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Cordero K, Coronel GG, Serrano-Illán M, Cruz-Bracero J, Figueroa JD, De León M. Effects of Dietary Vitamin E Supplementation in Bladder Function and Spasticity during Spinal Cord Injury. Brain Sci 2018; 8:E38. [PMID: 29495419 PMCID: PMC5870356 DOI: 10.3390/brainsci8030038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 11/25/2022] Open
Abstract
Traumatic spinal cord injury (SCI) results in debilitating autonomic dysfunctions, paralysis and significant sensorimotor impairments. A key component of SCI is the generation of free radicals that contributes to the high levels of oxidative stress observed. This study investigates whether dietary supplementation with the antioxidant vitamin E (alpha-tocopherol) improves functional recovery after SCI. Female adult Sprague-Dawley rats were fed either with a normal diet or a dietary regiment supplemented with vitamin E (51 IU/g) for eight weeks. The rats were subsequently exposed either to a contusive SCI or sham operation, and evaluated using standard functional behavior analysis. We report that the rats that consumed the vitamin E-enriched diet showed an accelerated bladder recovery and significant improvements in locomotor function relative to controls, as determined by residual volumes and Basso, Beatie, and Bresnaham BBB scores, respectively. Interestingly, the prophylactic dietary intervention did not preserve neurons in the ventral horn of injured rats, but it significantly increased the numbers of oligodendrocytes. Vitamin E supplementation attenuated the depression of the H-reflex (a typical functional consequence of SCI) while increasing the levels of supraspinal serotonin immunoreactivity. Our findings support the potential complementary use of vitamin E to ameliorate sensory and autonomic dysfunctions associated with spinal cord injury, and identified promising new cellular and functional targets of its neuroprotective effects.
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Affiliation(s)
- Kathia Cordero
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA.
| | - Gemma G Coronel
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA.
| | - Miguel Serrano-Illán
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA.
| | - Jennifer Cruz-Bracero
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA.
| | - Johnny D Figueroa
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA.
| | - Marino De León
- Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA.
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Gumrah A, Tanidir Y, Tinay I, Ozyurek M, Tarcan T. The effect of doxazosin and sildenafil citrate combination on bladder tissue contractility, alpha adrenergic receptor, and iNOS subtype expression in a male rat model of partially bladder outlet obstruction. Neurourol Urodyn 2016; 36:1479-1487. [DOI: 10.1002/nau.23155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/12/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Abdulkadir Gumrah
- Department of Urology; Marmara University School of Medicine; Istanbul Turkey
| | - Yiloren Tanidir
- Department of Urology; Marmara University School of Medicine; Istanbul Turkey
| | - Ilker Tinay
- Department of Urology; Marmara University School of Medicine; Istanbul Turkey
| | - Mustafa Ozyurek
- Ergun Özalp Basic Research Laboratory; Marmara University School of Medicine; Istanbul Turkey
| | - Tufan Tarcan
- Department of Urology; Marmara University School of Medicine; Istanbul Turkey
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3
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Albisinni S, Biaou I, Marcelis Q, Aoun F, De Nunzio C, Roumeguère T. New medical treatments for lower urinary tract symptoms due to benign prostatic hyperplasia and future perspectives. BMC Urol 2016; 16:58. [PMID: 27629059 PMCID: PMC5024450 DOI: 10.1186/s12894-016-0176-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lower Urinary Tract Symptoms (LUTS) in men are a common clinical problem in urology and have been historically strictly linked to benign prostatic hyperplasia (BPH), which may lead to bladder outlet obstruction (BOO). New molecules have been approved and have entered the urologists' armamentarium, targeting new signaling pathways and tackling specific aspects of LUTS. Objective of this review is to summarize the evidence regarding the new medical therapies currently available for male non-neurogenic LUTS, including superselective α1-antagonists, PDE-5 inhibitors, anticholinergic drugs and intraprostatic onabotulinum toxin injections. METHODS The National Library of Medicine Database was searched for relevant articles published between January 2006 and December 2015, including the combination of "BPH", "LUTS", "medical" and "new". Each article's title, abstract and text were reviewed for their appropriateness and their relevance. One hundred forty eight articles were reviewed. RESULTS Of the 148 articles reviewed, 92 were excluded. Silodosin may be considered a valid alternative to non-selective α1-antagonists, especially in the older patients where blood pressure alterations may determine major clinical problems and ejaculatory alterations may be not truly bothersome. Tadalafil 5 mg causes a significant decrease of IPSS score with an amelioration of patients' QoL, although with no significant increase in Qmax. Antimuscarinic drugs are effective on storage symptoms but should be used with caution in patients with elevated post-void residual. Intraprostatic injections of botulinum toxin are well-tolerated and effective, with a low rate of adverse events; however profound ameliorations were seen also in the sham arms of RCTs evaluating intraprostatic injections. CONCLUSION New drugs have been approved in the last years in the medical treatment of BPH-related LUTS. Practicing urologists should be familair with their pharmacodynamics and pharmacokinetics.
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Affiliation(s)
- Simone Albisinni
- Urology Department, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium.
| | - Ibrahim Biaou
- Urology Department, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium
| | - Quentin Marcelis
- Urology Department, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium
| | - Fouad Aoun
- Urology Department, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium
| | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, University "La Sapienza", Roma, Italy
| | - Thierry Roumeguère
- Urology Department, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium
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Goi Y, Tomiyama Y, Yokoyama A, Tatemichi S, Maruyama K, Kobayashi M, Yamaguchi O. Effect of silodosin, a selective α1A-adrenoceptor antagonist, on voiding behavior and bladder blood flow in a rat model of bladder outlet obstruction. Eur J Pharmacol 2015; 764:489-496. [DOI: 10.1016/j.ejphar.2015.07.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/18/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
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5
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Abdel-Hamid AAM, Ali EMT. Effect of testosterone therapy on the urinary bladder in experimental hypogonadism of rats. J Mol Histol 2015; 46:263-72. [PMID: 25805595 DOI: 10.1007/s10735-015-9617-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/17/2015] [Indexed: 11/24/2022]
Abstract
Testosterone (T) deficiency is prevalent particularly in elderly men and lead to physical and sexual morbidities. Although low levels of T are associated with low urinary tract symptoms, the correlation between T deficiency and bladder dysfunction is not clearly identified. The aim of this study was to investigate the effect of high dose testosterone replacement therapy (TRT) on the histological structure of the UB in castrated rats. Twenty-five adult male rats were divided into three groups: control, castrated and castrated + TRT. T was administrated in high dose (100 mg/kg) two intramuscular injections/week for 60 days. UB sections were prepared and stained with H&E, Masson's trichrome and immunohistochemical detection of Cytokeratin 20 (Ck20). All data were morphometrically and statistically analyzed. In castrated group, significant atrophy of the urothelium (P < 0.001) accompanied with widening of the corium were observed. The smooth muscle appeared thin with marked increase in the collagen fibers. On treating the castrated group with TRT, atypical Ck20 expression as well as significant increase in urothelial thickness (P < 0.05) and smooth muscle/collagen ratio (P < 0.001) were detected. In castrated rat model, high dose TRT has a positive effect on the UB smooth muscle rather than the urothelium which acquired atypical patterns.
