A male patient tells the nurse he awakens once or twice each night to void and has difficulty starting his stream of urine. He describes these symptoms as "annoying
" The patient's provider examines him and notes that the prostate is moderately enlarged. The patient is sexually active and tells the nurse that he does not want to take any medication that will interfere with sexual function. The nurse anticipates the provider will order: a. doxazosin [Cardura].
b. finasteride [Proscar].
c. silodosin [Rapaflo].
d. a transurethral prostatectomy.
A
Nonselective alpha1-adrenergic antagonists do not commonly affect sexual function and are use-ful in patients with mild to moderate symptoms, so doxazosin would be a drug of choice for this patient. Finasteride is a 5-alpha-reductase inhibitor and is used for patients with more severe en-largement of the prostate; it also reduces ejaculate volume and libido. Silodosin is a selective al-pha1-adrenergic antagonist and can cause abnormal ejaculation. Transurethral prostatectomy is reserved for patients with more severe enlargement of the prostate.
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