Alfa -1 reseptör blokeri ilaçların benign prostat hiperplazisi tedavisindeki kullanımlarının önemli noktaları ve yeni klinik kullanım alanları

Alfa-1 reseptör blokeri ilaçlar elli yıla yakın bir süredir BPH ile ilişkili AÜSY tedavisinde üroloji pratiği içerisindedir. Yaygın olarak kullanılan alfa-1 reseptör blokeri ilaçlar alfuzosin, doksazosin, terazosin, tamsulosin ve silodosindir. Bu ilaçlar BPH ile ilişkili AÜSY tedavisinde ilk basamak tedavi olarak kabul edilmektedir. Tüm alfa-1 reseptör blokerler benzer etkinliktedir ve aralarında etkinlik açısından belirgin bir fark bulunmamıştır. Alfa-1 reseptör blokeri ilaçlar ile idrar akım hızında %20–40 düzeyinde bir artış ve semptomlarda %30–50 düzeyinde bir azalma sağlanmıştır. Son yıllarda alfa-1 reseptör blokeri ilaçların yeni klinik kullanım alanları geliştirilmiştir. Bu yeni klinik kullanım alanları akut üriner retansiyon ve üriner sistem taş hastalığıdır. Tüm klinik kullanım alanlarında, alfa-1 reseptör bloker seçimi kardiyovasküler sistem ve cinsel fonksiyonlar üzerindeki yan etkileri dikkate alınarak yapılmalıdır

Important points of usage of alpha-1 receptor blocker drugs in the treatment of BPH and new areas of clinical usage

In the urology practice, alpha-1 receptor blocker drugs have been for the treatment of LUTS associated with BPH for about fifty years. The commonly used alpha-1 receptor blocker drugs are alfuzosin, doxazosin, terazosin, tamsulosin and silodosin. These drugs are considered as first-line therapy for the treatment of LUTS associated with BPH. All alpha-1 receptor blockers have similar efficacy and there was no significant difference in terms of the efficacy among them. With alpha-1 receptor blocker drugs, a 20–40% increase in urine flow rate and a 30– 50% decrease in symptoms were achieved. In recent years, new areas of clinical usage of alpha-1 receptor blocker drugs have been developed. These new areas of the clinical usage are acute urinary retention and urinary tract stone disease. In all areas of clinical usage, the choice of alpha-1 receptor blockers should be made considering the side effects on the cardiovascular system and sexual functions.

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  • 1. Caine M, Raz S, Zeigler M. Adrenergic and cholinergic receptors in the human prostate, prostatic capsule and bladder neck. BJU 1975;47:193– 202. [CrossRef]
  • 2. Bartsch G, Müller HR, Oberholzer M, Rohr HP. Light microscopic stereological analysis of the normal human prostate and of benign prostatic hyperplasia. J Urol 1979;122:487–9. [CrossRef]
  • 3. Roehrborn CG, Schwinn DA. Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol 2004;171:1029–35. [CrossRef]
  • 4. Emberton M, Fitzpatrick JM, Rees J. Risk stratification for benign prostatic hyperplasia (BPH) treatment. BJU Int 2011;107:876–80. [CrossRef]
  • 5. Gül ZG, Kaplan SA. BPH. Why Do Patients Fail Medical Therapy? Curr Urol Rep 2019;20:40. [CrossRef]
  • 6. Gravas S, Cornu JN, Gacci MC, Gratzke C, Herrmann TRW, Mamoulakis C, et al. Management of Non-neurogenic Male LUTS, 2020. https:// uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/
  • 7. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185:1793–803. [CrossRef]
  • 8. Roehrborn CG and Siegel RL. Safety and efficacy of doxazosin in benign prostatic hyperplasia: a pooled analysis of three double-blind, placebocontrolled studies. Urology 1996;48:404–15. [CrossRef]
  • 9. Samli MM and Dincel C. Terazosin and doxazosin in the treatment of BPH. results of a randomized study with crossover in non-responders. Urol Int 2004;73:125–9. [CrossRef]