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Affiliation(s)
- Ahmed A M Abdel-Hamid
- Department of Histology and Cell Biology, Faculty of Medicine, Mansoura University, P.O. 35516, Mansoura, Egypt,
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6
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Kawai Y, Oka M, Yoshinaga R, Fuchikami C, Oyama T. Effects of the phosphodiesterase 5 inhibitor Tadalafil on bladder function in a rat model of partial bladder outlet obstruction. Neurourol Urodyn 2015; 35:444-9. [DOI: 10.1002/nau.22732] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/15/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Yuko Kawai
- Discovery Research Laboratories; Nippon Shinyaku Co., Ltd; Kyoto Japan
| | - Michiko Oka
- Discovery Research Laboratories; Nippon Shinyaku Co., Ltd; Kyoto Japan
| | - Ryohei Yoshinaga
- Discovery Research Laboratories; Nippon Shinyaku Co., Ltd; Kyoto Japan
| | - Chiaki Fuchikami
- Discovery Research Laboratories; Nippon Shinyaku Co., Ltd; Kyoto Japan
| | - Tatsuya Oyama
- Discovery Research Laboratories; Nippon Shinyaku Co., Ltd; Kyoto Japan
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Shimizu S, Tsounapi P, Shimizu T, Honda M, Inoue K, Dimitriadis F, Saito M. Lower urinary tract symptoms, benign prostatic hyperplasia/benign prostatic enlargement and erectile dysfunction: Are these conditions related to vascular dysfunction? Int J Urol 2014; 21:856-64. [DOI: 10.1111/iju.12501] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Shogo Shimizu
- Department of Pharmacology; Kochi Medical School, Kochi University; Nankoku Japan
| | - Panagiota Tsounapi
- Division of Urology; Tottori University School of Medicine; Yonago Japan
| | - Takahiro Shimizu
- Department of Pharmacology; Kochi Medical School, Kochi University; Nankoku Japan
| | - Masashi Honda
- Division of Urology; Tottori University School of Medicine; Yonago Japan
| | - Keiji Inoue
- Department of Urology; Kochi Medical School; Kochi University; Nankoku Japan
| | - Fotios Dimitriadis
- B' Urologic Department; Papageorgiou General Hospital; School of Medicine; Aristotle University; Thessaloniki Greece
| | - Motoaki Saito
- Department of Pharmacology; Kochi Medical School, Kochi University; Nankoku Japan
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Magari T, Shibata Y, Arai S, Kashiwagi B, Suzuki K, Suzuki K. Time-dependent effects of castration on the bladder function and histological changes in the bladder and blood vessels. Asian J Androl 2014; 16:457-60. [PMID: 24556746 PMCID: PMC4023378 DOI: 10.4103/1008-682x.123676] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/14/2013] [Accepted: 09/01/2013] [Indexed: 11/06/2022] Open
Abstract
We examined the effect of androgens on bladder blood flow (BBF), bladder function and histological changes in castrated male rats. Male Wistar rats were classified into unoperated group (control group), groups castrated at the age of 8 weeks (group 8wPC) and groups castrated at the age of 4 weeks (group 4wPC). Each rat was used at the age of 20 weeks. BBF was measured using fluorescent microspheres. Bladder cystometry was performed without anesthesia or restraint; the bladder was first irrigated with saline and then with 0.25% acetic acid (AA) solution. Maximum voiding pressure and voiding interval were measured. The bladder and iliac artery were histologically examined for differences in smooth muscle and quantity of collagen fiber to analyze the effect of castration on the smooth muscle content. No differences were noted in BBF following castration. The voiding intervals for all groups were shortened (P < 0.001) following AA irrigation. No significant difference was noted in the maximum voiding pressure. Histological changes were observed in bladder and iliac artery. Smooth muscle/collagen ratio at the bladder was lower in groups 8wPC and 4wPC compared to the control group (P< 0.01), while that at the iliac artery was decreased in group 4wPC compared to the control group (P< 0.001). In conclusion, our findings indicate that castration does not alter BBF, but leads to histological changes in the bladder as well as its associated blood vessels.
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Affiliation(s)
- Tomohiro Magari
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Urology, Kurosawa Hospital, Takasaki, Japan
| | - Yasuhiro Shibata
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Seiji Arai
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Bunzo Kashiwagi
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Keiji Suzuki
- Department of Pathology, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Kurizaki Y, Ishizuka O, Imamura T, Ichino M, Ishikawa M, Ogawa T, Nishizawa O. Correlation Between Bladder Mucosal Alpha-1D/Alpha-1A Adrenoceptor mRNA Ratio and Lower Urinary Tract Function in Benign Prostatic Obstruction Patients. Low Urin Tract Symptoms 2013; 5:60-4. [PMID: 26663371 DOI: 10.1111/j.1757-5672.2012.00164.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Alpha-1 adrenoceptor (AR) antagonists are commonly used as therapeutic agents for patients with benign prostatic obstruction (BPO). Our objective was to investigate the correlation between the ratio of bladder mucosal alpha-1D/alpha-1A adrenoceptor mRNA and lower urinary tract function in BPO patients. METHODS In 20 BPO patients, the expression level of alpha-1 AR mRNAs in the bladder mucosal biopsies was investigated by reverse transcriptase polymerase chain reaction. The subjects were divided into two groups. In Group 1, the ratio of alpha-1D mRNA to alpha-1A mRNA was greater than one. In Group 2, the ratio was less than one. We determined the correlation by Schäfer nomogram between Group 1 and Group 2 patients and lower urinary tract function as determined by a video urodynamic study. RESULTS Two patients were excluded due to inability to void. Another was excluded because the alpha-1D/alpha-1A mRNA ratio was one. On the Schäfer nomogram, six of nine Group 1 cases had obstructions less than IV and normal or weak detrusor contractility. For Group 2, six of eight cases had obstructions more than IV and normal or strong detrusor contractility. CONCLUSION Patients with higher levels of alpha-1D AR mRNA were distinct from those with higher alpha-1A AR mRNA levels with regard to obstruction and detrusor activity. The results suggest that the Schäfer nomogram might be useful in determining which alpha-1 AR antagonists are better for BPO patients suffering from storage symptoms.
