Similar symptoms and confounding conditions: benign prostatic hyperplasia versus hyperglycemia.

The traditional approach to diagnosing men with symptoms associated with benign prostatic hyperplasia (BPH) based on the American Urological Association symptom index may be limiting. There are often concurrent conditions that may be responsible for the urinary complaints of men with BPH, namely hyperglycemia. Both conditions manifest many of the same symptoms and complaints by patients, but treatment of one can lead to a missed diagnosis of the other.

Depressive symptoms in women with urinary incontinence: a prospective study.

In this prospective study, the incidence of depression in women who suffer from urinary incontinence (UI) is examined. Although the literature has confounding information directly linking depression to UI, this study revealed depression was significantly higher in women with UI as opposed to their counterparts without UI.

Impact of commercial marketing on patient demand.

This pilot study attempts to determine the impact of commercial direct-to-consumer advertising on the incidence of patients requesting medication for urinary incontinence by brand name. Of 310 patients interviewed prior to urodynamics, 237 (76%) sought treatment after seeing related commercials. After testing, 119 (50.2%) were prescribed the advertised drug for detrusor instability. Fifty-nine (24.8%) were diagnosed with intrinsic sphincter deficiency and were recommended anticholinergics, collagen injections, or surgery. Forty-one (17.2%) men were found to have bladder outlet obstruction, but only four were prescribed the advertised drug. Three (1.2%) were recommended intermittent catheterization along with the advertised drug and 15 (6.6%) had various other treatments. The results suggest that 50% of those seeking treatment were not candidates for the medication advertised.

Doxazosin in physiologically and pharmacologically normotensive men with benign prostatic hyperplasia.

OBJECTIVES: To compare the effects of doxazosin on blood pressure when used for the treatment of benign prostatic hyperplasia (BPH) in men who are either physiologically or pharmacologically normotensive. METHODS: Sixty-three men with BPH were enrolled in two open-label, parallel, randomized studies. Thirty-one were physiologically normotensive and 32 had hypertension controlled by antihypertensive therapy (pharmacologically normotensive). Of these, 17 were taking calcium channel blockers; 6, angiotensin-converting enzyme inhibitors; and 9, beta blockers. After a 3-week titration period, patients from one study received doxazosin (4 mg/day) for 3 months, given as a single dose in either the morning or evening, and in the second study patients were randomized to receive either 4 mg or 8 mg daily, either in the morning or evening. Effects on blood pressure, maximum uroflow, and the Boyarsky symptom score were measured. RESULTS: Doxazosin produced statistically significant but clinically unimportant reductions in blood pressure in both physiologically and pharmacologically normotensive groups. Statistically and clinically significant improvements in BPH symptoms and maximal perfusion occurred in both groups within 1 month, and further improvements were improved after 3 months. These effects were evident whether doxazosin was administered in the morning or evening. Doxazosin was well tolerated, the only adverse events being dizziness in 5 patients and fatigue in 4. By protocol, all patients reporting adverse events were required to be discontinued from the study. Adverse events did not differ between the groups. There was some indication that patients experiencing adverse events also experienced greater reductions in blood pressure. CONCLUSIONS: Doxazosin may be introduced for the treatment of BPH in hypertensive men whose blood pressure is already controlled by another antihypertensive agent, without a further clinical reduction in blood pressure. It is effective and well tolerated as a once-daily dose given in the morning or evening.