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Pharmacology of the Lower Urinary Tract
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Pedro Abreu-Mendes, João Silva, Francisco Cruz
Adverse effects:Dizziness, rhinitis, headache, asthenia, postural hypotension are AEs related to the alpha-1B AR. More common in non-selective alpha-blockers.Silodosin (Alpha-A1 selective) − better CV profile but higher rate of ejaculatory dysfunction.Tamsulosin (and possibly silodosin also) is associated with a high risk of floppy iris syndrome (Alpha-1A).
Adrenergic Antagonists
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Silodosin is an α1A subtype selective adrenoceptor antagonist utilized for treating BPH accompanied by little impact on BP. Rapid absorption with 32% bioavailability can be observed succeeding oral administration. It is 95.6% bound to protein specifically with AGP. Metabolism is by several pathways and the main metabolites produced are alcohol dehydrogenase (ADH/ALDH) via UDP-glucuronosyltransferase. Adverse effects include dizziness, orthostatic hypotension and the main adverse effect is retrograde ejaculation (Gugger, 2011; Matsubara et al., 2006; Michel, 2010; Montorsi, 2010; Rossi et al., 2010).
Urinary Incontinence in Older Adults
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Nicole Strong, Sara Z. Salim, Jean L. Nickels, K. Rao Poduri
Alpha-adrenergic blocker medications include tamsulosin, silodosin, doxazosin, and alfuzosin. They act by blocking the alpha-adrenergic receptors (alpha-1 and alpha-2) in the bladder and prostate gland, causing relaxation of the bladder neck smooth muscle and prostatic tissue.30 This relaxation ultimately results in less resistance to urine flow.30,52 Silodosin and tamsulosin are third-generation alpha-receptor antagonists and are considered to be uroselective because they strictly target the prostate alpha-1 receptors.9 Alfuzosin is a second-generation alpha-1 blocker that is also uroselective. Uroselectivity is worth noting because these medications are associated with decreased cardiovascular side effects.9 A meta-analysis evaluating efficacy of all the alpha-blockers in the treatment of BPH symptoms demonstrated a mean decrease in symptom scores and increase in urinary flow rate.62 These medications may be used alone or in combination with 5-alpha reductase inhibitors. Alpha-blockers must be used with caution in older adults, as they may induce orthostatic hypotension.30
Pre-treatment serum testosterone level can be a useful factor to predict the improvement in bladder outlet obstruction by tadalafil for male patients with lower urinary tract symptoms induced by benign prostatic obstruction
Published in The Aging Male, 2020
Yoshihisa Matsukawa, Yoshie Kanada, Shun Takai, Satoshi Inoue, Tsuyoshi Majima, Yasuhito Funahashi, Masashi Kato, Tokunori Yamamoto, Momokazu Gotoh
Curative drugs for benign prostatic hyperplasia (BPH) have been reported to improve lower urinary tract symptoms (LUTS), and relieving bladder outlet obstruction (BOO) is considered the main mechanism [1–3]. However, in real clinical practice, some patients fail to obtain an improvement in subjective symptoms or BOO. Thus, identifying patients who will not respond to pharmacotherapy ahead of drug administration is important. With regard to predictive factors for therapeutic effects of α1-adrenoceptor antagonists (α1-blockers) which are widely used as first-choice drug for LUTS suggestive of BPH (LUTS/BPH), prostate volume, and severity of pre-treatment subjective symptoms reportedly affect their therapeutic efficacy [4,5]. Recently, we have reported that intravesical prostatic protrusion (IPP) is a useful predictor of the therapeutic effects of silodosin for subjective symptoms and BOO [6].
Efficacy of silodosin on the outcome of semi-rigid ureteroscopy for the management of large distal ureteric stones: blinded randomised trial
Published in Arab Journal of Urology, 2018
Ahmed Mohey, Tarek M. Gharib, Hisham Alazaby, Mostafa Khalil, Ahmed Abou-Taleb, Yasser A. Noureldin
In the present series, the stone-free rate was higher in the Silodosin group than in the Placebo group at 24–48 h (91.94% vs 73.85%, P = 0.009) and after 4 weeks (94.64% vs 75.43%, P = 0.007). This was close to the rates reported in various studies for URS management of distal ureteric stones, which range from 77.5% to 94.6% [27,28]. In the literature, the reported overall complication rates for URS range from 9% to 25% [29–31]. In the present study, the overall complication rate was higher in the Placebo group than the Silodosin group (20% vs 6.4%). Mucosal injury and haematuria were obvious complications in the Placebo group. This supports the notion that silodosin facilitates the advancing of the ureteroscope to the stone by relaxing the ureteric smooth muscles. In the literature, administration of α-AR blockers reduced the need for analgesia [32,33]. This is congruent with the results reported in the present study, as the need for postoperative analgesia was significantly lower in the Silodosin group than in the Placebo group. We consider that the success of advancing the ureteroscope to access the stones with ease, swiftly, and with less complications, as the cornerstone of the present study.
Comparing tamsulosin, silodosin versus silodosin plus tadalafil as medical expulsive therapy for lower ureteric stones: A randomised trial
Published in Arab Journal of Urology, 2018
Md Jawaid Rahman, M. Shazib Faridi, Naloh Mibang, Rajendra Sinam Singh
Ureteric colic occurs due to an increase in intraureteric pressure proximal to site of obstruction. α-AR antagonists block C fibres responsible for mediating ureteric colic [18]. In our present study, Group C had significantly fewer pain episodes than Group A and Group B (P < 0.001), and Jayant et al. [17] also showed significantly fewer pain episodes with a tadalafil and tamsulosin combination as compared to tamsulosin alone. This may be due to two drugs with different actions on the ureter. Silodosin blocks the C fibres and tadalafil probably decreases the frequency and amplitude of ureteric phasic peristaltic contractions that accompanies ureteric obstruction and decreases the intraureteric pressure, and hence decreases pain episodes.