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Affiliation(s)
- Yoshiki Kurizaki
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuya Imamura
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Midori Ichino
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masakuni Ishikawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Teruyuki Ogawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Nishizawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
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10
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Effect of Tamsulosin on Bladder Microcirculation in Rat Model of Bladder Outlet Obstruction Using Pencil Lens Charge-coupled Device Microscopy System. Urology 2013. [DOI: 10.1016/j.urology.2012.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Magari T, Shibata Y, Arai S, Kashiwagi B, Suzuki K. Influence of castration on bladder blood flow and function during the rapid phase of androgen deprivation. Scand J Urol 2012; 47:236-41. [DOI: 10.3109/00365599.2012.739639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Cho ST, Park EY, Kim JC. Effect of Angiotensin II Receptor Antagonist Telmisartan on Detrusor Overactivity in Rats With Bladder Outlet Obstruction. Urology 2012; 80:1163.e1-7. [DOI: 10.1016/j.urology.2012.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/04/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
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Matsui T, Oka M, Fukui T, Tanaka M, Oyama T, Sagawa K, Nomiya M, Yamaguchi O. Suppression of bladder overactivity and oxidative stress by the phytotherapeutic agent, Eviprostat, in a rat model of atherosclerosis-induced chronic bladder ischemia. Int J Urol 2012; 19:669-75. [PMID: 22458726 DOI: 10.1111/j.1442-2042.2012.03000.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To clarify the mechanism by which chronic bladder ischemia causes bladder functional changes, and to investigate the involvement of oxidative stress and pro-inflammatory cytokines, and the effects of the phytotherapeutic drug, Eviprostat, on these biochemical marker levels and bladder function. METHODS Male Sprague-Dawley rats aged 15 weeks were divided into three groups. Arterial injury was experimentally induced by balloon endothelial injury of the iliac arteries, and a 2% cholesterol diet was given for 8 weeks. Rats in the arterial-injury group were given daily oral vehicle or Eviprostat, whereas sham-operated animals on a regular diet (0.09% cholesterol) were given vehicle for the last 2 weeks. Eight weeks after surgery, the levels of bladder pro-inflammatory cytokines, as well as bladder and urinary oxidative-stress markers, were determined. Cystometrograms were carried out without anesthesia or restraint. RESULTS Bladder and urinary oxidative-stress markers, and bladder pro-inflammatory cytokine levels were significantly increased in the arterial-injury group, and Eviprostat markedly suppressed these increase. The cystometrograms showed that arterial injury decreased the intermicturition interval without affecting the micturition pressure. This decrease was reversed by Eviprostat treatment. CONCLUSIONS Oxidative stress and pro-inflammatory cytokines might be involved in the development of overactive bladder by atherosclerosis-induced chronic bladder ischemia. Eviprostat might provide an attractive treatment option for individuals with bladder dysfunction due to chronic bladder ischemia because of its anti-oxidant and anti-inflammatory properties.
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Affiliation(s)
- Takahiro Matsui
- Research Laboratories, Nippon Shinyaku Co., Ltd., Kyoto, Japan.
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Matsumoto S, Kakizaki H. Causative significance of bladder blood flow in lower urinary tract symptoms. Int J Urol 2011; 19:20-5. [PMID: 22146061 DOI: 10.1111/j.1442-2042.2011.02903.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The association between metabolic syndrome and lower urinary tract symptoms has been attracting enormous interest and attention. This enthusiasm is based on the presence of many common risk factors being involved in both metabolic syndrome and lower urinary tract symptoms, as shown by various epidemiological studies. Metabolic syndrome and lower urinary tract symptoms have many pathophysiological features in common, particularly overactive bladder. Herein, we analyze the pathophysiological relationship between metabolic syndrome and lower urinary tract symptoms with a special emphasis on bladder blood flow. We also propose a new treatment strategy for treating lower urinary tract symptoms from the viewpoint of bladder blood flow.
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Affiliation(s)
- Seiji Matsumoto
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
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15
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Effect of Tamsulosin on Bladder Blood Flow and Bladder Function in a Rat Model of Bladder Over Distention/Emptying Induced Bladder Overactivity. J Urol 2011; 186:2470-7. [DOI: 10.1016/j.juro.2011.07.085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Indexed: 11/18/2022]
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Gotoh M. The Mechanisms Underlying α1-Adrenoceptor Antagonists and Modulation of Bladder Function: An Emerging Role for Changes in Perfusion. J Urol 2011; 186:2154-5. [DOI: 10.1016/j.juro.2011.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Mizuno H, Yamamoto T, Okutsu H, Ohtake A, Sasamata M, Matsukawa Y, Funahashi Y, Kato M, Hattori R, Gotoh M. Effect of tamsulosin on bladder microcirculation in a rat ischemia-reperfusion model, evaluated by pencil lens charge-coupled device microscopy system. Urology 2010; 76:1266.e1-5. [PMID: 21056274 DOI: 10.1016/j.urology.2010.06.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/12/2010] [Accepted: 06/19/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate the effect of tamsulosin hydrochloride on bladder microcirculation in a rat ischemia-reperfusion model using a pencil lens charge-coupled device microscopy system (PLCMS). METHODS Changes in blood flow through a submucosal capillary of the rat bladder were measured during bladder filling using the PLCMS. One week after starting infusion of either physiological saline or tamsulosin, blood flow in the bladder was halted by bladder overdistention via an infusion of physiological saline. The bladder was then emptied to be reperfused with blood. Changes in blood flow through a submucosal capillary of the bladder during ischemia and reperfusion were measured using a PLCMS, and the data obtained for the control group and tamsulosin group were compared. RESULTS As the bladder was distended, the velocity of red blood cell flow in a submucosal capillary of the bladder slowed and stopped altogether when the bladder became overdistended. In the control group, capillary blood flow improved over time after release from overdistention but failed to return to the baseline level, demonstrating that reperfusion injury to bladder microcirculation was caused by bladder overdistention and emptying. In the tamsulosin group, capillary blood flow rapidly returned to baseline after release from overdistention. CONCLUSIONS Using a PLCMS, bladder microcirculation was able to be visualized and quantitatively assessed by measuring the velocity of blood flow in a submucosal capillary of the bladder. Findings from the present study suggest that tamsulosin hydrochloride exerts a protective effect on blood flow in ischemia-reperfusion injury of the bladder.
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Affiliation(s)
- Hideki Mizuno
- Department of Urology, Nagoya University, Graduate School of Medicine, Nagoya, Japan.