  • 10. Senkul T, Yilmaz O, Iseri C, Adayener C, Akyol I, Ates F. Comparing the therapeutic outcome of different alpha-blocker treatments for BPH in the same individuals. Int Urol Nephrol 2008;40:663–6. [CrossRef]
  • 11. Karadağ E, Öner S, Budak YU, Atahan Ö. Randomized crossover comparison of tamsulosin and alfuzosin in patients with urinary disturbances caused by benign prostatic hyperplasia. Int Urol Nephrol 2011;43:949–54. [CrossRef]
  • 12. Atan A, Başar MM, Yıldız M, Akalın Z. The effect of age in the usage of alpha receptor blocker treatment in prostate patients. Arch Ital Urol Androl 1997;69:299–301. https://pubmed.ncbi.nlm.nih.gov/9477614/
  • 13. Michel MC, Mehlburger L, Bressel HU, Goepel M. Comparison of tamsulosin efficacy in subgroups of patients with lower urinary tract symptoms. Prostate Cancer Prostatic Dis 1998;1:332–5. [CrossRef]
  • 14. Roehrborn CG, Van Kerrebroeck P, Nordling J. Safety and efficacy of alfuzosin 10 mg once-daily in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a pooled analysis of three double-blind, placebo-controlled studies. BJU Int 2003;92:257–61. [CrossRef]
  • 15. Shapiro E, Hartanto V, Lepor H. The response to alpha blockade in benign prostatic hyperplasia is related to the percent area density of prostate smooth muscle. Prostate 1992;21:297–307. [CrossRef]
  • 16. Hong SJ, Ko WJ, Kim SI, Chung BH. Identification of baseline clinical factors which predict medical treatment failure of benign prostatic hyperplasia: an observational cohort study. Eur Urol 2003;44:94–100. [CrossRef]
  • 17. Hong KP, Byun YJ, Yoon H, Park YY, Chung WS. Prospective factor analysis of alpha blocker monotherapy failure in benign prostatic hyperplasia. Korean J Urol 2010;51:488–91. [CrossRef]
  • 18. Hirayama K, Masui K, Hamada A, Shichiri Y, Masuzawa N, Hamada S. Evaluation of Intravesical Prostatic Protrusion as a Predictor of Dutasteride-Resistant Lower Urinary Tract Symptoms/Benign Prostatic Enlargement With a High Likelihood of Surgical Intervention. Urology 2015;86:565–9. [CrossRef]
  • 19. Kalkanli A, Tandogdu Z, Aydin M, Karaca AS, Hazar AI, Balci MB, et al. Intravesical Prostatic Protrusion: A Potential Marker of Alpha-blocker Treatment Success in Patients With Benign Prostatic Enlargement. Urology 2016;88:161–5. [CrossRef]
  • 20. Topazio L, Perugia C, De Nunzio C, Gaziev G, Lacovelli V, Bianchi D, et al. Intravescical prostatic protrusion is a predictor of alpha blockers response: results from an observational study. BMC Urol 2018;18:6. [CrossRef]
  • 21. McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003;349:2387–98. [CrossRef]
  • 22. Verhamme KM, Dieleman JP, Bleumink GS, Bosch JL, Stricker BH, Sturkenboom MC. Treatment strategies, patterns of drug use and treatment discontinuation in men with LUTS suggestive of benign prostatic hyperplasia: the Triumph project. Eur Urol 2003;44:539–45. [CrossRef]
  • 23. Ghuman A, de Jonge SW, Dryden SD. Feeney T, Buitrago DH, Phang PT. Prophylactic use of alpha-1 adrenergic blocking agents for prevention of postoperative urinary retention: A review & meta-analysis of randomized clinical trials. Am J Surg 2018;215:973–9. [CrossRef]
  • 24. McNeill SA, Hargreave TB, Roehrborn CG; Alfaur Study Group. Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a double-blind placebo-controlled study. Urology 2005;65:83–9. [CrossRef]
  • 25. Desgrandchamps F, De La Taille A, Doublet JD; RetenFrance Study Group. The management of acute urinary retention in France: a crosssectional survey in 2618 men with benign prostatic hyperplasia. BJU Int 2006;97:727–33. [CrossRef]
