Clinical uroselectivity of alfuzosin in the treatment of benign prostatic hyperplasia.

The efficacy of alfuzosin in improving lower urinary tract symptoms and relieving bladder outlet obstruction has been demonstrated in numerous short- and long-term placebo-controlled studies and large-scale open studies, involving over 16,000 patients with symptomatic benign prostatic hyperplasia (BPH). Treatment with sustained release alfuzosin (5 mg twice daily) for 3 months resulted in a 5-point reduction in the International Prostate Symptom Score and a 29% increase in urinary flow rate. The benefits of alfuzosin have been confirmed in general practice. A 1-year prospective study of 5,849 men with clinical BPH treated with alfuzosin showed a 51% reduction in mean total symptom score, with a 56% decrease in mean irritative symptoms. Improvement in health-related quality of life of 3 years' duration have been recorded, including a reduction in the frequency of both diurnal and nocturnal micturition. Alfuzosin has a good safety profile. Unlike most other alpha1-blockers, a low risk of first-dose effect is seen, conveniently eliminating the necessity of dose titration at initiation of therapy. Postural symptoms related to orthostatic hypotension (a common side-effect of alpha1-blockers) are infrequent, including in the elderly and hypertensives. Central nervous system effects are also limited due to poor penetration of the blood-brain barrier. In conclusion, the positive benefits/risk ratio of alfuzosin allows it to be classified as a uroselective alpha1-blocker, which provides a beneficial contribution to the management of symptomatic BPH.