**6.10 Cystometry**

It is not a routine exam for BPH evaluation. However, cystometry can help to identify high bladder pressure, low bladder compliance and detrusor instability that considerably affects renal function (Rule, Lieber et al. 2005; Yamasaki, Naganuma et al. 2011).

Benign Prostate Hyperplasia and Chronic Kidney Disease 365

total amount of daily fluid (above 1500 mL per day), avoidance of alcohol and caffeine because they have diuretic and irritant effect, bladder retraining to increase its capacity and constipation treatment. Watchful waiting is based on the notion that some symptoms may spontaneously improve whilst others may remain stable for years. The PSA level and the prostate volume may be helpful in predicting the risk of acute urinary retention, although they should not be used as a sole determinant for active therapy (Levy and Samraj 2007). Approximately 85% of men will be stable on WW at 1 year, deteriorating progressively to 65% at 5 years (Wasson, Reda et al. 1995; Netto, de Lima et al. 1999). This approach is not

Medical approaches are not used to treat BPH complications (in which CKD is included). They are used for LUTS relief and for prevention of BPH progression (especially 5 alpha

Alpha-blockers address the dynamic component of prostatic obstruction by antagonizing the adrenergic receptors responsible for smooth muscle tone within the stroma, prostate capsule and bladder neck, providing the most rapid symptom relief. They include: terazosin, doxazosin, alfuzosin, tamsulosin and silodosin. These drugs have similar efficacy

**Alfuzosin** 10 mg once a day Fatigue, edema, rhinitis, headache,

**Tamsulosin** 0,4 mg once a day Dizziness, rhinitis, abnormal ejaculation

The older, less costly, generic alpha blockers remain reasonable choices. However, these require dose titration and blood pressure monitoring. Alpha-blockers are the most prescribed medications for BPH as long as they have a rapid (symptoms may improve in 48

5-Alpha-Reductase Inhibitors (5-ARI) are anti-androgenic hormonal agents that address the static component of BPH by reducing the prostate volume (up to 20-30%). They include

Asthenia, hypotension, dizziness, somnolence

Orthostatic hypotension, fatigue and dyspnea

upper respiratory tract infection

Diarrhea, headache and commons cold symptoms, nasal congestion, retrograde ejaculation (the most common)

**Blocker Dosage Side-effects** 

May increase up to 20 mg a day

May increase up to 8 mg once daily

8 mg once a day 4 mg once a day for men with moderate kidney dysfunction

Table 3. Alpha blockers used, dosage and side-effects.

hours) and significant improvement on LUTS.

**7.3.2 5-alpha-reductase inhibitors** 

suitable for men with installed CKD due to bladder outlet obstruction.

**7.3 Medical treatment** 

**7.3.1 Alpha-blockers** 

**Alpha-**

**Silodosin** 

reductase inhibitors - 5-ARI).

but different patterns of side-effects:

**Terazosin** 1 mg once a day

**Doxazosin** 1 mg once a day
