Use of α₁-Blockers in Female Functional Bladder Neck Obstruction

Abstract

Introduction: Bladder outflow obstruction may cause obstructive or irritative symptoms. The diagnosis of female functional bladder neck obstruction requires a pressure/flow study and electromyography performed by videourodynamics. The treatment includes self-catheterization or bladder neck incision. We administered tamsulosin, an α₁A/α₁D-selective adrenergic antagonist, in women with functional bladder neck obstruction to evaluate its potential therapeutic effects. Patients andMethods: A group of 18 women affected by functional bladder neck obstruction was selected. The diagnosis was made by means of a pressure/flow study combined with electromyography and a fluoroscopic test. The diagnostic criteria were: high detrusor pressure with reduced maximum flow, silent electromyography activity, and bladder neck nonfunnelling during the fluoroscopic test. Tamsulosin 0.4 mg once daily was administered for at least 30 days. Patients with a postvoid residual urine volume ≧100 ml performed intermittent self-catheterization. Patients with a postvoid residual urine volume <100 ml performed self-catheterization every 7 days. After 30 days of therapy, all patients underwent a new pressure/flow study and a micturition fluoroscopic test. Results: 10 (56%) out of 18 treated patients showed a statistically significant improvement in symptoms, maximum flow, and postvoid residual urine volume (p < 0.01). Conclusion: The use of α₁-blockers may be an initial treatment option for female functional bladder neck obstruction, as this therapeutic option proved to be effective in more than 50% of our patients suffering from this voiding dysfunction.

Open-Label, Longitudinal Study of Tamsulosin for Functional Bladder Outlet Obstruction in Women

“…The majority of patients accepted to continue therapy for more than 1 month indicating a lack of severe adverse effects and improvement in their symptomatology on the basis of the patients' perspective. These results are a little better than the improvement rates reported by Kumar et al [14] and Pischedda et al [15] . They reported significant improvement in symptoms, Q max and PVR in 50 and 56% of women with functional BOO.…”

“…Finally Yucel et al [8] reported their experience on 28 children with dysfunctional voiding and urinary retention concluding that ␣ -blocker therapy seems to be a viable alternative to biofeedback in this group of patients as it is well tolerated and improves bladder emptying. Kumar et al [14] , Pischedda et al [15] and more recently Kessler et al [2] reported significant improvement in symptoms and urodynamic parameters in women with functional BOO. The few data available from studies and experimental models in males agree on the rationale for ␣ -lithic agents as therapy for women with micturitional disturbances due to functional obstructive symptoms of the lower urinary tract.…”

Een α‑adrenerge receptorantagonist als behandeling van blaasontledigingsklachten bij vrouwen: Feit of fictie?

“…Urodynamisch gezien leidde in alle prospectieve onderzoeken tamsulosine tot een significante verbetering van de Qmax met 3,3-7,1 ml/s, en in de studie waarin 1-5 mg terazosine werd gegeven zelfs met 11,1 ml/s [9][10][11][12][13][14]. De PdetQmax werd in twee prospectieve studies onderzocht en daalde in de ene studie met 10 cmH2O en in de andere studie met 20 cmH2O [13,14]. Het residu na mictie nam met circa een derde af, terwijl het mictievolume nagenoeg gelijk bleef.…”

Effect of Urethral Dilatation on Women With Voiding Dysfunction

“…Pharmacologic strategies also have been used to address outlet resistance. α-Adrenoreceptor blockade with alfuzosin [20], terazosin [21], and tamsulosin [22] has been shown to lead to improvements in bladder emptying, quality of life, and lower urinary tract symptoms in women with VD. Although α-blockers have been used in men with bladder outlet obstruction for many years, their use in women has drawn interest only relatively recently.…”