Quality Care - everyone, everytime
 

7.4 Drugs for Genito-Urinary Disorders

7.4.1 Drugs for urinary retention

Watchful waiting may be preferable to treatment in men with mild to moderate symptoms of BPH

Note reduction in blood pressure (an advantage in co-existing hypertension)

NICE CG97 - The Management of Lower Urinary Tract Infections in Men June 2010

 1st      TAMSULOSIN M/R  

Combination therapy in BPH with 5-alpha reductase inhibitors is called for under the following conditions: See section 6.4

Moderate to severe symptoms and where monotherapy with either tamsulosin or finasteride has failed

Patients with large prostate > 30g and symptomaticPatients with PSA > 1.4 and moderate to severe LUTS

Mr J Ochai's BPH Presentation 2010

     COMBODART (tamsulosin & dutasteride)
     VESOMNI (solifenacin 6mg/tamsulosin MR 0.4mg) 
     For patients with mixed symptoms due to BPH (WISE: weak stream, intermittent or interrupted stream, straining to void and poor emptying) and overactive bladder or storage symptoms (FUN: frequency, urgency with or without incontinence and nocturia)

7.4.2 Drugs for urinary frequency, enuresis, and incontinence

Use pharmacological treatment of OAB within a holistic context, including bladder training, psychological support and lifestyle adjustment.

NICE CG171 - The Management of Urinary incontinence in Women September 2013

 1st Line
      OXYBUTYNIN (immediate release then MR)  
     OXYBUTYNIN transdermal patch (Kentera)
    Use of oxybutynin may be limited by side effects. These may be reduced by starting at a lower dose or using a modified release preparation. Alternatives are more expensive, consider cost.
     MIRABEGRON
    Only when antimuscarinics are contraindicated/ ineffective/ have unacceptable side effects.
     NICE TA290 - Overactive bladder - mirabegron June 13
     
 2nd Line 
     TROSPIUM BD (Flotros)
     TROSPIUM XL (Regurin XL)
    If the above therapies have been tried without improvement of the condition, a referral to Urology/Gynaecology should be made.
   SPC link  TOLTERODINE
     TOLTERODINE XL
     
 3rd line
     FESOTERODINE
     SOLIFENACIN
     DULOXETINE
     BOTULINUM TOXIN
     A Botulinum toxin is used for bladder spasms and overactive bladder symptoms as a last resort in Multiple Sclerosis patients.

 7.4.3 Drugs used in urological pain

     POTASSIUM CITRATE Mixture
    For the alkalinisation of urine. This is preferentially exchanged in proximal tubules and increases calcium excretion in urine reducing stone formation
     PENTOSAN POLYSULFATE SODIUM (Elmiron) (Yellow)
     

 7.4.4 Bladder instillations and urological surgery

     INSTILLAGEL (Lidocaine hydrochloride 2%)
     

 7.4.5 Drugs for erectile dysfunction

 Erectile Dysfunction & Premature Ejaculation Primary Care Guidelines
 For sex hormones, please see section 6.4
 1st    SILDENAFIL
 2nd    AVANAFIL (Spedra)
 3rd    TADALAFIL (Cialis 5mg) for ED with LUTS
For patients with combined LUTS/BPH & ED (Erectile dysfunction). No need to prescribe separately PDE5 and alpha-blocker. Cialis 5mg once daily will treat both conditions. For primary care prescribing, patient must fulfil SLS criteria as specified in the Drug Tariff (Part XVIIIB)
     VACUUM PUMP after failed oral treatment with PDE5i
 4th    ALPROSTADIL
     ALPROSTADIL Cream (Vitaros)
     

 7.4.6 Drugs for premature ejaculation

 Treatment Algorithm for Premature Ejaculation
   SPC DAPOXETINE (Priligy)  (provisional - awaiting guidlines)

 

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