Causes (DRIP):
- Drugs, delirium
- Retention, Restricted mobility
- Impaction, infection, inflammation
- Polyuria, prostatitis
Treatment:
- Urge:
- Anti-muscarinic and anticholinergic: oxybutynin, tolterodine, fesoterodine, trospium, solifenacin, darifenacin
- B-agonist: mirabegron
- Stress:
- alpha-adrenergic agonists: pseudoephedrine, phenylephrine
- topical estrogens if other signs of estrogen deficiency
- SSRI/SNRI: only duloxetine
- Overflow:
- alpha-adrenergic agonists: alfuzosin, tamsulosin
- 5-alpha-reductase inhibitors: finasteride, dutasteride
- Parasympathomimetic: bethanechol
- Phosphodiesterase inhibitor: tadalafil
- BPH:
- Meds that exacerbate: alpha-adrenergic agonists like decongestants, anticholinergic drugs (antispasmodics, antihistamines, tricyclics, phenothiazines), diuretics and testosterone.
- Treatment:
- alpha-blockers: doxazosin and terazosin are non-specific and also lower blood pressure. Newer agents (tamsulosin, silodosin, alfuzosin)
are more specific. - alpha- reductase inhibitors: dutasteride and finasteride are reserved for men with large prostate volume (>40 grams). Takes 6 months for full effect.
- Phosphodiesterase inhibitors: tadalafil 5 mg
- alpha-blockers: doxazosin and terazosin are non-specific and also lower blood pressure. Newer agents (tamsulosin, silodosin, alfuzosin)