Advances in Alpha-Blocker Therapy in the Management of Urological Disorders
Introduction
RIUS0000(Sanofi)_12-05.qxd 12/5/06 6:09 PM Page S1 INTRODUCTION Advances in Alpha-Blocker Therapy in the Management of Urological Disorders Herbert Lepor, MD Department of Urology, New York University School of Medicine, New York, NY [Rev Urol. 2006;8(suppl 4):S1-S2] © 2006 MedReviews, LLC lpha-blockers were originally developed for the treatment of hypertension. Over the past 30 years, -blockers have played an increasing role in the management of urological disorders. This supplement to Reviews in Urology addresses the role of -blockers in urology. The rationale for using -blockers for the treatment of benign prostatic hyperplasia (BPH) was based on the observation that -adrenoceptors were abundant in the prostate and mediated prostate smooth muscle tone. In the first article in this issue, I discuss the evolution of -blockers for the treatment of BPH. Phenoxybenzamine was the initial -blocker reported to be effective for the treatment of BPH, in 1975. This drug was associated with problematic side effects and required multiple dosing. Over the past 30 years, advances in -blocker therapy have largely focused on improving the tolerability and convenience of dosing. A VOL. 8 SUPPL. 4 2006 REVIEWS IN UROLOGY S1 RIUS0000(Sanofi)_12-05.qxd 12/5/06 6:09 PM Page S2 Alpha-Blocker Therapy for Urological Disorders continued What is the optimal way to apply medical therapies for the treatment of BPH? Fortunately, the treatment guidelines for medical therapy of BPH are based on a robust, evidence-based literature. Many double-blind, placebocontrolled trials have examined the safety and effectiveness of several blockers and 5-reductase inhibitors, the combination of these medical therapies, and how these agents— independently and in combination— impact on the natural history of the disease. Steven A. Kaplan, MD, a member of the American Urological Association (AUA) Practice Guidelines Committee, discusses the most recent iteration of the AUA guidelines for treating BPH. The most commonly prescribed blockers for the treatment of BPH are tamsulosin and alfuzosin. Both of these drugs have been shown to be very effective for the treatment of BPH when administered once daily without dose titration. These drugs are differentiated by the fact that the sustained-release formulation of alfuzosin does not cause erectile S2 VOL. 8 SUPPL. 4 2006 dysfunction. Is this clinically relevant? This is a judgment that the individual urologist and primary care physician must make. Until recently, the pathophysiology for erectile dysfunction associated with tamsulosin was poorly understood. Wayne J.G. Hellstrom, MD, and Jeffrey P. Wolters provide compelling evidence from both the laboratory and clinical studies that tamsulosin causes primary anejaculation. Prostatitis is a very common condition treated by the practicing urologist. The disease is frustrating both for the afflicted patient and the physician because it can be quite debilitating and there is no consensus regarding optimal management. There are several medical options offered for treating prostatitis, but they are supported by poorly controlled studies. Some experts advocate lifestyle modification. Of all of the treatment options recommended for prostatitis, the data are most compelling for -blockers. J. Curtis Nickel, MD, is one investigator who has championed randomized placebo-controlled trials for prostati- REVIEWS IN UROLOGY tis. Dr. Nickel reviews the literature supporting -blockers for prostatitis. Finally, the most recent application of -blockers in urological disease has been to facilitate the spontaneous passage of obstructing ureteral calculi. The tension of ureteral smooth muscle is mediated by 1-adrenoceptors. Several small studies have shown that various 1-blockers increase both the spontaneous passage rate and the time to spontaneously pass obstructing ureteral calculi. It is likely that the use of 1-blockers to treat distal ureteral calculi will limit the requirement for instrumentation. Michael Lipkin, MD, and Ojas Shah, MD, review the clinical data supporting 1-blockers for treating ureteral stones. Alpha-blockers have changed the management of BPH and a host of other urological conditions. I am confident that you will enjoy reading the 5 articles in this supplement, which all deliver important clinical messages. I am indebted to my colleagues and friends for their scholarly contributions to this supplement.