Aim:The etiology of the ejaculatory disorder induced by alpha-1 blockers is still controversial, although it has been suggested to be retrograde ejaculation. The aim of this study was to investigate the distribution of alpha-1 adrenoceptor subtype mRNA in human seminal vesicles, and to analyze the prevalence and etiology of the disorder in healthy men. Methods: Experimental Study. Seminal vesicles from 10 surgical specimens (eight radical prostatectomy, two radical cystectomy) were dissected. Real-time PCR was conducted for quantification of mRNA expression of each alpha-1 adrenoceptor subtype. Clinical Study. Ejaculatory disorder was investigated using 17 healthy male volunteers. Tamsulosin (0.2 mg and 0.4 mg) and naftopidil (50 mg and 100 mg) were administered in a crossover manner for 3 days. The ejaculatory volume, sperm count in midstream urine after ejaculation, and fructose concentration in seminal plasma were investigated. Results: Real-time PCR revealed that alpha-1a mRNA was significantly predominant in seminal vesicles (P < 0.001; 1a, 75.0%; 1b, 11.7%; 1d, 13.3%). Ejaculatory volume (baseline 2.72 ± 0.28 mL) significantly decreased in the tamsulosin group (0.2 mg, 1.75 ± 0.31 mL; 0.4 mg, 1.51 ± 0.39 mL; P < 0.05), but not in the naftopidil group (50 mg, 2.70 ± 0.24 mL; 100 mg, 2.48 ± 0.26 mL; P = NS). There was no sperm in midstream urine after any ejaculation. Conclusions: The current study demonstrates that alpha-1a mRNA is predominant among the adrenoceptor subtypes in human seminal vesicles. Decreased capacity of contraction of the seminal vesicles is proposed as the cause of the ejaculatory disorder induced by alpha-1 blockers.
We conclude that 1) hepatic resection is effective in select patients with colorectal metastases; 2) adequate resection margin and adjuvant regional chemotherapy can improve outcome; and 3) microscopic fibrous pseudocapsule may offer additional postoperative information as an independent prognostic factor.
Aim:The aim of this study was to investigate whether the preoperative degree of bladder outlet obstruction (BOO), detrusor underactivity (DUA) or detrusor overactivity (DO) affected the short-term outcome of transurethral resection of the prostate (TURP) for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Methods: Ninety-two patients with LUTS/BPH aged 50 years or older who were considered to be appropriate candidates for TURP were included in this study. Pressure-flow study and filling cystometry were performed to determine BOO, DUA and DO before TURP. The efficacy of TURP was determined at 3 months after surgery using the efficacy criteria for treatment of BPH assessed by the International Prostate Symptom Score, QOL index, maximum flow rate and postvoid residual urine volume. Results: On preoperative urodynamics, 60%, 40% and 48% of patients showed BOO, DUA and DO, respectively. After TURP, 76% showed 'excellent' or 'good' overall efficacy, whereas only 13% fell into the 'poor/worse' category. The efficacy was higher as the preoperative degree of BOO worsened. In contrast, neither DO nor DUA influenced the outcome of TURP. However, the surgery likely provided unfavorable efficacy for patients having DO but not BOO. Only 20% of the patients who had both DO and DUA but did not have BOO achieved efficacy. Conclusions: Transurethral resection of the prostate is an effective surgical procedure for treatment of LUTS/BPH, especially for patients with BOO. DUA may not be a contraindication for TURP. The surgical indication should be circumspect for patients who do not have BOO but have DO.Key words benign prostatic hyperplasia, bladder outlet obstruction, detrusor contractility, detrusor overactivity, transurethral resection of the prostate.
In order to examine to what extent adrenergic mechanism contributes to the urethral pressure in patients with benign prostatic hypertrophy, changes in the intraurethral pressure in the prostatic zone were measured in vivo by both the urethral pressure profile technique and the balloon method before and after administration of alpha-adrenergic stimulants and an alpha-adrenergic blocker. The effect of spinal anesthesia on the urethral pressure was also investigated. It is suggested that 40 per cent of the total urethral pressure in patients with benign prostatic hypertrophy is due to alpha-adrenergic tone, and the remaining 53 per cent is due to static pressure resulting from the hypertrophied prostatic bulk. The in vitro study indicates that the increase in urethral pressure and contraction of the prostate, prostatic capsule and prostatic urethra.
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