Benign Prostatic Hyperplasia: Pharmaceutical Agent Justification

This essay explores the use of doxazosin mesylate, an alpha-blocker, in the treatment of Benign Prostatic Hyperplasia (BPH). The essay begins by defining BPH, its prevalence, and its impact on men's health. It then delves into the pathophysiology of BPH, including the role of hormonal imbalances and the aging process in prostate enlargement and the development of lower urinary tract symptoms (LUTS). The essay highlights the symptoms associated with BPH, such as frequent urination, weak urine stream, and urinary retention. The core of the essay focuses on the justification for using doxazosin mesylate. The essay explains how doxazosin mesylate works by relaxing the muscles in the prostate and bladder neck, thereby improving urine flow and alleviating symptoms. The essay also provides a comparison of doxazosin mesylate with other treatment options, such as 5-alpha reductase inhibitors, highlighting the advantages of doxazosin mesylate, including its rapid onset of action and fewer side effects. The essay concludes by summarizing the benefits of doxazosin mesylate in managing BPH and its effectiveness in improving the quality of life for affected individuals. The essay also references various studies and research to support the arguments and findings.

Running head: PATHOPHYSIOLOGY AND PHARMACOLOGY 1
Benign Prostatic Hyperplasia
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PATHOPHYSIOLOGY AND PHARMACOLOGY 2
Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is a disorder that refers to the proliferative
development of the cellular features of the prostate or the voiding dysfunction emanating from
enlargement of prostate and obstruction of the bladder passage (Foo, 2017). At least 90 % of the
men will develop the condition at age 80 years. However, the level of the prostatic enlargement
emanating from the hyperplasia is significantly varied (Foo, 2017). Globally approximately 105
million men are affected by BPH, attributed to age and lifestyle changes. The precise origin of
BPH is not clearly defined however it has been presumed that the pathophysiology of the lower
urinary tract symptoms (LTUS) is the cause of obstruction of the bladder passage (Foo, 2017).
The condition is treatable through medication or surgery however, one can have the disorder
without experiencing any symptoms. This paper will discuss the BPH causes, symptoms, and
treatment approaches approved in its treatment.
BPH causes a varying degree of blockage, even without the symptoms being realized.
The severity of clinical BPH can be classified based on the level of obstruction and the exhibited
symptoms (Gacci et al., 2016). Impaired emptying functions contributes to insistent post-void
residual urine while a small maximum emptied volume is identified when the storage functions
are impaired (Gacci et al., 2016). The symptoms attributed to BPH include; loss of bladder
control, frequent urination, weak stream, inability to pass urine, and troubles starting to urinate.
Risk of developing BPH is mainly attributed to advancing age and family history. Inactivity,
obesity, and erectile dysfunction are also linked to increased risk of getting BPH (Vignozzi,
Gacci & Maggi, 2016). The condition affects at least 45 % of men aged between 51-60 years;
however, less than 10% of the affected require medical or surgical involvement (Vignozzi, Gacci
& Maggi, 2016). In BPH the prostate gland increases in size which may compress the urethra

PATHOPHYSIOLOGY AND PHARMACOLOGY 3
which courses through the center of the prostrate, the compressed urethra may impede urine flow
from the bladder to the outside. If the condition is untreated it may lead to loss of bladder control
(Vignozzi et al., 2016).
The precise origin of BPH is not documented. However, there are various risks and
deductions attributed to the be the root of BPH (Van-Asseldonk, Barkin & Elterman, 2015).
Hormones, mainly androgens type (testosterone), are alleged to play an accommodating role in
developing the condition (Van-Asseldonk et al., 2015). For the disorder to occur, androgens must
be present; however, it does not signify that they are the direct cause of BPH. Based on research
findings individuals who have undergone castrations do not develop the condition (Van-
Asseldonk et al., 2015). Further studies have indicated that BPH development is attributed to the
failure in the spermatic venous voiding system leading in increased hydrostatic pressure and
local testosterone levels elevated above serum levels. Also, concurrent obesity, diabetes, and
impaired glucose metabolism are among metabolic syndromes linked with the development of
BPH (Chen et al., 2015).
BPH is an age-associated disorder. According to Misrepair accumulation aging model,
the development of BPH is brought about by fibrosis and the failing of the muscular tissue in the
prostate (Pagano, Laudato, Griffo & Capasso, 2014). The tissue is vital as it aids in the
functioning of the prostate and offers a force for expelling the fluid formed in the prostatic
glands. Repeated dilations and contractions of the myofibers can lead to injuries and the
malfunction of the myofibers. The myofibers have low regeneration potential; hence, the
collagen fibers are used to replace the malfunctioned myofibers (Chen, Miao, Gao, Wang & Xu,
2015). The Misrepairs leads to weakening of the muscular tissue, and the fluid secreted by the
glands is not entirely excreted (Pagano et al., 2014). The accumulated fluid increases the

