockers are warned not to rise immediately because of the postural hypotension that the drugs usually cause which can lead to dizziness. Other than that, there is no tacchycardia or palpitation, which were observed in the older members of the family of drug.
For Terazosin or Hytrin, it is recommended that the patient is started on 1 mg nightly to be increased to 2 mg if symptoms do not subside. Better yet, consult your favorite doctor. We have the experience of Drs. Benito Sunga, Andres Marrero and Rollie Santos in our midst. Meanwhile, I give a high five for Hytrin!
(April 6, 2003 issue)
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