Clinical and urodynamic assessment of alpha-adrenolytic therapy in patients with neurogenic bladder function

Abstract

Abstract. The efficacy of alpha-adrenolytic treatment with oral phenoxybenzamine chloride (40 mg per day during three to four months) has been assessed both clinically and urodynamically among 249 patients with neurogenic bladder function. The results were significantly better in patients with autonomous (n = 95) than in the ones with automatic (n = 154) bladders (urethral sphincter spasticity and detrusor sphincter dyssynergia dominating the clinical picture in the latter event). A further striking difference was noticed when the data were analysed with regard to the patient's age, a far better therapeutic response being regularly recorded in subjects below age 35, while minimal and inconsistent improvements were observed in the older age group. No major side effects were encountered.Caution is however required in tetraplegics where phenoxybenzamine may aggravate orthostatic hypotension. On the other side the drug proves highly beneficial in these same patients in that it markedly lowers the incidence of dysreflexic states.

Nicergoline in the treatment of neuropathic bladder dysfunction: a preliminary report

“…absence of emission, a known side effect of the alpha blocking drugs on the seminal tract (Hachen, 1980). The duration of treatment ranged from 6-12 months, with an average time of 9· 5 months.…”

“…Several authors (Hachen, 1980;Scott, 1978) report better results in lower motor neurone lesions, probably due to the urethral denervation hypersensitivity, while others (Mobley, 1976) report better results in reflex bladders.…”

“…From a clinical point of view the alpha blocking agents are being used increasingly in the management of the outflow urinary obstruction, both in neuropathic bladder (Hachen, 1980;Scott, 1978) and in prostatism (Caine et al, 1976). The drug most commonly used is phenoxybenzamine hydro chloride, which causes urethral relaxation similar to phentolamine with the advantage of oral administration, thus allowing long term treatment.…”

“…IT is well known that the alpha-adrenergic blocking agents are effective in the treatment of the neurogenic bladder (Hachen, 1980;Mobley, 1976). They also produce a relaxing effect on the urethral smooth muscle (Donker et at., 1972;Whitfield et at., 1976), and also reduce the detrusor hyperactivity (Kaplan and Nanninga, 1979).…”

The use of urodynamic studies to assess the effect of pharmacological agents with particular references to alpha-adrenergic blockade

“…Similarly Olsson and colleagues (1977) reported improved voiding as judged by flow measurements in six patients out of II with upper motor neurone lesions. Conversely, Hachen (1980) reported the value of phenoxybenzamine in improving voiding in patients with auto nomous bladders but with no effect in those with automatic bladders. In vitro studies of human detrusor strips have shown that phentolamine resulted in the inhibition of an electrically evoked response.…”