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18
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Kurizaki Y, Ishizuka O, Imamura T, Ichino M, Ogawa T, Igawa Y, Nishizawa O, Andersson KE. Relation between expression of α1-adrenoceptor mRNAs in bladder mucosa and urodynamic findings in men with lower urinary tract symptoms. ACTA ACUST UNITED AC 2010; 45:15-9. [PMID: 20961266 DOI: 10.3109/00365599.2010.515611] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yoshiki Kurizaki
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuya Imamura
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Midori Ichino
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Teruyuki Ogawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuhiko Igawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Nishizawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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Yazaki J, Aikawa K, Shishido K, Yanagida T, Nomiya M, Ishibashi K, Haga N, Yamaguchi O. Alpha1-Adrenoceptor Antagonists Improve Bladder Storage Function Through Reduction of Afferent Activity in Rats With Bladder Outlet Obstruction. Neurourol Urodyn 2010; 30:461-7. [DOI: 10.1002/nau.20984] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 06/22/2010] [Indexed: 01/09/2023]
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20
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Liu HP, Chen GL, Liu P, Xu XP. Amlodipine alone or combined with terazosin improves lower urinary tract disorder in rat models of benign prostatic hyperplasia or detrusor instability: focus on detrusor overactivity. BJU Int 2009; 104:1752-7. [DOI: 10.1111/j.1464-410x.2009.08659.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Auffenberg GB, Helfand BT, McVary KT. Established Medical Therapy for Benign Prostatic Hyperplasia. Urol Clin North Am 2009; 36:443-59, v-vi. [DOI: 10.1016/j.ucl.2009.07.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Okutsu H, Matsumoto S, Hanai T, Noguchi Y, Fujiyasu N, Ohtake A, Suzuki M, Sato S, Sasamata M, Uemura H, Kurita T. Effects of tamsulosin on bladder blood flow and bladder function in rats with bladder outlet obstruction. Urology 2009; 75:235-40. [PMID: 19647304 DOI: 10.1016/j.urology.2009.05.045] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 04/14/2009] [Accepted: 05/20/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the mechanism underlying the ameliorating effect of tamsulosin, an alpha(1)-adrenoceptor antagonist, on storage symptoms associated with benign prostatic hyperplasia, the effects of tamsulosin on bladder blood flow (BBF) and bladder function was evaluated in rats with bladder outlet obstruction (BOO). METHODS BOO was produced by partial ligature of the proximal urethra, which was maintained for 2 weeks. Tamsulosin was subcutaneously administered via an osmotic pump for 2 weeks immediately after the BOO surgery. The BBF in the sham-operated rats, the control BOO rats, and the tamsulosin-treated BOO rats was measured using the fluoromicrosphere method. Each rat was kept in a metabolic cage for observation of micturition behavior. Expression of the alpha(1)-adrenoceptor subtype mRNA in the vesical artery was measured by reverse transcriptase-polymerase chain reaction. RESULTS BBF was significantly reduced in BOO rats compared with sham-operated rats, and tamsulosin significantly increased the BBF in BOO rats. Tamsulosin ameliorated the decrease in mean voided volume in BOO rats with bladder masses < 500 mg. Expression of the alpha(1)-adrenoceptor subtype in the vesical artery was alpha(1a)- > alpha(1d)-adrenoceptors; almost no expression was observed of alpha(1b)-adrenoceptors in either sham-operated or BOO rats. CONCLUSIONS Tamsulosin increased BBF in BOO rats via an antagonistic effect, presumably on the alpha(1A)- and/or alpha(1D)-adrenoceptor in the vesical artery mainly, and improved the decrease in mean voided volume. Therefore, the results of this study suggest that tamsulosin improves bladder overactivity via improvement of BBF.
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Affiliation(s)
- Hiroko Okutsu
- Applied Pharmacology Research Laboratories, Astellas Pharma Inc, Miyukigaoka, Tsukuba-shi, Ibaraki, Japan
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Gur S, Sikka SC, Chandra S, Koka PS, Agrawal KC, Kadowitz PJ, Hellstrom WJ. Alfuzosin attenuates erectile dysfunction in rats with partial bladder outlet obstruction. BJU Int 2008; 102:1651-7. [DOI: 10.1111/j.1464-410x.2008.07914.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Combined use of melatonin and terazosin restores bladder contractility in rabbits with partial outlet obstruction. Urology 2008; 72:439-43. [PMID: 18455780 DOI: 10.1016/j.urology.2008.02.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Revised: 02/20/2008] [Accepted: 02/26/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate the effects of terazosin and melatonin on isolated rabbit bladder strips after partial bladder outlet obstruction and determine responses to agonist-induced contractility and changes in oxidant-antioxidant system. METHODS We created partial bladder outlet obstruction in 5 groups of rabbits, each containing 8. Rabbits with sham operation (group 1) received no drug treatment. Similarly, animals in group 2 underwent partial bladder outlet obstruction and received no drug treatment. Rabbits in groups 3 were administered 5 mg/day oral terazosin, and rabbits in group 4 received 10 mg/kg/day melatonin intraperitoneally. Animals in group 5 received both terazosin and melatonin. We removed their bladders and performed histopathological and biochemical measurements. We assessed tissue malondialdehyde and antioxidant enzyme activity levels and recorded in vitro contractility response to KCl in isolated organ baths. RESULTS The thickness of muscularis propria was significantly increased in group 2 compared with all other groups. KCl-evoked contractions after partial outlet obstruction were significantly impaired in group 3 and 4 animals receiving terazosin and melatonin, respectively. However, combined use of melatonin and terazosin in group 5 showed contractility responses similar to sham-operated animals (P <0.05). Melatonin administration to groups 4 and 5 showed decreased levels of lipid peroxidation. Similarly, animals receiving melatonin and melatonin plus terazosin showed statistically significant increase in antioxidant enzyme activities. CONCLUSIONS In the present study, we showed that oxidative stress induced by partial bladder outlet obstruction can be successfully antagonized by the potent antioxidant melatonin, and its combined use with an alpha-antagonist such as terazosin may restore in vitro contractility.
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Michel MC, Barendrecht MM. Physiological and pathological regulation of the autonomic control of urinary bladder contractility. Pharmacol Ther 2008; 117:297-312. [DOI: 10.1016/j.pharmthera.2007.12.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 12/04/2007] [Indexed: 01/10/2023]
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26
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Andersson KE, Gratzke C. Bladder Pharmacology and Treatment of Lower Urinary Tract Symptoms: Recent Advances. ACTA ACUST UNITED AC 2008. [DOI: 10.3834/uij.1939-4810.2008.07.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Kulovac B, Aganović D, Prcić A, Hadziosmanović O. Management of chronic nonbacterial prostatitis/chronic pelvic pain syndrome. Bosn J Basic Med Sci 2007; 7:245-9. [PMID: 17848151 PMCID: PMC5736117 DOI: 10.17305/bjbms.2007.3053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic nonbacterial prostatitis/chronic pelvic pain syndrome is unsatisfactorily defined and insufficiently studied illness. Also, the treatment success is questionable and therefore, this illness is a therapeutical problem for urologists--which medications are the best choice in treating this uncomfortable condition? This paper presents results of prospective, open, analytical, comparative study that was performed on 90 patients with diagnosed chronic nonbacterial prostatitis/chronic pelvic pain syndrome. Patients were divided into three groups and were treated with two medications ciprofloxacin (C), doxazosin (D) and combination of ciprofloxacin + doxazosin (C+D). The effects were measured using symptom questionnaire for prostate illnesses of the National Institute for Health - USA (NIH-CPSI). During the basic evaluation, sum ranging from 0 to 43 was calculated for each patient. This number is called total sum NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) of the questionnaire, which generates the questions from 1 to 9. The most significant change occurred in C+D group where the total sum changed from 18-38 in the beginning to 5-31 at the end of the treatment (55,1% (p<0,001)). Significant changes were also found in D group where the change was 46, 4% (p<0,001). At the end of the treatment no significant change was registered in C group (p<0,005): p<0,001--significance threshold. Combination of ciprofloxacin + doxazosin proved to be the best choice for treatment.
