α-Blockers: An effective treatment for prostatitis?

Abstract

Chronic prostatitis is a multifaceted problem affecting men that is both poorly understood and poorly treated. It is inevitable, therefore, that no single treatment will benefit all patients. However, data suggest that some patients' problems can be treated effectively with alpha-blockers. The prostate is rich in alpha-adrenergic receptors, and some urodynamic studies have shown a failure of the bladder neck to relax during voiding. Other studies have demonstrated turbulent flow in the prostate leading to prostatic duct reflux. Because urine is acidic, reflux into the prostatic ducts will cause inflammation and pain. Thus alpha-blockers are an effective treatment for men with prostatitis caused by dysfunctional voiding.

The distribution of BCG prostatitis: A clue for pathogenetic processes?

“…The ducts draining PZ glands enter the urethra as a double lateral line along the whole of the distal urethral segment . They are relatively narrow (0.15‐0.3 mm) but enter the urethra at a less obtuse angle than those from other zones, which may make them more prone to the reflux of urine, perhaps with a contribution from turbulence . This has led to the proposal that carcinogens or inflammatory stimuli may reflux from the urethra into the PZ via its ducts …”

“…It seems likely that the microanatomical arrangement of the prostatic ducts makes the PZ prone to access by urine‐contained injurious agents, such as BCG. Urinary reflux in other circumstances could be implicated in the pathogenesis of other prostatic diseases, including conventional prostatitis and even prostatic adenocarcinoma.…”

“…31 They are relatively narrow (0.15-0.3 mm) 31 but enter the urethra at a less obtuse angle than those from other zones, which may make them more prone to the reflux of urine, perhaps with a contribution from turbulence. 33 This has led to the proposal that carcinogens or inflammatory stimuli may reflux from the urethra into the PZ via its ducts. 26 Our observations on the zonal and duct-associated distribution of BCG granulomatous prostatitis support the view that intraductal reflux is likely to be a common phenomenon, and that it affects predominantly the PZ of the prostate gland.…”

Chronische Schmerzsyndrome in der Urologie

“…Hilfreich kann die zusätzliche Verordnung eines α-Blockers sein [19].Eine transurethrale Resektion bei Therapieversagen sollte erst bei Männern über 50 Jahre diskutiert werden, da daraus eine retrograde Ejakulation resultiert.…”

“…Diese Obstruktion ist am ehesten funktionell zu deuten. Daher ist der Einsatz von α-Blockern sinnvoll [19].…”