The adrenergic and cholinergic receptors of the human prostatic capsule, prostatic "adenoma", and bladder neck, were investigated by the in-vitro isometric technique. The prostatic capsule was found to be very rich in both alpha-adrenergic receptors and cholinergic receptors. The prostatic adenoma was moderately rich in alpha-adrenergic receptors, but cholinergic receptors were absent. Beta-adrenergic receptors were absent in the prostatic adenoma, and there was an equivocal response in less than half the specimens of the prostatic capsule. An attempt was made to distinguish between the trigonal component at the posterior bladder neck, and the true bladder neck muscle both posteriorly and antero-laterally. The results indicat that the "posterior bladder neck" seen at operation is predominantly trigonal muscle, and is poor in cholinergic receptors. The adrenergic response is variable in the true bladder neck muscle, but is present and strong in the trigonal muscle. This response is characteristically gradual in its development. In view of the findings in this investigation, it is suggested that certain instances of acute retention of urine in prostatic patients are due to over-stimulation of the alpha-adrenergic receptors, particularly those in the prostatic capsule. Similarly, the accepted clinical contraindication to the use of cholinergic drugs for retention in the prostatic patient is supported by the distribution of the cholinergic receptors in the tissues examined.
Summary
As a result of previous in‐vitro studies on the a‐adrenergic receptor activity of the human prostate and prostatic capsule a trial was made of a‐adrenergic blockers for the relief of obstructive prostatic symptoms.
Considerable benefit was obtained in several groups of patients, as demonstrated either by the relief or prevention of complete retention, or by diminution in residual urine or improvement in urinary flow‐rate recordings. A number of illustrative cases are described, and the indications for the use of this treatment are suggested.
It is emphasised that this treatment provides symptomatic relief only, and in no sense purports to be a treatment of the enlarged prostate itself.
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