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Affiliation(s)
- Benjamin Kulovac
- Urology Clinic, University of Sarajevo Clinics Centre, Bolnicka 25, 71 000 Sarajevo, Bosnia and Herzegovina
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Andersson KE, Gratzke C. Pharmacology of α1-adrenoceptor antagonists in the lower urinary tract and central nervous system. ACTA ACUST UNITED AC 2007; 4:368-78. [PMID: 17615548 DOI: 10.1038/ncpuro0836] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 04/30/2007] [Indexed: 02/02/2023]
Abstract
The main use of alpha(1)-adrenoceptor (AR) antagonists in urology has been to treat lower urinary tract symptoms (LUTS) in men with benign prostatic obstruction (BPO). The beneficial effects of these agents are primarily assumed to be because of relaxation of prostatic and urethral smooth muscle. The weak correlation between LUTS and prostatic enlargement, outflow obstruction, or both, however, has refocused interest on the role of extraprostatic alpha-ARs in the pathogenesis of LUTS and their treatment. The alpha(1)-ARs present in the bladder, urethra, vas deferens, peripheral ganglia, nerve terminals, and in the central nervous system could all potentially influence LUTS and, when the receptors are blocked, contribute to both the therapeutic and adverse effects of alpha(1)-AR antagonists. The relevance of alpha(1)-AR-subtype selectivity on the clinical usefulness of existing drug therapies has not been firmly established but it seems that blockade of both alpha(1A/L)- and alpha(1D)-ARs is necessary for the optimum balance between clinical efficacy and adverse effects.
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Affiliation(s)
- Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA.
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29
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Yono M, Yamamoto Y, Yoshida M, Ueda S, Latifpour J. Effects of doxazosin on blood flow and mRNA expression of nitric oxide synthase in the spontaneously hypertensive rat genitourinary tract. Life Sci 2007; 81:218-22. [PMID: 17574276 PMCID: PMC2077832 DOI: 10.1016/j.lfs.2007.05.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2006] [Revised: 04/13/2007] [Accepted: 05/07/2007] [Indexed: 12/01/2022]
Abstract
Hypertension may impact pelvic arterial blood flow resulting in reduction of nitric oxide synthase (NOS) levels. Although doxazosin, an alpha(1)-adrenoceptor antagonist, has been shown to improve erectile dysfunction as well as benign prostatic hyperplasia (BPH) and hypertension, it is not clear whether these improvements using doxazosin are primarily due to direct actions on the prostate, urinary bladder and penis, possibly via inhibition of vascular alpha(1)-adrenoceptors, or other sites of actions. Therefore, we investigated effects of doxazosin to the spontaneously hypertensive rat (SHR) on blood flow and NOS levels in the genitourinary tract. Four groups of rats were assessed: group 1, SHRs treated with doxazosin (30 mg/kg/day) for 4 weeks; group 2, SHRs treated with nifedipine (30 mg/kg/day) for 4 weeks; group 3, untreated SHRs; and group 4, untreated Wistar-Kyoto (WKY) rats. Blood flow to the ventral prostate, dorsolateral prostate, urinary bladder and penis was determined using a fluorescent microsphere infusion technique. Expression levels of nNOS and eNOS mRNAs were quantified by real-time RT-PCR using SYBR Green I. Blood flow to the ventral prostate, dorsolateral prostate, urinary bladder and penis was significantly lower in untreated SHRs than WKY rats. Treatment with doxazosin increased blood flow to each tissue studied in SHRs. RT-PCR data indicated that untreated SHRs had lower mRNA expression levels of nNOS in the bladder and penis and eNOS in the penis than WKY rats and that administration of doxazosin to the SHR caused an increase in expression levels of these genes, i.e., up-regulation of nNOS in the bladder and penis and eNOS in the penis. However, nifedipine had no significant effects on blood flow and NOS levels in the SHR genitourinary tract. Our data demonstrate that doxazosin treatment causes differential alterations in blood flow and NOS levels in the SHR genitourinary tract. These findings may provide insight into the beneficial effects of alpha(1)-adrenoceptor antagonists, on prostate, bladder and penile function, when used to treat symptoms of BPH and elevated blood pressure.
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Affiliation(s)
- Makoto Yono
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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Barendrecht MM, Chichester P, Michel MC, Levin RM. Effect of short-term outlet obstruction on rat bladder nerve density and contractility. ACTA ACUST UNITED AC 2007; 27:47-53. [PMID: 17199875 DOI: 10.1111/j.1474-8673.2006.00393.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
1 The present study was designed to investigate the relationship between innervation density and contractile responses to field stimulation and exogenous agonists at early time points after induction of bladder outlet obstruction (BOO) in rats. 2 When compared with sham-operated animals, 1, 3 and 7 days of BOO were associated with a 75%, 80% and 90% increase of bladder weight. Field stimulation caused a frequency-dependent increase in force of contraction. The force of contraction was reduced at each frequency in BOO rats with the greatest decrease after 1 day and a gradual but incomplete recovery thereafter. In contrast, contractile responses to ATP, carbachol and KCl were markedly reduced after 1 day of BOO and fully recovered after 7 days. The neurofilament staining was not altered by 1 day of BOO, but gradually decreased with increasing duration of BOO reaching the lowest levels after 7 days. 3 We conclude that impaired cellular contractility seems to underlie the early reductions of field stimulation-induced contraction, possibly reflecting surgical trauma of the tissue. However, at later time points a reduced nerve density, possibly reflecting a partial denervation, appears to be the main reason for impaired contractile response to field stimulation.
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Affiliation(s)
- M M Barendrecht
- Department of Pharmacology and Pharmacotherapy, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
Lower urinary tract symptoms (LUTS) are commonly divided into storage, voiding, and postmicturition symptoms, and may occur in both men and women. Male LUTS have historically been linked to benign prostatic hyperplasia (BPH), but are not necessarily prostate related. The focus of treatment for LUTS has thus shifted from the prostate to the bladder and other extraprostatic sites. LUTS include symptoms of the overactive bladder (OAB), which are often associated with detrusor overactivity. Treatment for LUTS suggestive of BPH has traditionally involved the use of alpha(1)-adrenoceptor (AR) antagonists; 5alpha-reductase inhibitors; and phytotherapy-however, several new therapeutic principles have shown promise. Selective beta(3)-adrenoceptor agonists and antimuscarinics are potentially useful agents for treating LUTS, particularly for storage symptoms secondary to outflow obstruction. Other agents of potential or actual importance are antagonists of P2X(3) receptors, botulinum toxin type A, endothelin (ET)-converting enzyme inhibitors, and drugs acting at vanilloid, angiotensin, and vitamin D(3) receptor sites. Drugs interfering with the nitric oxide/cGMP-cAMP pathway, Rho-kinase and COX inhibitors, as well as drugs targeting receptors and mechanisms within the CNS, are also of interest and deserving of further study for the treatment of LUTS.
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Affiliation(s)
- K-E Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina 27157, USA.
