Benign Prostatic Obstruction Relief in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Enlargement Undergoing Endoscopic Surgical Procedures or Therapy with Alpha-Blockers: A Review of Urodynamic Studies

Abstract

Benign prostatic obstruction (BPO) contributes to the genesis of lower urinary tract symptoms as well as to pathologic remodeling of the lower and upper urinary tract in patients with benign prostate enlargement. Urodynamic studies demonstrate that both medical therapy with alpha-blockers (ABs) and endoscopic surgical procedures provide BPO relief. However, the magnitude of improvement is higher after surgery. Among ABs, silodosin is associated with the highest improvement of bladder outlet obstruction index (BOOI). A complex relationship exists between BOOI improvement and variations of both maximum urinary flow (Q ) and detrusor pressure. When the reduction of BOOI is small, the improvement of Q is clinically irrelevant and the BOOI is mainly influenced by a decrease of detrusor pressure. In contrast, when the magnitude of BOOI reduction is robust, a meaningful improvement of both detrusor pressure and urinary flow is evident. When clustering ABs according to their receptor pharmacologic selectivity and urodynamic efficacy, three subgroups can be identified,with silodosin being the only member of a subgroup characterized by the highest levels of BOOI improvement and α-1A/α-1B receptor affinity ratio.

The association between burning mouth syndrome and urologic chronic pelvic pain syndrome: A case‐control study

“…While the overlap between some conditions is well documented in the literature, such as neck pain, headache, low back pain, and jaw/face pain, 11 few data are presented on the relationship between burning mouth syndrome (BMS) and urologic chronic pelvic pain syndrome (UCPPS), a clinical syndrome characterized, principally, by the presence of pain and discomfort in the pelvic, genital, and perineal region, associated with urinary and sexual disfunction in the absence of a diagnosable cause 12 . This condition, which encompasses both interstitial cystitis/bladder pain syndrome (IC/BPS) 13 and chronic prostatitis/chronic pelvic pain syndrome (CP/CPSS), 14 is frequently associated with irritable bowel syndrome, chronic fatigue syndrome, TMDs, vulvodynia, and fibromyalgia 15‐17 …”

Silodosin 8 mg improves benign prostatic obstruction in Caucasian patients with lower urinary tract symptoms suggestive of benign prostatic enlargement: results from an explorative clinical study

“…Phase III randomized controlled trials as well as post hoc analyses of these studies performed in Japan, US and Europe demonstrated that silodosin provides clinically relevant benefits in terms of storage and voiding LUTS as well as in terms of Quality of Life (QoL) as assessed by the International Prostate Symptom Score (IPSS) [ 8 – 11 ]. Benign Prostatic Obstruction (BPO) is considered a key pathophysiological link between Benign Prostatic Enlargement (BPE) and LUTS [ 12 , 13 ]. Moreover, long lasting BPO may activate pathways leading to progressive remodeling of both lower and upper urinary tract with subsequent functional impairments [ 12 ].…”

“…Benign Prostatic Obstruction (BPO) is considered a key pathophysiological link between Benign Prostatic Enlargement (BPE) and LUTS [ 12 , 13 ]. Moreover, long lasting BPO may activate pathways leading to progressive remodeling of both lower and upper urinary tract with subsequent functional impairments [ 12 ]. Therefore, BPO relief represents a major goal of LUTS/BPE treatment.…”

“…Therefore, BPO relief represents a major goal of LUTS/BPE treatment. A diagnosis of BPO requires an invasive Pressure/Flow studies (PFS) that allows to calculate the Bladder Outlet Obstruction Index (BOOI) [ 12 ]. Clinical studies investigating invasive urodynamic measures of BPO in LUTS/BPE patients receiving silodosin demonstrated that this agent, as other ABs, significantly improves BOOI [ 11 – 13 ].…”

Sexual function in patients undergoing combination treatment with α1‐adrenoceptor antagonists and 5α‐reductase inhibitors: a step forward in a still‐open debate

“…Combination treatment with α1‐adrenoceptor antagonists and 5α‐reductase inhibitors (5ARIs) is recommended in men with moderate‐to‐severe LUTS and risk of disease progression . These drugs can improve symptoms as well as urodynamic markers of BOO . Despite the clinical benefits, the potential negative impact of these drugs on sexual function is of major concern, and may be cause for treatment discontinuation.…”