Dutasteride–IndianExperience.ppt

Dutasteride – Indian Experience Dr. Sunil Shroff Professor HOD, Dept. of Urology Renal TransplantationSri Ramachandra Medical College Research Institution, ChennaiE-mail: sshroff@ or srmc69@ / urology BPH – Changing Patterns in Management Over the last 10 years Treatment of BPH has changed dramatically The emphasis is more towards symptom improvement and prevention of Clinical progression of BPH Medical Treatment with Alpha Blockers and 5-Alpha Reductase Inhibitors are now established alternative to ‘Invasive Therapy’ Clinical Progression of BPH Determines if a patient with BPH develops any of the below mentioned symptoms on follow up during watchful waiting Period AUR Recurrent urinary tract infection or urosepsis, Four-point or greater increase in baseline AUA symptom, Incontinence Need for prostate surgery Renal insufficiency due to BPH BPH – Age Related Morbidity Among 50 yrs old men, an estimated 35% lifetime incidence of surgical or medical intervention A 60 years old has a 23% chance of experiencing Acute Urinary Retention if he survives for additional 20 years Nearly 1 in 10 men in their 70’s will have Acute Urinary Retention in the subsequent 5 years Reduction in Surgical Treatment Decrease in NUMBER of Prostatectomies - 1987 ----- 250,000 1996 ----- 116,000 2000 ----- 88,000 55% Reduction in TURP The above decrease may be the result of safer and better medical therapies Medical Management of BPH The effectiveness of alpha-blockers and Androgen Suppression have validated the Hypothesis that the patho- physiology of BPH comprises of: - A Dynamic Component - related to prostate smooth muscle tension (Mechanism of Action for Alpha Blockers) A Static Component - related to prostate size (Mechanism of Action for 5 Alpha Reductase inhibitors) Does Prostate Volume Reduction Help Prostate Volume does not have strong co-relation to prostate symptoms However Prostate volume is an important predictor of risk for d