Complications of Prostate Brachytherapy: Cause, Prevention, and Treatment
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Alpha-blockers are considered the first-line treatment for urinary symptoms after brachytherapy. Alpha-blockers are effective at relieving obstructive symptoms such as incomplete voiding, weak stream, and acute urinary retention by relaxing the prostatic smooth muscle. Patients with irritative symptoms also benefit with the use of alpha-blockers by promoting complete bladder emptying. Local bladder anesthetics such as pyridium are frequently used for patients with significant dysuria. Non-steroidal anti-inflammatory drugs (NSAIDs) may also provide relief of irritative symptoms in select patients. In patients with urinary urgency, anticholinergics such as Tolterodine (Detrol, Pfizer) and antispasmodics such as oxybutynin (Ditropan, Alta) relieve smooth muscle contractions of the bladder. However, these medications should be used with caution as they may precipitate acute urinary retention.
2018 ESC/ESH Guidelines for the Management of Arterial Hypertension
Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei in Manual of Hypertension of the European Society of Hypertension, 2019
Centrally active drugs were widely used in the earliest decades of antihypertensive treatment when other treatments were not available, but are less frequently used now, principally because of their poorer tolerability relative to the newer major classes of drugs. The alpha-blocker doxazosin was effective in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) as third-line therapy (with no increase in the risk of heart failure) [309], and was more effective than placebo but less effective than spironolactone at lowering BP in resistant hypertension in the Prevention And Treatment of Hypertension With Algorithm-based therapY-2 (PATHWAY-2) study [310]. Alpha-blockers may also be required in specific indications (e.g. the treatment of symptomatic prostatic hypertrophy). Antihypertensive drugs, other than the major classes already discussed above, are no longer recommended for the routine treatment of hypertension, and are primarily reserved for add-on therapy in rare cases of drug-resistant hypertension where all other treatment options have failed.
Hypertension
Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson in Health Care Needs Assessment, 2018
The best evidence for the use of alpha-blockers in hypertension again comes from the ALLHAT trial, in which the alpha-blocker – diuretic arm was terminated and reported early.108 This found that although no difference was seen in the main end point of fatal CHD or non-fatal MI, the alpha-blocker (doxazosin) performed significantly worse with respect to both the combined CVD end point (25% increase) and congestive heart failure (doubling of risk). These results need to be interpreted cautiously because the diuretic arm achieved a small but significantly greater reduction in systolic blood pressure (2 mmHg) which may be enough to explain some or all of the increased risk (especially in non-CHF CVD), and again the clinical diagnosis of CHF is likely to have been reduced in the diuretic group. Nevertheless, the degree of increased risk is probably significant enough to avoid the first line use of alpha-blockers unless there is good reason in terms of drug intolerance or co-morbidity, particularly benign prostatic hypertrophy.
Pharmacologic therapies for the management of non-neurogenic urinary incontinence in children
Published in Expert Opinion on Pharmacotherapy, 2019
Tiernan Middleton, Pamela Ellsworth
The International Children’s Continence Society (ICCS) defines dysfunctional voiding as habitual contraction of the urethral sphincter or pelvic floor muscles during voiding. Dysfunctional voiding may result in incomplete bladder emptying, incontinence, and urinary tract infections. Dysfunctional voiding may co-exist with overactive bladder. The first-line therapy for dysfunctional voiding is behavioral with the use of biofeedback in select individuals. Pharmacologic therapy, anticholinergic agents, may be useful in those individuals with co-existent overactive bladder. The role of alpha-blockers in the management of dysfunctional voiding is not FDA approved. Limited studies have, however, evaluated the role of alpha-blockers in children with non-neurogenic bladder dysfunction. Alpha-blockers block the alpha-adrenergic receptors of the bladder neck. Alpha-blockers are thought to decrease obstruction-related detrusor over activity, by decreasing bladder outlet resistance and lowering voiding pressure. Currently, the ICCS does not recommend the use of alpha-blockers for dysfunctional voiding.
Results of purified micronized flavonoid fraction in the treatment of categorized type III chronic pelvic pain syndrome: a randomized controlled trial
Published in The Aging Male, 2020
Aytac Sahin, Musab Ali Kutluhan, Caglar Yildirim, Ahmet Urkmez, Serkan Akan, Ayhan Verit
RCTs do not support the fact that antibiotics or alpha-blockers are the primary treatment option in this patient group (Type III CPPS). However, it is considered that alpha-blockers may be part of multimodal therapy. Furthermore, it is reported that anti-inflammatory or immunomodular drugs are not effective in monotherapy, hormonal drugs cannot be offered as a primary treatment option in this group of patients, and some patients in this group have been reported to benefit from physiotherapy (perineal ESWL, acupuncture, aerobic exercise) [20]. In our study, we also think that purified micronized flavonoid fraction may be a part of Type III CPSI treatment and should be preferred as the first option especially in patients with comorbidities such as hemorrhoids and varicocele. As a matter of fact, in the study conducted by Pavone et al., patients who were admitted to urology outpatient clinic were divided into 2 groups. The study group consisted of chronic prostatitis patients and the control group consisted of patients without chronic prostatitis. Varicocele and hemorrhoids were significantly more common in the study group, (14.9–8.5% and 5.02–5.8%), respectively.
Efficacy and safety of tamsulosin 0.4 mg single pills for treatment of Asian patients with symptomatic benign prostatic hyperplasia with lower urinary tract symptoms: a randomized, double-blind, phase 3 trial
Published in Current Medical Research and Opinion, 2018
Jae Hoon Chung, Cheol Young Oh, Jae Heon Kim, U-Syn Ha, Tae Hyo Kim, Seung Hwan Lee, Jun Hyun Han, Jae Hyun Bae, In Ho Chang, Deok Hyun Han, Tag Keun Yoo, Jae Il Chung, Sae Woong Kim, Jina Jung, Yong-Il Kim, Seung Wook Lee
Benign prostatic hyperplasia (BPH) causes lower urinary tract symptoms (LUTS) and is one of the most common diseases of aging males1. BPH is histologically observed in almost half of men in their 60s and in most men in their 80s2. BPH leading to LUTS reduces quality of life by disturbing normal activities such as sleeping, and may cause complications such as urinary tract infections or acute urinary retention. Traditionally, transurethral resection of the prostate was most commonly carried out to treat LUTS/BPH. Currently, medical treatment with alpha-blockers or 5-alpha-reductase inhibitors (5-ARIs) has become the first line of therapy3,4. Alpha-blockers, which relax the prostate smooth muscle and improve urination, are most commonly used for LUTS/BPH patients5.
Related Knowledge Centers
- Benign Prostatic Hyperplasia
- Receptor Antagonist
- Hypertension
- Erectile Dysfunction
- Adrenergic Receptor
- Active Ingredient
- Raynaud Syndrome
- Alpha-1 Blocker
- Alpha-2 Blocker
- Alpha-2 Adrenergic Receptor