Tamsulosin: Efficacy and Safety in Patients With Neurogenic Lower Urinary Tract Dysfunction Due to Suprasacral Spinal Cord Injury

Abrams, Paul; Amarenco, G.; Bakke, August; Buczyński, Andrzej; Castro-Díaz, David; Harrison, Simon; Kramer, Guus; Maršik, Robert; Prajsner, Andrzej; Stöhrer, M.; Kerrebroeck, Philip Van; Wyndaele, Jean Jacques

doi:10.1097/01.ju.0000084623.65480.f8

Cited by 96 publications

(53 citation statements)

References 17 publications

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“…Tamsulosin has been used clinically for treatment of voiding dysfunction and improvement in lower urinary tract function and symptoms of autonomic dysreflexia shown in randomized controlled trials in SCI patients (Abrams et al, 2003). Blockade of ␣-1A-adrenergic receptors by Tamsulosin had no effect in normal rats but improved bladder function in OP-control rats and to a greater extent in NRP/GRP rats, presumably through its action on upregulated ␣-1 receptors.…”

Section: Lower Urinary Tract Functionmentioning

confidence: 99%

“…Postsynaptic targets of severed descending pathways, particularly monoaminergic pathways, may become more sensitive to transmitters because of receptor upregulation (Roudet et al, 1993;Kim et al, 1999; Y. Hayashi, S. Jacob, J.-M. Nothias, S. McBride, R. Olexa, K. Simansky, M. Murray, and J. S. Shumsky, unpublished observations). The noradrenergic system is implicated in regulation of micturition (Ishizuka et al, 1996;Yoshiyama et al, 2000), and administration of antagonists improve lower urinary tract function in SCI patients (Abrams et al, 2003). We therefore examined the effects of administration of Tamsulosin, an ␣-1A receptor antagonist, on urodynamics.…”

Section: Introductionmentioning

confidence: 99%

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Transplantation of Neuronal and Glial Restricted Precursors into Contused Spinal Cord Improves Bladder and Motor Functions, Decreases Thermal Hypersensitivity, and Modifies Intraspinal Circuitry

Mitsui¹,

Shumsky²,

Lepore³

et al. 2005

J. Neurosci.

170

187

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Transplanting neuronal and glial restricted precursors (NRP/GRP) into a midthoracic injury 9 d after contusion improved bladder and motor function, diminished thermal hypersensitivity, and modified lumbosacral circuitry compared with operated controls (OPcontrols). Histological analysis showed that NRP/GRP survived, filled the lesion site, differentiated into neurons and glia, and migrated selectively. Volume of spinal cord spared was increased in NRP/GRP recipients, suggesting local protection. Bladder areflexia developed in both operated groups, but NRP/GRP recipients exhibited an accelerated recovery, with decreased micturition pressure and fewer episodes of detrusor hyperreflexia. Because noradrenergic receptors proliferate after spinal injury and descending noradrenergic pathways contribute to regulation of bladder control, we examined the effects of administering an ␣-1A-adrenergic antagonist, Tamsulosin, on urodynamics. This improved all cystometric parameters in both operated groups, and micturition pressure in NRP/GRP rats recovered to normal levels. Both operated groups initially showed increased sensitivity to a thermal stimulus applied to the tail; the NRP/GRP rats showed significant improvement over time. NRP/GRP grafts also produced greater recovery of hindlimb function in several tests, although both groups showed persistent and similar deficits in locomotion on a grid.Because bladder, hindlimb, and tail sensory and motor functions are organized through lumbosacral cord, we examined descending and primary afferent projections at L6 -S1. The density of serotonergic, noradrenergic, and corticotrophin releasing factor-positive fibers increased in the NRP/GRP group compared with OP-controls, suggesting some sparing and/or sprouting of these modulatory pathways. Immunocytochemical staining density of dorsal root axons in the dorsal horn increased in the OP-controls but appeared normal in the NRP/GRP group. Synaptophysin immunoreactivity in the lumbosacral dorsal horn was similar among groups, consistent with restoration of synaptic density in both groups of operated animals but by different pathways. We suggest that local protection provided by NRP/GRP resulted in increased sparing/sprouting of descending pathways, which prevented sprouting by dorsal root axons, and that this modification in lumbosacral circuitry contributes to the recovery of function.