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Michel MC, Vrydag W. Alpha1-, alpha2- and beta-adrenoceptors in the urinary bladder, urethra and prostate. Br J Pharmacol 2006; 147 Suppl 2:S88-119. [PMID: 16465187 PMCID: PMC1751487 DOI: 10.1038/sj.bjp.0706619] [Citation(s) in RCA: 338] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
1 We have systematically reviewed the presence, functional responses and regulation of alpha(1)-, alpha(2)- and beta-adrenoceptors in the bladder, urethra and prostate, with special emphasis on human tissues and receptor subtypes. 2 Alpha(1)-adrenoceptors are only poorly expressed and play a limited functional role in the detrusor. Alpha(1)-adrenoceptors, particularly their alpha(1A)-subtype, show a more pronounced expression and promote contraction of the bladder neck, urethra and prostate to enhance bladder outlet resistance, particularly in elderly men with enlarged prostates. Alpha(1)-adrenoceptor agonists are important in the treatment of symptoms of benign prostatic hyperplasia, but their beneficial effects may involve receptors within and outside the prostate. 3 Alpha(2)-adrenoceptors, mainly their alpha(2A)-subtype, are expressed in bladder, urethra and prostate. They mediate pre-junctional inhibition of neurotransmitter release and also a weak contractile effect in the urethra of some species, but not humans. Their overall post-junctional function in the lower urinary tract remains largely unclear. 4 Beta-adrenoceptors mediate relaxation of smooth muscle in the bladder, urethra and prostate. The available tools have limited the unequivocal identification of receptor subtypes at the protein and functional levels, but it appears that the beta(3)- and beta(2)-subtypes are important in the human bladder and urethra, respectively. Beta(3)-adrenoceptor agonists are promising drug candidates for the treatment of the overactive bladder. 5 We propose that the overall function of adrenoceptors in the lower urinary tract is to promote urinary continence. Further elucidation of the functional roles of their subtypes will help a better understanding of voiding dysfunction and its treatment.
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MESH Headings
- Adrenergic Agonists/pharmacology
- Animals
- Gene Expression Regulation
- Humans
- Male
- Muscle Contraction
- Muscle, Smooth/metabolism
- Prostate/drug effects
- Prostate/metabolism
- Receptors, Adrenergic/drug effects
- Receptors, Adrenergic/genetics
- Receptors, Adrenergic/metabolism
- Receptors, Adrenergic, alpha-1/metabolism
- Receptors, Adrenergic, alpha-2/metabolism
- Receptors, Adrenergic, beta/metabolism
- Urethra/drug effects
- Urethra/metabolism
- Urinary Bladder/drug effects
- Urinary Bladder/metabolism
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology & Pharmacotherapy, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Spigt M, van Schayck O, Knipschild P, Westerterp K, van de Beek C, van Kerrebroeck P, Pel J, van Mastrigt R, Knottnerus A. Is it possible to improve elderly male bladder function by having them drink more water? A randomized trial of effects of increased fluid intake/urine output on male lower urinary tract function. Urology 2006; 68:1031-6. [PMID: 17113895 DOI: 10.1016/j.urology.2006.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Revised: 05/08/2006] [Accepted: 07/31/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Several animal studies have shown that bladder performance improves as a result of diuresis. Whether increased urine output also has beneficial effects on elderly male bladder function and lower urinary tract symptoms is unknown. METHODS We performed a randomized placebo-controlled trial of 141 men, 55 to 75 years of age, with moderate lower urinary tract symptoms. The experimental group drank 1.5 L of extra water daily. The control group consumed one tablespoon of placebo syrup daily. After 6 months, we evaluated bladder contractility, voided volumes, and the severity of lower urinary tract symptoms. The actual increase in water consumption was measured using the deuterium urine dilution method. RESULTS Water consumption in the intervention group increased by 359 mL (95% confidence interval [CI] 171 to 548) per 24 hours compared with the control group. At 6 months, no statistically significant effect was found in the maximal flow rate (0.9 mL/s, 95% CI -0.4 to 2.2) compared with placebo. A statistically significant effect was found for bladder pressure (20 cm H2O, 95% CI 6 to 34) and bladder wall stress (1.9 N/cm2, 95% CI 0.3 to 3.5). In addition, it showed that the experimental group had greater maximal (44 mL, 95% CI -1 to 90) and average (26 mL, 95% CI 1 to 51) voided volumes per urination. The subjective effect parameters improved in both groups, but no statistically significant differences were found between the two groups. CONCLUSIONS It seems possible to improve some aspects of male bladder function by drinking more water. However, the effects are too small to be clinically relevant.
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Affiliation(s)
- Mark Spigt
- Department of General Practice, Maastricht University, Maastricht, The Netherlands.
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Ohtake A, Ukai M, Saitoh C, Sonoda R, Noguchi Y, Okutsu H, Yuyama H, Sato S, Sasamata M, Miyata K. Effect of tamsulosin on spontaneous bladder contraction in conscious rats with bladder outlet obstruction: Comparison with effect on intraurethral pressure. Eur J Pharmacol 2006; 545:185-91. [PMID: 16887117 DOI: 10.1016/j.ejphar.2006.06.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 03/09/2006] [Accepted: 06/20/2006] [Indexed: 11/30/2022]
Abstract
We investigated the effect of tamsulosin, an alpha(1)-adrenoceptor antagonist, on bladder function, especially spontaneous bladder contractions before micturition (premicturition contraction), in conscious rats with bladder outlet obstruction induced by partial urethral ligation, and compared the results with the effect on intraurethral pressure response in anesthetized rats. In obstructed rats, the alpha(1)-adrenoceptor antagonists tamsulosin, naftopidil and urapidil and non-selective alpha-adrenoceptor antagonist phentolamine inhibited premicturition contractions in a dose-dependent fashion. In contrast, yohimbine, an alpha(2)-adrenoceptor antagonist, and atropine, a muscarinic receptor antagonist, hardly inhibited them. Tamsulosin and urapidil showed clearly inhibitory effects on increases in intraurethral pressure induced by phenylephrine, an alpha(1)-adrenoceptor agonist, in the same dose range as that at which they inhibited premicturition contractions, whereas naftopidil required somewhat higher doses to inhibit increases in intraurethral pressure than those at which it inhibited premicturition contractions. In conclusion, premicturition contractions observed in obstructed rats were sensitive to alpha(1)-adrenoceptor antagonists, but not to alpha(2)-adrenoceptor or muscarinic receptor antagonists. Tamsulosin was shown to be effective against both premicturition contraction and intraurethral pressure response in the same dose range in rats. These results partly support the fact that tamsulosin has improved storage symptoms as well as voiding symptoms in patients with lower urinary tract symptoms associated with bladder outlet obstruction by blocking alpha(1)-adrenoceptors.
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Affiliation(s)
- Akiyoshi Ohtake
- Pharmacology Research Labs., Drug Discovery Research, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba, Ibaraki, 305-8585, Japan.
