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Research Database PMU-SQQUID

alpha-Blockers improve chronic ischaemia of the lower urinary tract in patients with lower urinary tract symptoms.
Pinggera, GM; Mitterberger, M; Pallwein, L; Schuster, A; Herwig, R; Frauscher, F; Bartsch, G; Strasser, H;
BJU Int. 2008; 101(3):319-324
Originalarbeiten (Zeitschrift)

PMU-Authors

Mitterberger Michael

Abstract

OBJECTIVE To investigate whether a mechanism of action of alpha-blockers on lower urinary tract symptoms (LUTS) involves improved perfusion of the LUT. PATIENTS, SUBJECTS AND METHODS The accuracy of perfusion measurements using transrectal colour Doppler ultrasound (TRCDUS) and colour pixel density (CPD) was initially confirmed in a porcine model. Following this confirmation, measurements were taken from four healthy male volunteers and 19 patients with LUTS. The urinary bladder was filled slowly (50 mL/min) with 0.2 M KCl, which resembles the osmolarity of concentrated urine, and evaluated by cystometry. In parallel, TRCDUS and measurement of the CPD of the LUT were performed. The patients with LUTS were then treated with daily alpha-blocker (0.4 mg tamsulosin) for 5 weeks and urodynamic variables as well as perfusion were evaluated again. RESULTS In the healthy men, perfusion of the LUT increased considerably (157%) during filling of the bladder to a mean (SD) maximum cystometric capacity (C(max)) of 481 (28.9) mL. All the patients with LUTS had a reduced mean C(max) during filling with KCl at 322.4 (58.5) mL. The mean CPD in the urinary bladder and the prostate were only increased by 58.4% during filling with KCl. After alpha-blocker therapy the mean C(max) during filling with KCl rose to 382.5 (42.9) mL; furthermore, perfusion of the LUT measured by CPD was significantly increased (132.8%). CONCLUSIONSThe present data strongly suggest that LUTS are associated with chronic ischaemia of the prostate and urinary bladder. alpha-blockers increase perfusion in the LUT and C(max). These results might explain the therapeutic effects of alpha-blockers on LUTS.


Useful keywords (using NLM MeSH Indexing)

Adrenergic alpha-Antagonists/therapeutic use*

Adult

Aged

Animals

Case-Control Studies

Chronic Disease

Humans

Ischemia/drug therapy*

Ischemia/physiopathology

Ischemia/ultrasonography

Male

Middle Aged

Prostate/blood supply*

Prostate/physiopathology

Prostate/ultrasonography

Prostatic Hyperplasia/complications

Prostatism/drug therapy*

Prostatism/physiopathology

Prostatism/ultrasonography

Sulfonamides/therapeutic use*

Swine

Treatment Outcome

Urinary Bladder/blood supply*

Urinary Bladder/physiopathology

Urinary Bladder/ultrasonography

Urodynamics/physiology


Find related publications in this database (Keywords)

lower urinary tract symptoms
perfusion of bladder and prostate
alpha-blocker
tamsulosin
ischaemia