PATHOPHYSIOLOGY AND PHARMACOLOGY 4
resistance of the muscular tissue during dilation and contraction movements leading to break
down of more myofibers which are replaced by collagen fibers.
There are different methods currently utilized in treatment of BPH. Alpha-blockers, 5-
alpha reductase inhibitors, and Phosphodiesterase type 5 inhibitors (PDE5 inhibitor) are the
common drugs used to treat the dynamic factors linked to the disorder (Allen & Aghajanyan,
2017). To individuals who suffer LUTS and are at risk of disorder progression, combination
therapy is recommended (Bechis, Otsetov, Ge & Olumi, 2014). Alpha-blockers drugs function
by relaxing the prostate and the bladder neck muscles, which aids to relieve urinary impediment
(Mathur, Nayak, Sivaramakrishnan & Jain, 2014). The drugs contribute to symptoms
improvement within a few weeks and have no impact on the size of the prostate. The drugs have
some side effects including; fatigue, headaches, ejaculation problems, and a significant decrease
in the volume of semen (Mathur et al., 2014). The common alpha-blockers used in BPH
treatment comprise of, doxazosin mesylate, tamsulosin (Flomax) and alfuzosin (Uroxatral)
5-alpha reductase inhibitors are used in BPH therapy and work by treating the static
component of BPH by blocking the conversion of testosterone into its dynamic form in the
prostrate (Gacci et al., 2016). Enlargement of the prostate in BPH is highly reliant on the
hormone dihydrotestosterone. Therefore, the medications are attributed to an approximate 25%
reduction in the size of the prostrate in about 6 to 12 months (Gacci et al., 2016). The urinary
symptoms, therefore, take this long to occur. Some of the 5-alpha reductase inhibitors used in
BPH treatment include the finasteride (Proscar) and dutasteride (Avodart) (Gacci et al., 2016).
The drug, however, has some side effects, which include erectile dysfunction and ejaculation
problems which are attributed to the dihydrotestosterone, which causes a decrease in libido
(Gacci et al., 2016).

PATHOPHYSIOLOGY AND PHARMACOLOGY 5
PDE5 inhibitor is used in the treatment of the active part of BPH by lowering the tone of
the smooth muscles in the urethra, prostate, and the bladder (Gacci et al., 2016). The drugs,
however, appear to be less effective in improving maximal urine flow rate when compared with
the alpha-blockers. PDE5 inhibitor drugs side effects include facial flushing, stomach upset,
dizziness, and nasal congestion (Gacci et al., 2016).
Doxazosin mesylate an Alphas blocker was highly recommended in the treatment of BPH
as it works by blocking the chemicals that are attributed to the blockage leading to the enlarged
prostate. This consequently helps in widening the blood vessels and relaxes the muscles in the
prostate and bladder. Doxazosin mesylate is superior to other drugs as it offers rapid
improvements in symptoms and urinary flow rate. Unlike other drugs that require an extended
period of up to six months to one year for fully recovery, with doxazosin mesylate, patients can
have full recovery within fourteen weeks. Doxazosin mesylate also has fewer side effects that
are detrimental to the patient compared to other pharmaceutical agents used in the treatment of
BPH that have major side effects.
To sum it up, BPH is an age-associated disorder that affects men as they get older. The
dysfunction leads to uncomfortable urinary symptoms and in extreme cases, leads to the urinary
tract and kidney problems. Various practical therapy approaches have been derived and used to
treat the conditions including drugs, and in some minor instances, invasive therapies and surgery
are carried out. The most effective treatment for the disease is the used of Alphas blockers
( doxazosin mesylate) since they exhibit a rapid onset and can alleviate the symptoms with a
short time. Research is being carried out to determine the exact causes of the condition to come
up with preventive measures.

PATHOPHYSIOLOGY AND PHARMACOLOGY 6
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