A 60 year diabetic & hypeensive male with second grade prostatism admitted for prostatectomy developed myocardial infarction. Treatment now would be -

Ans. is 'b' i.e., Terazocin This patient needs medical treatment to relieve him of symptoms of prostatism (now better k/a LUTS i.e. lower urinary tract symptoms) Two classes of drugs are commonly used for BPH Alfuzosin , ala a) a Adrenergic blockers - eg. Prazosin, Terazosin (a, blockers) & Tamsulosin, Alf blockers) b) 5 a reductase inhibitors - eg. Finasteride, Dutasteride, Triptorelin pamoate a-Adrenergic blockers Since activation of a, receptors in the bladder neck, prostate and prostatic urethra increases their smooth muscle tone, their blockade relaxes these structures, reducing the dynamic obstruction and increasing the urinary flow rate. 5a reductase inhibitor These drugs prevent the conversion of testosterone into more active dihydrotestosterone responsible for androgen action in many tissues including prostate. Their use results in reduction in the size of the gland and improvement in symptom. But six months of therapy is required to see the maximum effect on prostate size and symptomatic improvement and symptomatic improvement is seen only in men with enlarged prostate (> 40 cm3) Ref Smith's Urology 17/e. Since the patient in the question needs to relieve him of his symptoms till he gets fit to be operated, an a blocker (Terazocin) would be used. a-blockers afford faster and greater symptomatic relief than finasteride. The bad point about a blocker is that their effect lasts only till drug is given and even with continued therapy, benefits may decline after several years due to disease progression. About Combination therapy Combination of both these class of drugs is used by surgeons to derive combined benefit from both; its use is not justified in this patient as he needs to alleivate his symptoms till he gets operated - the definitive & most effective t/t.