The effect of alpha-blocker treatment on bladder hypoxia inducible factor-1 alpha regulation during lower urinary tract obstruction

Abstract

Aims: To determine whether α1-blocker treatment, in chronic bladder outlet obstruction (BOO), influences bladder tissue ischemia. Materials and Methods: This prospective study included 60 patients with BOO, of which 40 were under α1-blocker medication and 20 without treatment. Patients underwent transurethral resection of the prostate (TURP) or suprapubic prostatectomy (SPP). Ten patients with non-muscle invasive bladder cancer underwent transurethral resection of the bladder tumor and served as the control group. Tissue specimens were immunohistochemically stained for hypoxia inducible factor-1α (HIF-1α). Results: Bladder tissue from obstructed subjects showed high immunoreactivity to HIF-1α. The specimens from the control group, showed no or weak, mainly cytoplasmic immunoreactivity to HIF-1α. Patients under α -blocker treatment did not differ in the number of HIF-1α positive cells compared to subjects with no treatment (median number 86.8 [20-150] and 88.6 [0-175], respectively) (p > 0.05). The lowest bladder pressure at which HIF-1α was up regulated, was detected at detrusor pressure Qmax (PdetQmax) = 60 cm H2O. Conclusions: Treatment with α-blockers in obstructed patients considered as non-responders, does not result in HIF-1α down regulation, thus bladder continues to be under chronic stress.

Effects of varying degrees of partial bladder outlet obstruction on urinary bladder function of rats: A novel link to inflammation, oxidative stress and hypoxia

“…Currently, the treatment for LUTS/BPH involves decreasing the degree of obstruction with pharmacotherapy. Koritsiadis et al reported that high HIF‐1α protein levels in patients with BOO were not reversed by α 1 ‐adrenergic receptor antagonists, and therefore the bladder continued to be under chronic stress. Moreover, α 1 ‐adrenergic receptor antagonist, silodosin improved bladder function by restoring bladder blood flow in a rat model of chronic bladder ischemia .…”

The efficacy and safety of oral Tamsulosin controlled absorption system (OCAS) for the treatment of lower urinary tract symptoms due to bladder outlet obstruction associated with benign prostatic hyperplasia: an open-label preliminary study

“…The 24-hour sustained efficacy extending over a longer period of time, even at night, leads to improvements in LUTS/BPH, such as nocturia with fewer side effects. This effect can be explained by the specific mechanism of alpha blockers (13). Nocturia is one of the most bothersome LUTS in BPH, and is the most common cause of sleep disturbance in older men.…”

Is there a link between overactive bladder and the metabolic syndrome in women? A systematic review of observational studies

“…Accumulating evidence from clinical studies and basic research suggests that ischaemia may be an independent factor in the development of non‐obstructed non‐neurogenic bladder overactivity and LUTS. A close correlation between pelvic ischaemia and bladder overactivity has been documented in elderly men and women . Recent research has established a link between LUTS and the MetS in men , providing a rationale for the present review, which focuses on the relationship between MetS and OAB in women.…”