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McMurray G, Casey JH, Naylor AM. Animal models in urological disease and sexual dysfunction. Br J Pharmacol 2006; 147 Suppl 2:S62-79. [PMID: 16465185 PMCID: PMC1751496 DOI: 10.1038/sj.bjp.0706630] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
There are several conditions associated with dysfunction of the lower urinary tract or which result in a reduction in the ability to engage in satisfactory sexual function and result in significant bother to sufferers, partners and/or carers. This review describes some of the animal models that may be used to discover safe and effective medicines with which to treat them. While alpha adrenoceptor antagonists and 5-alpha-reductase inhibitors deliver improvement in symptom relief in benign prostatic hyperplasia sufferers, the availability of efficacious and well-tolerated medicines to treat incontinence is less well served. Stress urinary incontinence (SUI) has no approved medical therapy in the United States and overactive bladder (OAB) therapy is limited to treatment with muscarinic antagonists (anti-muscarinics). SUI and OAB are characterised by high prevalence, a growing ageing population and a strong desire from sufferers and physicians for more effective treatment options. High patient numbers with low presentation rates characterizes sexual dysfunction in men and women. The introduction of Viagra in 1998 for treating male erectile dysfunction and the success of the phosphodiesterase type 5 inhibitor class (PDE5 inhibitor) have indicated the willingness of sufferers to seek treatment when an effective alternative to injections and devices is available. The main value of preclinical models in discovering new medicines is to predict clinical outcomes. This translation can be established relatively easily in areas of medicine where there are a large number of drugs with different underlying pharmacological mechanisms in clinical usage. However, apart from, for example, the use of PDE5 inhibitors to treat male erectile dysfunction and the use of anti-muscarinics to treat OAB, this clinical information is limited. Therefore, current confidence in existing preclinical models is based on our understanding of the biochemical, physiological, pathophysiological and psychological mechanisms underlying the conditions in humans and how they are reflected in preclinical models. Confidence in both the models used and the pharmacological data generated is reinforced if different models of related aspects of the same disorder generate confirmatory data. However, these models will only be fully validated in retrospect once the pharmacological agents they have helped identify are tested in humans.
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Affiliation(s)
- Gordon McMurray
- Pfizer Global Research and Development, Sandwich Laboratories, Ramsgate Road, Kent CT13 9NJ
| | - James H Casey
- Pfizer Global Research and Development, Sandwich Laboratories, Ramsgate Road, Kent CT13 9NJ
| | - Alasdair M Naylor
- Pfizer Global Research and Development, Sandwich Laboratories, Ramsgate Road, Kent CT13 9NJ
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Gotoh M, Kamihira O, Kinukawa T, Ono Y, Ohshima S, Origasa H. Comparison of tamsulosin and naftopidil for efficacy and safety in the treatment of benign prostatic hyperplasia: a randomized controlled trial. BJU Int 2005; 96:581-6. [PMID: 16104914 DOI: 10.1111/j.1464-410x.2005.05688.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of two alpha1a/alpha1d adrenoceptor (AR) antagonists with different affinity for the alpha1AR subtypes, tamsulosin and naftopidil, in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Patients with BPH were randomized to receive either tamsulosin or naftopidil. The primary efficacy variables were the changes in the total International Prostate Symptom Score (IPSS), maximum flow rate on free uroflowmetry, and residual urine volume. The secondary efficacy variables were average flow rate, changes in the IPSS storage score, IPSS voiding score, and quality-of-life (QoL) Index score, from baseline to endpoint (12 weeks). Data on all randomized patients were included in the safety analyses for adverse effects and changes in blood pressure. RESULTS Of the 185 patients enrolled data for 144 who were eligible for inclusion in the efficacy analysis were analysed (75 from the tamsulosin and 69 from the naftopidil group). There was no significant difference in any variable at baseline between the groups. There were statistically significant improvements for all primary and secondary variables in both groups, except for residual urine in the tamsulosin group. However, there was no significant intergroup difference in the improvement of any efficacy variable between the groups. The adverse effects were comparable, with no significant differences in systolic and diastolic blood pressure after treatment in both groups. CONCLUSIONS This study suggests that naftopidil is as effective and safe as tamsulosin. Both drugs were effective in improving storage and voiding symptoms. However, there was no difference in clinical efficacy or adverse effects between the alpha1 AR antagonists with different affinity to alpha1 subtypes, alpha1a and alpha1d.
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Affiliation(s)
- Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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37
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Andersson KE, Wein AJ. Pharmacology of the lower urinary tract: basis for current and future treatments of urinary incontinence. Pharmacol Rev 2005; 56:581-631. [PMID: 15602011 DOI: 10.1124/pr.56.4.4] [Citation(s) in RCA: 394] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The lower urinary tract constitutes a functional unit controlled by a complex interplay between the central and peripheral nervous systems and local regulatory factors. In the adult, micturition is controlled by a spinobulbospinal reflex, which is under suprapontine control. Several central nervous system transmitters can modulate voiding, as well as, potentially, drugs affecting voiding; for example, noradrenaline, GABA, or dopamine receptors and mechanisms may be therapeutically useful. Peripherally, lower urinary tract function is dependent on the concerted action of the smooth and striated muscles of the urinary bladder, urethra, and periurethral region. Various neurotransmitters, including acetylcholine, noradrenaline, adenosine triphosphate, nitric oxide, and neuropeptides, have been implicated in this neural regulation. Muscarinic receptors mediate normal bladder contraction as well as at least the main part of contraction in the overactive bladder. Disorders of micturition can roughly be classified as disturbances of storage or disturbances of emptying. Failure to store urine may lead to various forms of incontinence, the main forms of which are urge and stress incontinence. The etiology and pathophysiology of these disorders remain incompletely known, which is reflected in the fact that current drug treatment includes a relatively small number of more or less well-documented alternatives. Antimuscarinics are the main-stay of pharmacological treatment of the overactive bladder syndrome, which is characterized by urgency, frequency, and urge incontinence. Accepted drug treatments of stress incontinence are currently scarce, but new alternatives are emerging. New targets for control of micturition are being defined, but further research is needed to advance the pharmacological treatment of micturition disorders.
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Affiliation(s)
- Karl-Erik Andersson
- Department of Clinical Pharmacology, Lund University Hospital, S-221 85 Lund, Sweden.
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Yono M, Foster HE, Shin D, Takahashi W, Pouresmail M, Latifpour J. Doxazosin-induced up-regulation of alpha 1A-adrenoceptor mRNA in the rat lower urinary tract. Can J Physiol Pharmacol 2005; 82:872-8. [PMID: 15573147 DOI: 10.1139/y04-098] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Alpha1-adrenoceptor (AR) antagonists can provide effective treatment of symptoms caused by benign prostatic hyperplasia. However, their mechanisms of action have not been fully elucidated. We previously reported that chronic administration of doxazosin causes an up-regulation in the mRNA expression of all three alpha1-AR subtypes in the rat prostate. As alpha1-AR antagonists might also affect the properties of alpha1-ARs in the lower urinary tract, we examined the effects of doxazosin (2 or 4 mg/kg daily subcutaneously, supplemented with 4 mg/kg daily orally for 8 or 12 weeks) on alpha1-AR subtype mRNAs in the rat bladder dome, bladder base, and urethra using real-time reverse transcription PCR. Rats that received the highest doses of doxazosin had significantly heavier bladder base and prostatic urethra than controls. PCR data showed that all three alpha1-AR subtypes were expressed in all tissues studied. Doxazosin treatment caused an up-regulation in the mRNA levels of alpha1A-AR in the rat bladder base and prostatic urethra, indicating that chronic doxazosin treatment may cause an alteration in the properties of alpha1A-AR subtype mRNA in these two areas. Furthermore, the heavier bladder base and prostatic urethra in the doxazosin-treated rats suggest that alpha1-AR antagonist treatment might also influence the growth process in these areas of the rat lower urinary tract.
