Urinary Incontinence in Older Adults
K. Rao Poduri in Geriatric Rehabilitation, 2017
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
Pharmacology of the Lower Urinary Tract
Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple in Basic Urological Sciences, 2021
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
Sahab Uddin, Rashid Mamunur in 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).
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.
Recent advances in the understanding of urothelial tumorigenesis
Published in Expert Review of Anticancer Therapy, 2023
Masato Yasui, Liam Cui, Hiroshi Miyamoto
Emerging evidence has suggested the promotion of urothelial tumorigenesis via AR activation [21–23]. Because anti-AR agents have been widely prescribed for the treatment of not only malignant diseases, including prostate cancer, but also non-neoplastic conditions, such as scalp hair loss and acne, androgen blockade may be an effective yet relatively safe option for the prevention of bladder tumor recurrence. As aforementioned, it has indeed been documented that androgen deprivation therapy (for prostate cancer) effectively prevents disease recurrence, particularly in men with AR-positive bladder tumor [24,71]. In this context, silodosin, a selective α1-adrenergic receptor antagonist used for the symptomatic treatment of benign prostatic hyperplasia, and ergosterol, an active component of traditional Chinese medicine, both of which are linked to AR signals in urothelial cells [26,29,72], may also be useful for the prevention of bladder cancer development. In particular, preclinical and clinical data [27] described earlier suggest that treatment with silodosin, among various α1-adrenergic receptor antagonists clinically available, is the most beneficial in men with concurrent or a history of urothelial cancer. Alternatively, because AR activation has been associated with resistance to conventional non-surgical therapy for bladder cancer [73–76], including intravesical BCG or doxorubicin instillation, concurrent anti-androgen treatment may result in considerable enhancement in the efficacy of existing immunotherapy or chemotherapy for non-muscle-invasive disease and thereby overcoming therapeutic resistance potentially seen in patients with AR-positive tumor.
Related Knowledge Centers
- Benign Prostatic Hyperplasia
- Bladder Stone
- Dopamine Agonist
- Hematuria
- Hydronephrosis
- Urinary Retention
- Hypersensitivity
- Medication
- Alpha-1 Blocker
- Indication