Volume 7, Supplement 4Review ArticlesPathophysiology of Benign Prostatic Hyperplasia in the Aging Male PopulationHerbert LeporBenign prostatic hyperplasiaLower urinary tract symptomsBladder outlet
Volume 7, Supplement 4Review ArticlesHistorical Overview of Medical Therapy for Benign Prostatic HyperplasiaHerbert LeporClaus G Roehrborn
Volume 8, Supplement 4Review ArticlesAdvances in Alpha-Blocker Therapy in the Management of Urological DisordersIntroductionHerbert Lepor
Volume 8, Supplement 4Review ArticlesThe Evolution of Alpha-Blockers for the Treatment of Benign Prostatic HyperplasiaAdvances in Alpha-Blocker Therapy in the Management of Urological DisordersHerbert LeporAlpha-blockers have been evaluated for the treatment of benign prostatic hyperplasia (BPH) for 30 years, from early trials with the nonselective a-inhibitor phenoxybenzamine to short-acting (prazosin) then long-acting (terazosin, doxazosin, tamsulosin, alfuzosin) selective a1-antagonists. All of the a-blockers evaluated have demonstrated comparable effectiveness, and the evolution of a-blocker therapy for BPH has therefore focused primarily on improving convenience and tolerability. Although all of the long-acting a1-blockers are well tolerated, only tamsulosin and alfuzosin SR are administered without the requirement for dose titration. Alfuzosin has the additional advantage over tamsulosin of a lower incidence of ejaculatory dysfunction. Studies of subtype-selective a1-antagonists have not demonstrated superior efficacy or improved tolerability over the existing long-acting a1-blockers. [Rev Urol. 2006;8(suppl 4):S3-S9]Benign prostatic hyperplasiaBlockersLower urinary
Volume 8, Number 4Review ArticlesThe Role of Gonadotropin- Releasing Hormone Antagonists for the Treatment of Benign Prostatic HyperplasiaTreatment UpdateHerbert LeporMedical therapy is the preferred first-line approach in the management of lower urinary tract symptoms in men with benign prostatic hyperplasia. The magnitude of the improvement in lower urinary tract symptoms observed in response to combination therapy (-blocker plus 5- reductase inhibitors) does not approach that achieved with prostatectomy. Various drugs have been under consideration, including BXL628, lonidamine, and phosphodiesterase inhibitors, all of which have had unacceptable side effects. The gonadotropinreleasing hormone antagonist cetrorelix is associated with dose-dependent symptom improvement and reduction of prostate volume. Elucidating the mechanism for cetrorelix-mediated improvement in lower urinary tract symptoms will likely contribute to unraveling the pathophysiology of lower urinary tract symptoms in men. [Rev Urol. 2006;8(4):183-189]Benign prostatic hyperplasiaBlockers5-reductase inhibitorsLH-RH antagonistsCetrorelix
Volume 8, Number 1Reviews in UrologySpontaneous Retroperitoneal Hemorrhage Caused by Segmental Arterial MediolysisCase ReviewHerbert LeporCourtney K PhillipsRetroperitoneal hemorrhageSegmental arterial mediolysisCase report
Volume 9, Number 4Review ArticlesAlpha Blockers for the Treatment of Benign Prostatic HyperplasiaTreatment UpdateHerbert LeporThe evolution of alpha blocker therapy for benign prostatic hyperplasia (BPH) has focused on improving convenience and tolerability. Indications for treating BPH include reversing signs and symptoms or preventing progression of the disease. The indication that most commonly drives the need for intervention is relief of lower urinary tract symptoms (LUTS) with the intent of improving quality of life. Alpha blockers are the most effective, least costly, and best tolerated of the drugs for relieving LUTS. Four long-acting alpha 1 blockers are approved by the Food and Drug Administration for treatment of symptomatic LUTS/BPH: terazosin, doxazosin, tamsulosin, and alfuzosin. All are well tolerated and have comparable dose-dependent effectiveness. Tamsulosin and alfuzosin SR do not require dose titration. Alfuzosin, terazosin, and doxazosin have all been shown to be effective in relieving LUTS/BPH independent of prostate size. [Rev Urol. 2007;9(4):181-190]Benign prostatic hyperplasiaLower urinary tract symptomsQuality of lifeTamsulosinAlfuzosinDoxazosinTerazosin
Volume 9, Number 3Case ReviewSpontaneous Renal Artery DissectionCase ReviewHerbert LeporJamie A KanofskySpontaneous renal artery dissection (SRAD) is a rare event, and thus may be a challenge for physicians to diagnose and treat. We report a case of SRAD in a healthy 56-year-old male who presented with flank pain, fever, and elevated white blood cell count. The patient was initially diagnosed with nephrolithiasis versus pyelonephritis and was admitted for observation. Multiple imaging modalities, including non-contrast computed tomography (CT), magnetic resonance imaging (MRI) with gadolinium, CT angiogram, and intraoperative angiogram, were used to make the final diagnosis of SRAD. The patient was treated with endovascular stent placement and is currently free of pain with normal laboratory values and blood pressure. [Rev Urol. 2007;9(3):156-160]KidneyRenal arteryDissectionAngiogramEndovascular stenting
Volume 9, Supplement 2Review ArticlesChallenging the Current Treatment Paradigm of Androgen-Independent Prostate CancerIntroductionHerbert Lepor