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Affiliation(s)
- Makoto Yono
- Section of Urology, Yale University School of Medicine, New Haven, CT 06520, USA
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Abstract
Although currently available antimuscarinic agents are the standard of care for overactive bladder (OAB), they are limited by certain side effects, particularly dry mouth and constipation. Research aimed at discovering new therapies for OAB has resulted in the identification of some promising drugs. Investigations of pharmacologic targets in the central nervous system (CNS) have yielded encouraging results with several agents, including tramadol and gabapentin. Further investigation may show that drugs acting at serotonergic and noradrenergic CNS sites are clinically useful as therapies for OAB. Some peripherally acting drugs, such as resiniferatoxin and botulinum toxin, have already been proved to be of clinical value. However, development of other agents that block afferent or efferent nerve impulses in the bladder through activity at vanilloid, purinergic, or opioid-like receptor sites may result in clinically useful drugs.
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Affiliation(s)
- Karl-Erik Andersson
- Department of Clinical Pharmacology, Lund University Hospital, Lund, Sweden.
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O'Leary MP. Lower urinary tract symptoms/benign prostatic hyperplasia: maintaining symptom control and reducing complications. Urology 2003; 62:15-23. [PMID: 12957196 DOI: 10.1016/s0090-4295(03)00480-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Because the average patient with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), or LUTS/BPH, has a remaining life expectancy of 15 to 20 years, both short-term and long-term outcomes matter in the management of LUTS/BPH. Sustained symptom control and improvement of quality of life (QOL), control of disease progression (ie, prevention or reduction of bladder wall hypertrophy [BWH]/increased bladder mass and reduction of the risk of serious complications), and minimization of the need to switch to other medical therapy or surgery are important. In this respect, alpha(1)-adrenoceptor antagonists, such as tamsulosin, have been shown to provide effective and rapid relief of symptoms and improvement in QOL, which is sustained in the long term (up to 6 years). Obstruction may, in the long term, induce changes in the bladder wall (eg, BWH), which may result in (irreversible) bladder damage and serious complications. Preliminary data suggest that alpha(1)-adrenoceptor antagonists prevent the development of BWH in rabbits and reduce existing BWH in obstructed LUTS/BPH patients. Pooled analyses and indirect comparisons of clinical studies up to 1 year have shown that alpha(1)-adrenoceptor antagonists, such as tamsulosin, reduce the risk of acute urinary retention and the need for surgery to at least the same extent as the 5alpha-reductase inhibitor finasteride. In addition, monotherapy with an alpha(1)-adrenoceptor antagonist reduces the risk of long-term clinical progression; the combination with finasteride may be more beneficial in patients at high risk (patients with large prostate volume, high level of prostate-specific antigen, high International Prostate Symptom Score, high postvoid residual amount, and low maximum flow rate). Therefore, alpha(1)-adrenoceptor antagonists, such as tamsulosin, are first-line therapy, not only in the short term but also in the long-term management of LUTS/BPH.
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Affiliation(s)
- Michael P O'Leary
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
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Nomiya M, Yamaguchi O. A quantitative analysis of mRNA expression of alpha 1 and beta-adrenoceptor subtypes and their functional roles in human normal and obstructed bladders. J Urol 2003; 170:649-53. [PMID: 12853849 DOI: 10.1097/01.ju.0000067621.62736.7c] [Citation(s) in RCA: 194] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We compared the expression level of alpha 1-adrenoceptor (AR) subtype mRNA to that of beta-AR subtype mRNA in control and obstructed human bladders, and examined whether alpha 1-AR mediated contraction and beta-AR mediated relaxation of human detrusor muscle are altered by bladder outlet obstruction. MATERIALS AND METHODS A real-time quantitative reverse transcriptase-polymerase chain reaction based method was used to quantify alpha1 and beta-AR subtype mRNA expression. The contractile response to alpha-AR agonists and the relaxant effect of beta-AR agonists were examined using an isometric contraction technique. RESULTS The mRNA of alpha 1a, alpha 1b, alpha 1d, beta 1 and beta 2-AR mRNAs was expressed at low levels, while beta 3-AR was the most highly expressed subtype at the mRNA level in control and obstructed bladders. The expression level of alpha 1 and beta-AR subtype mRNA was not significantly different between the 2 groups. The mean contractile response to 10(-4) M phenylephrine +/- SEM was only 4.4% +/- 1.4% and 5.2% +/- 1.4% of the 10(-7) M carbachol induced contraction in the control and obstructed groups, respectively. Contractile responses to phenylephrine were not significantly increased in obstructed bladder. Isoproterenol and the beta 3-AR selective agonist L755,507 relaxed human detrusor muscle in a concentration dependent manner (10(-9) to 10(-4) M). However, the beta 1/beta 2-AR agonist dobutamine and the beta 2-AR selective agonist clenbuterol did not produce relaxation at a concentration of 10(-9) to 10(-5) M in the 2 groups. CONCLUSIONS These findings indicate that neither up-regulation of alpha1-ARs nor down-regulation of beta-ARs occurs and relaxation mediating beta 3-ARs are by far predominant in the human obstructed bladder. Therefore, it is not likely that bladder alpha1-ARs are responsible for detrusor overactivity and storage symptoms in patients with benign prostatic obstruction.
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MESH Headings
- Adrenergic Agonists/pharmacology
- Aged
- Carbachol/pharmacology
- Humans
- In Vitro Techniques
- Male
- Middle Aged
- Muscle Contraction
- Muscle Relaxation/drug effects
- Muscle, Smooth/metabolism
- Muscle, Smooth/physiopathology
- RNA, Messenger/analysis
- Receptors, Adrenergic, alpha-1/genetics
- Receptors, Adrenergic, alpha-1/metabolism
- Receptors, Adrenergic, alpha-1/physiology
- Receptors, Adrenergic, beta/genetics
- Receptors, Adrenergic, beta/metabolism
- Receptors, Adrenergic, beta/physiology
- Reverse Transcriptase Polymerase Chain Reaction
- Urinary Bladder/metabolism
- Urinary Bladder/physiopathology
- Urinary Bladder Neck Obstruction/metabolism
- Urinary Bladder Neck Obstruction/physiopathology
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Affiliation(s)
- Masanori Nomiya
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima City, Japan
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Levin RM, Chichester P, Hass MA, Gosling JA, Buttyan R. Obstructive Bladder Dysfunction: Morphological, Biochemical and Molecular Changes. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1569-9056(02)00119-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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