期刊
INTERNATIONAL JOURNAL OF UROLOGY
卷 20, 期 1, 页码 28-39出版社
WILEY
DOI: 10.1111/iju.12008
关键词
a1-adrenoceptor antagonists; 5a-reductase inhibitors; antimuscarinics; lower urinary tract symptoms; phosphodiesterase inhibitors; ss 3-adrenoceptor agonists
Recent studies suggest that antimuscarinics might suppress bladder afferent activity by blocking muscarinic receptors in the urothelium, myofibroblasts and detrusor, thereby improving overactive bladder symptoms. beta 3-Adrenoceptors are predominantly expressed in the human bladder and mediate relaxation of detrusor muscle. beta 3-Adrenoceptor agonists increase bladder capacity and prolong micturition interval. It is assumed that beta 3-adrenoceptor agonists could exert an inhibitory effect on bladder afferent through beta 3-adrenoceptors in the urothelium and detrusor, which eventually improve the symptom of urgency. Mirabegron is a potent and selective beta 3-adrenoceptor agonist. A Japanese phase 3 study showed that mirabegron has excellent efficacy and safety for treating overactive bladder. a1-Adrenoceptor antagonists (a1-blockers) have become a mainstay of male lower urinary tract symptoms treatment. The a1A subtype is known to mediate functional obstruction as a result of benign prostatic enlargement. Recent studies have suggested that a1A-adrenoceptors are additionally involved in the generation of storage symptoms. The a1D subtype is thought to play a role in the facilitation of voiding reflex; that is; storage symptoms. a1-Blockers often fail to alleviate overactive bladder symptoms. In this context, combination therapy with a1-blockers and antimuscarinics has been recommended. Treatment with 5a-reductase inhibitor for 1 year improves urinary symptoms and flow rate by reducing prostatic volume in men with benign prostatic enlargement. A pooled analysis showed that the long-term (2 or 4 years) treatment with 5a-reductase inhibitor reduced the rate of progression to acute urinary retention and surgery. Combination therapy with 5a-reductase inhibitor and a1-blocker was shown to provide a rapid improvement in lower urinary tract symptoms, and reduce the relative risk of acute urinary retention and benign prostatic hyperplasia-related surgery. Phosphodiesterase inhibitors might target a nitric oxidecyclic guanosine monophosphate pathway in the prostate, urethra and bladder. Phosphodiesterase-5 inhibitors (sildenafil or tadalafil) were shown to provide clinically relevant improvements in both male lower urinary tract symptoms and erectile dysfunction.
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