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Section: Lower Urinary Tract Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transplantation of Neuronal and Glial Restricted Precursors into Contused Spinal Cord Improves Bladder and Motor Functions, Decreases Thermal Hypersensitivity, and Modifies Intraspinal Circuitry

Mitsui¹,

Shumsky²,

Lepore³

et al. 2005

J. Neurosci.

170

187

View full text Add to dashboard Cite

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“…Tamsulosine (0.4 resp. 0.8 mg once daily) improves storage capacity and emptying of the bladder (class II evidence [107]). Antispastic agents: Baclofen has a positive effect in spastic or dyssynergic sphincter when given orally (class III evidence [108], class III evidence [109]).…”

Section: Bladder Symptomsmentioning

confidence: 99%

Symptomatic Treatment of Multiple Sclerosis

2006

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Besides immunomodulation and immunosuppression, the specific treatment of symptoms is an essential component of the overall management of multiple sclerosis (MS). Symptomatic treatment is aimed at the elimination or reduction of symptoms impairing the functional abilities and quality of life of the affected patients. Moreover, with symptomatic treatment the development of a secondary physical impairment due to an existing one may be avoided. Many therapeutic techniques as well as different drugs are used for the treatment of MS symptoms, but only a few of them have been investigated, especially in MS patients, and are approved by the national health authorities. Despite an overwhelming number of publications, only a few evidence-based studies exist and consensus reports are very rare, too. Therefore, it seemed necessary to develop a consensus statement on symptomatic treatment of MS comprising existing evidence-based literature as well as therapeutic experience of neurologists who have dealt with these problems over a long time. This consensus paper contains proposals for the treatment of the most common MS symptoms: disorders of motor function and coordination, of cranial nerve function, of autonomic, cognitive, and psychological functions as well as MS-related pain syndromes and epileptic seizures.

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“…In multiple sclerosis and suprasacral SCI patients, tamsulosin has been shown to improve bladder storage and emptying and is well-tolerated up to the maximum daily dose of 0.8 mg [30,31]. No effective drugs exist to increase outlet resistance, although α-adrenergic agonists, estrogens, β-adrenergic agonists, and tricyclic antidepressants all have been assessed [1•].…”

Section: Pharmacotherapymentioning

confidence: 99%

Current Concepts in Female Neurogenic Voiding Dysfunction

Kit

Kaufman

Dmochowski

2011

Curr Bladder Dysfunct Rep

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Neurogenic lower urinary tract dysfunction (NLUTD) encompasses a wide spectrum of abnormal voiding patterns ranging from detrusor overactivity and urgency to detrusor-external sphincter dyssynergia and urinary retention. NLUTD results from injury to the central or peripheral nervous system or some primary neurological disease that disrupts the normal neurological regulation of the lower urinary tract. Female patients with neurogenic voiding dysfunction deal with special challenges that make management of incontinence and lower urinary tract storage more problematic than in their male counterparts. Over the past 30 years, technological advancements have improved the care of these patients and reduced the morbidity and mortality associated with NLUTD. More recent developments, including intravesical botulinum toxin injection and neuromodulation (not US Food and Drug Administration approved for this indication), have provided further treatment options, resulting in improved quality of life. Still, management of the neurogenic bladder patient can be exceptionally complex, and attentive, specialized care is critical.

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Tamsulosin: Efficacy and Safety in Patients With Neurogenic Lower Urinary Tract Dysfunction Due to Suprasacral Spinal Cord Injury

Abstract: Long-term tamsulosin treatment (0.4 and 0.8 mg once daily) seems to be effective and well tolerated in patients with neurogenic lower urinary tract dysfunction. The results suggest that it improves bladder storage and emptying, and decreases symptoms of autonomic dysreflexia.

Cited by 96 publications

References 17 publications

Transplantation of Neuronal and Glial Restricted Precursors into Contused Spinal Cord Improves Bladder and Motor Functions, Decreases Thermal Hypersensitivity, and Modifies Intraspinal Circuitry

Transplantation of Neuronal and Glial Restricted Precursors into Contused Spinal Cord Improves Bladder and Motor Functions, Decreases Thermal Hypersensitivity, and Modifies Intraspinal Circuitry

Symptomatic Treatment of Multiple Sclerosis

Current Concepts in Female Neurogenic Voiding Dysfunction

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