Urodynamic effects of alpha-adrenoceptor blockers: a review of clinical trials

Kortmann, Barbara; Floratos, D.; Kiemeney, Lambertus A.; Wijkstra, Hessel; Rosette, Jean J.M.C.H. de la

doi:10.1016/s0090-4295(02)02113-1

Cited by 61 publications

(49 citation statements)

References 40 publications

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“…It has been found that treatment with α1-blockers increased average maximum flow rate to 2.9 mL/s (range 0.9-5.6 mL/s) and the PdetQmax decreased to average 17.4 cm H2O (38.2-0.0 cm H2O) from a base line of 85.1 cm H2O (range 70-100.4 cm H2O) to 67.1 cm H2O (range 39.7-93 cm H2O), but this interval is always above normal detrusor pressure, for non obstructed voiding (17)(18)(19)(20)(21). Patients in these studies however, experienced marked symptomatic improvement as assessed by IPSS, although still remaining obstructed.…”

Section: A B C Dmentioning

confidence: 92%

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

et al. 2010

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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.

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Section: A B C Dmentioning

confidence: 92%

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

et al. 2010

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“…Firstly, storage symptoms such as non-voiding bladder contractions in animals induced by a partial ligature around the urethra were effectively inhibited by α -blockers (20), although under such circumstances these drugs clearly could not improve bladder outlet obstruction. Secondly, a systematic review of urodynamic studies in men with LUTS suggestive of BPH demonstrated that α -blockers as a class have only little effect on bladder outlet resistance (21). Moreover, we have recently demonstrated that improvements in voiding symptoms upon α -blocker treatment show only a poor if any correlation with treatment-associated alterations in bladder outlet resistance ( Fig.…”

Section: Efficacymentioning

confidence: 93%

The Forefront for Novel Therapeutic Agents Based on the Pathophysiology of Lower Urinary Tract Dysfunction: α-Blockers in the Treatment of Male Voiding Dysfunction — How Do They Work and Why Do They Differ in Tolerability?

Michel

2010

J Pharmacol Sci

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Abstract. α 1 -Adrenoceptor antagonists are the mainstay of medical treatment of male voiding dysfunction which typically is attributed to benign prostatic hyperplasia. While original concepts have assumed that they relieve voiding dysfunction by relaxing prostatic smooth muscle, newer data indicate that their therapeutic effects at least partly occur independent of prostatic relaxation, perhaps involving direct effects on blood vessels, urothelium, afferent nerves, and/or smooth muscle of the urinary bladder. The adverse event profiles differ among α 1 -adrenoceptor antagonists, with tamsulosin having a particularly good cardiovascular tolerability. While this was originally attributed to its selectivity for α 1A -adrenoceptors, it appears that alfuzosin which lacks subtype-selectivity, has a very similar tolerability. In contrast, doxazosin and terazosin, which are chemically and pharmacologically more closely related to alfuzosin than to tamsulosin, appear to have more side effects attributable to the cardiovascular system. More recent data indicate that tolerability differences between α 1 -adrenoceptor antagonists may at least partly relate to pharmacokinetic rather than to pharmacodynamic differences. Taken together, these data emphasize the idea that concepts about drug efficacy and tolerability despite being highly plausible may not necessarily be true and always require thorough experimental testing.

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“…U mokraćnom sustavu oni su najbrojniji u glatkim mišićnim stanicama prostate kao i na vratu mjehura [29][30][31] . Blokadom tih receptora dolazi do smanjenja tonusa prostate kao i opuštanja vrata mokraćnoga mjehura, što posljedično dovodi do olakšanog mokrenja.…”

