The Present Role of Alpha-Adrenergic Blockers in the Treatment of Benign Prostatic Hypertrophy

Caine, Marco

doi:10.1016/s0022-5347(17)44709-4

Cited by 258 publications

(126 citation statements)

References 30 publications

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“…The scientific rationale for the use of a 1 -blockers in the therapy of BPH is based on the role of a 1 -adrenergic receptors in mediating smooth muscle relaxation, particularly at the bladder neck; overstimulation of these receptors leads to LUTS. 33 The nonsexual side effects of the a 1 -blockers have been well documented. A number of reports and metaanalyses have demonstrated that these medications may cause adverse events including dizziness, headache, asthenia, syncope, postural hypotension, and somnolence.…”

Section: Medical Therapy For Bphmentioning

confidence: 99%

Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life

Carbone

Hodges

2003

Int J Impot Res

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Therapies for benign prostatic hyperplasia (BPH) may either improve or exacerbate sexual function with an ensuing impact on quality of life. Here we review a total of 73 papers on medical therapies for BPH with a focus on the effects of different pharmacological agents on sexual function. For example, certain a 1 -adrenergic receptor blockers may improve erectile function; however, ejaculatory dysfunction with one of these agents, tamsulosin, occurs at a rate of 4-18%, rising to 30% with long-term use. In addition, treatment with the 5a-reductase inhibitor finasteride is associated with problems of ejaculation (2.1-7.7%), erection (4.9-15.8%), and libido (3.1-5.4%). Such significant and undesirable complications in relation to sexual function produce a welldocumented negative impact on quality of life. Thus, optimal treatment for men with BPH requires the use of agents that demonstrate efficacy and safety with fewer sexual side effects.

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Section: Medical Therapy For Bphmentioning

confidence: 99%

Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life

Carbone

Hodges

2003

Int J Impot Res

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“…These findings have led to a proposal that bladder outlet obstruction by BPH is composed of static and dynamic components. The former component is the physical obstruction produced by the presence of the hyperplastic tissue itself, whereas the latter factor is the tone of the prostatic smooth muscle regulated by the autonomic nervous system (Caine, 1986). A very dense network of adrenergic nerve fibres has been found histologically distributed within the smooth muscle layer of the prostatic glandular stroma (Vaalasti & Hervonen, 1980) and adrenoceptors of human prostatic tissue have been characterized and quantitated by radioligand receptor binding methods and in vitro isometric tension experiments (Lepor & Shapiro, 1984;Hedlund et al, 1985;Yokoyama et al, 1985;Yamada et al, 1987).…”

Section: Introductionmentioning

confidence: 99%

A possible role of decreased relaxation mediated by β‐adrenoceptors in bladder outlet obstruction by benign prostatic hyperplasia

Tsujii

Azuma

Yamaguchi

et al. 1992

British J Pharmacology

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1 To explore mechanisms of urinary obstruction in benign prostatic hyperplasia (BPH), the features of contraction and relaxation in human hyperplastic and non-hyperplastic (control) prostatic tissues were investigated for P-and a,-adrenoceptors by radioligand binding and in vitro isometric tension experiments. 2 Hyperplastic and control prostatic tissues had a similar number (per mg protein) of prazosin binding sites with similar affinities. Noradrenaline (NA) induced dose-dependent contraction in both tissues. Contraction induced by either exogenous NA or transmural stimulation was inhibited by prazosin in both tissues, indicating that the same contractile mechanisms mediated by ol-adrenoceptors exist in hyperplastic and control tissues. 3 The number of dihydroalprenolol (DHA) binding sites (per mg protein) was less in hyperplastic tissues than in controls, whereas the affinity to the ligand was identical in both tissues. Isoprenaline caused a marked relaxation of the tonic contraction induced by KCI in control tissues, but not in hyperplastic tissues. Propranolol enhanced exogenous NA-or transmural stimulation-induced contraction more in control tissues than in hyperplastic tissues. Both tissues, however, similarly responded to forskolin by relaxation.4 These results indicate that decreased P-adrenoceptor-mediated relaxation in hyperplastic prostatic tissues, which is attributable at least in part to the decreased number of P-adrenoceptors, may play a role in the urinary obstruction of BPH in addition to mechanical compression of the urethra by the enlarged prostate.

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“…16 Caine sug gested that a combination of mechanical and dynamic com ponents has a significant impact on lower urinary tract symptoms. The mechanical component, that is the enlarged prostate gland, does not spontaneously decrease with time.…”

Section: Discussionmentioning

confidence: 99%

Variability of Clinical and Pressure-Flow Study Variables After 6 Months of Watchful Waiting in Patients with Lower Urinary Tract Symptoms and Benign Prostatic Enlargement

et al. 1996

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Purpose; We quantified the physiological variability of clinical and pressure-flow study vari ables in patients with symptomatic benign prostatic enlargement.Materials and Methods: Symptom scores were measured, and advanced urodynamic studies with pressure-flow analysis were performed in 178 patients before and 6 months after a period of watchful waiting.Results: Patients without bladder outlet obstruction experienced significant symptomatic improvement. Symptoms in patients with obvious bladder outlet obstruction did not improve significantly. The reproducibility of mean pressure-flow variables was evident. However, there was an important intra-individual variability. Patients with obvious bladder outlet obstruction showed a significant decrease in detrusor pressure at maximal flow of 14 cm. water, a significant decrease in the urethral resistance factor of 7 cm. water and a significant decrease of 1 obstruc tion class on the linear passive urethral resistance relation nomogram, indicating less severe bladder outlet obstruction.Conclusions: Mean differences among therapy groups must be regarded critically, especially when the differences are slight and possibly within physiological variability.

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The Present Role of Alpha-Adrenergic Blockers in the Treatment of Benign Prostatic Hypertrophy

Cited by 258 publications

References 30 publications

Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life

Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life

A possible role of decreased relaxation mediated by β‐adrenoceptors in bladder outlet obstruction by benign prostatic hyperplasia

Variability of Clinical and Pressure-Flow Study Variables After 6 Months of Watchful Waiting in Patients with Lower Urinary Tract Symptoms and Benign Prostatic Enlargement

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