  • 26. Guang-Jun D, Feng-Bin G, Xun-Bo J. Α1-blockers in the management of acute urinary retention secondary to benign prostatic hyperplasia: a systematic review and meta-analysis. Ir J Med Sci 2015;184:23–30. [CrossRef]
  • 27. Karavitakis M, Kyriazis I, Omar MI, Gravas S, Cornu JN, Drake MJ, et al. Management of urinary retention in patients with Benign Prostatic Obstruction: A systematic review and meta-analysis. Eur Urol 2019;75:788–98. [CrossRef]
  • 28. Pickard R, Emberton M, Neal DE; National Prostatectomy Audit Steering Group. The management of men with acute urinary retention. Br J Urol 1998;81:712–20. [CrossRef]
  • 29. Tiong HY, Tibung MJ, Macalalag M, Li MK, Consigliere D. Alfuzosin 10 mg once daily increases the chances of successful trial without catheter after acute urinary retention secondary to benign prostate hyperplasia. Urol Int 2009;83:44–8. [CrossRef]
  • 30. Baldini G, Bagry H, Aprikian A, Carli F, Warner DS, Warner MA. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 2009;110:1139–57. [CrossRef]
  • 31. Chen J, Matzkin H, Lazauskas T, Lelcuk S, Braf Z. Posthernioplasty urinary retention: a noninvasive work-up for prediction. Urol Int 1993;51:243–5. [CrossRef]
  • 32. Clancy C, Coffey JC, O’Riordain MG, Burke JP. A meta-analysis of the efficacy of prophylactic alpha-blockade for the prevention of urinary retention following primary unilateral inguinal hernia repair. Am J Surg 2018;216:337–41. [CrossRef]
  • 33. Akkoc A, Aydin C, Topaktas R, Kartalmis M, Altin S, Isen K, Metin A. Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia. Int Braz J Urol 2016;42:578–84. [CrossRef]
  • 34. Yoon PD, Chalasani V, Woo HH. Systematic review and meta-analysis on management of acute urinary retention. Prostate Cancer Prostat Dis 2015;18:297–302. [CrossRef] 35. Fisher E, Subramonian K, Omar MI. The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men. Cochrane Database Syst Rev 2014;6:CD 006744. [CrossRef] 36. Campschroer T, Zhu X, Vernooij RWM, Lock TMTW. α-blockers as medical expulsive therapy for ureteric stones: a Cochrane systematic review. BJU Int 2018;122:932–45. [CrossRef] 37. Seitz C, Liatsikos E, Porpiglia F, Tiselius HG, Zwergel U. Medical therapy to facilitate the passage of stones: what is the evidence? Eur Urol 2009;56:455–71. [CrossRef] 38. Kobayashi M, Naya Y, Kino M, Awa Y, Nagata M, Suzuki H, et al. Low dose tamsulosin for stone expulsion after extracorporeal shock wave lithotripsy: efficacy in Japanese male patients with ureteral stone. Int J Urol 2008;15:495–8. [CrossRef] 39. Küpeli B, Irkilata L, Gürocak S, Tunç L, Kiraç M, Karaoglan U, Bozkirli I. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology 2004;64:1111–5. [CrossRef] 40. El Said NO, El Wakeel L, Kamal KM, Morad AER. Alfuzosin treatment improves the rate and time for stone expulsion in patients with distal uretral stones: a prospective randomized controlled study. Pharmacotherapy 2015;35:470–6. [CrossRef] 41. Erturhan S, Bayrak Ö, Şen H, Yılmaz AE, Seçkiner İ. Can alpha blockers facilitate the placement of ureteral access sheaths in retrograde intrarenal surgery? Turk J Urol 2019;45:108–12. [CrossRef] 42. Koo KC, Yoon JH, Park NC, Lee HS, Ahn HK, Lee KS, et al. The impact of preoperative α-adrenergic antagonists on ureteral access sheath insertion force and the upper limit of force required to avoid ureteral mucosal injury: A randomized controlled study. J Urol 2018;199:1622– 30. [CrossRef] 43. Lamb AD, Vowler SL, Johnston R, Dunn N, Wiseman OJ. Meta-analysis showing the beneficial effect of α-blockers on ureteric stent discomfort. BJU Int 2011;108:1894–902. [CrossRef] 44. He F, Man LB, Li GZ, Liu N. Efficacy of α-blocker in improving ureteral stent-related symptoms: a