There are numerous drugs used in urology, the medical specialty which deals with conditions of the male and female urinary tract and the male reproductive system. The drugs are categorized by their uses and mechanism of action.
The most commonly prescribed drug classes in urology include:
- Alpha-blockers: Work by relaxing muscles at the bladder neck to improve urinary flow
- 5-alpha inhibitors: Treat enlarged prostate by blocking the production of the male hormones that are associated with prostate enlargement
- Anticholinergics: Minimize bladder contractions and increase bladder capacity for people with an overactive bladder (OAB)
The drugs can be used on their own or in combination. Two-in-one drugs combine more than one component. For example, Duodart combines an alpha-blocker with a 5-alpha inhibitor.
Alpha-blockers, also called alpha-adrenergic antagonists, are used to treat some symptoms of benign prostatic hyperplasia (BPH), which is non-cancerous enlargement of the prostate gland.
These drugs prevent the hormone norepinephrine from constricting certain smooth muscles and blood vessels. By doing so, they can improve urinary flow in genetic males with prostate problems.
Alpha-blockers currently approved for the treatment of BPH symptoms include:
- Cardura or Cardura XL (doxazosin)
- Flomax (tamsulosin)
- Hydrin (terazosin)
- Uroxatral (alfuzosin)
Some alpha-blockers are available in short- and long-acting formulations. The short-acting drugs work quickly, but their effects only last a few hours. Long-acting versions may take longer to work, but their effects last longer. You and your healthcare provider can discuss what would be right for you based on your symptoms.
Side effects of alpha-blockers can include dizziness, headaches, postural hypotension (low blood pressure when you stand), erectile dysfunction, and reduced ejaculation due to retrograde ejaculation (a condition where semen is ejaculated into the bladder).
5-alpha inhibitors, also known as 5-alpha reductase inhibitors, are prescribed for long-term treatment of BPH and it may take up to six months before they exert their full effects. These medications are commonly used in combination with alpha-blockers to improve urine flow and bladder emptying in genetic males who have BPH.
5-alpha inhibitors work by preventing the conversion of testosterone to dihydrotestosterone. This hormone is associated with BPH and male pattern baldness.
5-alpha inhibitors currently approved for the treatment of BPH are:
- Avodart (dutasteride)
- Propecia or Proscar (low- and high-dose finasteride, respectively)
Side effects of 5-alpha inhibitors can include loss of libido, impotence, or retrograde ejaculation.
Anticholinergic drugs are prescribed for males and females to reduce the symptoms of OAB, a condition that causes people to feel as if they need to urinate even when the bladder isn’t full.
These medications work blocking the action of acetylcholine, a neurotransmitter that sends signals to the brain that trigger abnormal bladder contractions. Sometimes they are used in combination with alpha-blockers or 5-alpha reductase inhibitors for genetic males who have BPH and OAB.
Anticholinergics currently approved for the treatment of overactive bladder include:
- Detrol (tolterodine)
- Enablex (darifenacin)
- Oxytrol or Ditropan XL (oxybutynin)
- Regurin and Sanctura (trospium chloride)
- Toviaz (fesoterodine)
- Vesicare (solifenacin)
- Sanctura (trospium)
Anticholinergics may cause side effects such as confusion dry mouth, constipation, blurred vision, and rapid heartbeat (tachycardia). These medications can also cause slowing of the urine stream in men who have BPH. Trospium is less likely to cause confusion because it does not cross the blood brain barrier.
Other Drugs Used in Urology
Urologists treat conditions affecting the urinary system in males and females, and the reproductive system in males. Some of the conditions, including prostate cancer, urinary tract infections (UTIs), erectile dysfunction (ED), hypogonadism (low production of testosterone), and Peyronie’s disease (a condition characterized by a curved, painful erection) are treated surgically, and some are treated with medication or with a combination of surgery and medication.
To find a qualified urologist near you, ask your primary care provider for a referral or contact your insurance company for a list of approved providers.