Protecting Bladder Function and Reducing Disease Progression

Abstract

Infravesical obstruction impairs bladder function, and α 1-adrenoceptor (AR) antagonists can relieve such dysfunction in part due to their moderate deobstructing effects. Moreover, α 1-AR antagonists may also have beneficial effects on bladder function via mechanisms independent from those regulating bladder outlet resistance. Such beneficial effects have repeatedly been reported from various animal models of bladder outlet obstruction, and preliminary data indicate that this may perhaps also occur in lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) patients. The contribution of such effects on the bladder in the long-term treatment of LUTS/BPH remains to be assessed. The recently completed Medical Therapy Of Prostatic Symptoms (MTOPS) study has demonstrated that α 1-AR antagonists have beneficial effects on the progression of LUTS/BPH which are quantitatively similar to but qualitatively different from those of 5α-reductase inhibition. Due to this differential mode of action, long-term combination treatment was significantly more effective than either treatment alone. Since combination therapy is at least associated with the side effects of both the α 1-AR antagonist and 5α-reductase inhibitor, great care should be taken to identify patients at high risk in whom the benefits of combination treatment outweigh its risk. Use of an α 1-AR antagonist with very high tolerability may facilitate the use of combination treatment.