meta-analysis of both direct and indirect comparison. Drug Des Devel Ther 2016;10:1783–93. [CrossRef] 45. Fischer KM, Louie M, Mucksavage P. Ureteral stent discomfort and its management. Curr Urol Rep 2018;19:64. [CrossRef] 46. Liu S, Yu Y, Gao Y, Yang X, Pang Z. Decreased urinary glycosaminoglycan excretion following alfuzosin treatment on ureteral stent-related symptoms: a prospective, randomized, placebo-controlled study. Urolithiasis 2016;44:185–90. [CrossRef] 47. Alsaikhan B, Koziarz A, Lee JY, Pace KT. Preoperative Alpha-Blockers for Ureteroscopy for Ureteral Stones: A Systematic Review and MetaAnalysis of Randomized Controlled Trials. J Endourol 2020;34:33–41. [CrossRef] 48. Zhou L, Cai X, Li H, Wang KJ. Effects of α-Blockers, Antimuscarinics, or Combination Therapy in Relieving Ureteral Stent-Related Symptoms: A Meta-Analysis. J Endourol 2015;29:650–6. [CrossRef] 49. Zhang YM, Chu P, Wang WJ. PRISMA-combined α-blockers and antimuscarinics for ureteral stent-related symptoms: A meta-analysis. Medicine 2017;96:e6098. [CrossRef] 50. Yan H, Wang Y, Sun R, Cui Y. The Efficacy of Antimuscarinics Alone or in Combination with Alpha-Blockers for the Treatment of Ureteral StentRelated Symptoms: A Systematic Review and Meta-Analysis. Urol Int 2017;99:6–13. [CrossRef] 51. Fine SR, Ginberg P. Alpha-adrenergic receptor antagonists in older patients with benign prostatic hyperplasia: issues and potential complications. J Am Osteopath Assoc 2008;108:333–7. https://jaoa. org/article.aspx?articleid=2093615 52. Welk B, McArthur E, Fraser LA, Hayward J, Dixon S, Hwang YJ, Ordon M. The risk of fall and fracture with the initiation of a prostate-selective α antagonist: a population based cohort study. BMJ 2015;351:h5398. [CrossRef] 53. Nickel JC, Sander S, Moon TD. A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia. Int J Clin Pract 2008;62:1547– 59. [CrossRef] 54. Lee M. Tamsulosin for the treatment of benign prostatic hypertrophy. Ann Pharmacother 2000;34:188–99. [CrossRef] 55. Marks LS, Gittelman MC, Hill LA, Volinn W, Hoel G. Rapid efficacy of the highly selective alpha1A-adrenoceptor antagonist silodosin in men with signs and symptoms of benign prostatic hyperplasia: pooled results of 2 phase 3 studies. J Urol 2009;181:2634–40. [CrossRef] 56. Rees J, Bultitude M, Challacombe B. The management of lower urinary tract symptoms in men. BMJ 2014;348:g3861. [CrossRef] 57. Zhang LT, Lee SW, Park K, Chung WS, Kim SW, Hyun JS, et al. Multicenter, prospective, comparative cohort study evaluating the efficacy and safety of alfuzosin 10 mg with regard to blood pressure in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia with or without antihypertensive medications. Clin Interv Aging 2015;10:277–86. [CrossRef] 58. van Dijk MM, de la Rosette JJ, Michel MC. Effects of alpha(1)- adrenoceptor antagonists on male sexual function. Drugs 2006;66:287– 301. [CrossRef] 59. Gacci M, Ficarra V, Sebastianelli A, Corona G, Serni S, Shariat SF, et al. Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis. J Sex Med 2014;11:1554–66. [CrossRef] 60. Lepor H, Kazzazi A, Djavan B. α-Blockers for benign prostatic hyperplasia: the new era. Curr Opin Urol 2012;22:7–15. [CrossRef] 61. Giuliano F. Impact of medical treatments for benign prostatic hyperplasia on sexual function. BJU Int 2006;97:34–8. [CrossRef] 62. Roehrborn and the AUA BPH Guideline Update Panel. Guideline on the management of benign prostatic hyperplasia (BPH). 2003; chapters 1–23. http://www.auanet.org/guidelines/bph.cfm 63. Cunningham GR and Kadmon D, 2020. https://www.uptodate.com/contents/ medical-treatment-of-benign-prostatic-hyperplasia#H239931225