Section: Blokatori Alfa Adrenergičkih Receptoraunclassified

“…Blokadom tih receptora dolazi do smanjenja tonusa prostate kao i opuštanja vrata mokraćnoga mjehura, što posljedično dovodi do olakšanog mokrenja. Alfa-1 adrenergičkih receptora ima nekoliko podvrsta, a oni A i D su najučestaliji u mokraćnom sustavu dok su ostali podtipovi češći u krvnim žilama, glatkom mišićnom tkivu izvan prostate te u središnjem živčanom sustavu 30,31 . Blokatore alfa-1 adrenergičkih receptora, ovisno o tome djeluju li dominantno samo na receptore u mokraćnom sustavu možemo podijeliti na neselektivne i uroselektivne.…”

Section: Blokatori Alfa Adrenergičkih Receptoraunclassified

Benign prostatc hyperplasia – medicamentous treatment

et al. 2017

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Sažetak. Benigna hiperplazija prostate (BPH) karakterizirana je umnažanjem žljezdanih i/ili stromalnih elemenata prostate. Ona može dovesti do uvećanja prostate i uzrokovati smetnje mokrenja donjeg dijela mokraćnog sustava (LUTS). Rast prostate ovisan je o dobi i utjecaju spolnih hormona, prvenstveno dihidrotestosterona. Simptomi se dijele na iritativne, opstruktivne i postmikcijske. U osnovnu obradu pacijenata spada anamneza, korištenje upitnika o smetnjama mokrenja, dnevnik mokrenja, fizikalni pregled, analiza urina, serumska koncentracija kreatinina i prostata specifičnog antigena, mikciometrija i mjerenje rezidualnog urina. Terapiju se odabire na osnovi smetnji koje pacijent ima i rezultata dijagnostičke obrade. Prvi korak u liječenju predstavljaju određene promjene u ponašanju i prehrani. U pacijenata s blagim smetnjama preporučuje se aktivno praćenje. U ostalih pacijenata započinje se s medikamentoznom terapijom. Mogućnosti medikamentozne terapije su mnogobrojne: blokatori alfa adrenergičkih receptora, inhibitori 5-alfa-reduktaze, antagonisti muskarinskih receptora, analog vazopresina -dezmopresin, agonisti beta-3 adrenergičkih receptora, inhibitori 5-fosfodiesteraze, fitoterapija i kombinirana terapija. U slučaju neuspjeha medikamentozne terapije ili prisutnosti komplikacija BPH-a preporučuje se kirurško liječenje.Ključne riječi: benigna hiperplazija prostate; medikamentozna terapija; simptomi donjeg mokraćnog sustava Abstract. Benign prostatic hyperplasia (BPH) is characterized with proliferation of glandular and stromal components of the prostate. BPH can produce prostate enlargement and caused lower urinary tract symptoms (LUTS). The growth of the prostate depends on patient's age and influence of sexual hormones, specially dihydrotestosterone. Symptoms can be divided as irritative, obstructive and postmicturation symptoms. The basic evaluation included medical history, symptom score questionnaire, bladder diary, physical examination, urinalysis, creatinine and prostate specific antigen serum concentration, uroflowmetry and postvoid residual urine. The modality of treatment depends about patients symptoms and results of diagnostic evaluation. The initial step in the treatment are behavioural and dietary modifications. In the patients with mild symptoms watchful waiting is first line treatment. In the other patients medicamentous treatment is recommended. Pharmacological management included: alpha adrenoreceptor antagonists, 5-alpha-reductase inhibitors, muscarin receptors antagonists, vasopressin analoguedesmopressin, beta-3 agonists, phosphodiesterase 5 inhibitors, phytotherapy and combination therapy. If the medicamentous therapy failed or the complications of BPH are present surgical treatment is recommended.

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Urodynamic effects of alpha-adrenoceptor blockers: a review of clinical trials

Cited by 61 publications

References 40 publications

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

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

The Forefront for Novel Therapeutic Agents Based on the Pathophysiology of Lower Urinary Tract Dysfunction: α-Blockers in the Treatment of Male Voiding Dysfunction — How Do They Work and Why Do They Differ in Tolerability?

Benign prostatc hyperplasia – medicamentous treatment

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