Therapeutic Applications of Alpha-Blockers: Pharmacology, Clinical Evidence, and Evolving Therapeutic Strategies
Jean Paule Joumaa （ University of Balamand ）
Joe Abou Jaoude （ Department of Urology, Lebanese American University Rizk Medical Center, Lebanon ）
Carine El Khoury （ Faculty of Medicine and Biomedical Sciences, University of Balamand, Lebanon ）
Tony Sadek （ Faculty of Medicine and Biomedical Sciences, University of Balamand, Lebanon ）
Leona Antoun （ Faculty of Medicine and Biomedical Sciences, University of Balamand, Lebanon ）
Bendy Boulos （ Faculty of Medicine and Biomedical Sciences, University of Balamand, Lebanon ）
https://doi.org/10.37155/3060-8708-0301-1Abstract
Background: Alpha blockers are alpha adrenergic antagonists commonly used in urology to treat many conditions; particularly benign prostatic hyperplasia (BPH), ureteric stones, lower urinary tract obstruction, and chronic pelvic pain syndrome (CPPS). These drugs fall into three categories: nonselective, alpha-1, and alpha-2 blockers. They primarily act on alpha-adrenergic receptors of the sympathetic nervous system, thereby decreasing the vascular tone and leading to the relaxation of the smooth muscle. Despite their high effectiveness, these medications contribute to adverse side effects like hypotension, weakness, tachycardia, and even tremors.
Discussion: This review analyzes the pharmacological properties, therapeutic uses, comparative therapies, and safety profiles of alpha blockers (both selective and non-selective). The article addresses the pharmacodynamics and pharmacokinetics of the most commonly used agents like tamsulosin, silodosin, doxazosin, and alfuzosin. Additionally, a differential analysis of their therapeutic roles in monotherapies and combination therapies is presented, together with an evaluation of their clinical outcomes. Moreover, an interpretation of the determinants of treatment resistance is presented.
Conclusion: Advances in precision medicine and therapeutic formulations point to potential development and highlight the limitations of current research in urology. Based on clinical evidence, this paper contributes to improved decision-making and appropriate therapeutic management with minimal invasive techniques.
Keywords
Alpha-Blockers; Benign Prostatic Hyperplasia; Lower Urinary Tract Symptoms; Nocturia; Frequency; Urgency; Therapeutic Outcomes; Combination Therapy; Treatment Resistance; Precision MedicineFull Text
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Yeung HEL, Sena SJ, Calopedos RJ, Woo HH. Alfuzosin and Its Effect on Ejaculatory Dysfunction: A Systematic Review. World J Mens Health. 2021;39(2):186.
[2]. Ma C, Zhang J, Cai Z, Xiong J, Li H. Defining the Efficacy and Safety of Phosphodiesterase Type 5 Inhibitors with Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia with or without Erectile Dysfunction: A Network Meta-Analysis. BioMed Res Int. 2020;2020:1419520.
[3]. Ghanem AM. A REVIEW ON RECENT ADVANCES IN TRANSDERMAL DRUG DELIVERY SYSTEMS OF TAMSULOSIN. Int J Appl Pharm. 2024 Mar 7;28–33.
[4]. Yoosuf BT, Panda AK, Kt MF, Bharti SK, Devana SK, Bansal D. Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis. Sci Rep. 2024 May 15;14(1):11116.
[5]. Jindan L, Xiao W, Liping X. Evolving Role of Silodosin for the Treatment of Urological Disorders - A Narrative Review. Drug Des Devel Ther. 2022;16:2861–84.
[6]. Cheng C, Ma Y, Wen J, Xiang L, Jin X. The Effect of Preoperative Tamsulosin on Ureteral Navigation, Operation, and Safety: A Systematic Review and Meta-Analysis. Urol Int. 2023;107(6):557–63.
[7]. Calpin GG, O’Neill AM, Davey MG, Miller P, Joyce WP. Administering prophylactic alpha-blockade to reduce urinary retention post inguinal hernia repair: A systematic review and meta-analysis of randomised control trials. Surg Pract Sci. 2023 Sept;14:100204.
[8]. Campschroer T, Zhu X, Vernooij RW, Lock MT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2018 Apr 5;4(4):CD008509.
[9]. Hollingsworth JM, Canales BK, Rogers MAM, Sukumar S, Yan P, Kuntz GM, et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ. 2016 Dec 1;355:i6112.
[10]. Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D, et al. Effect of alpha-adrenoceptor antagonists on sexual function. A systematic review and meta-analysis. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2022 June 30;94(2):252–63.
[11]. Batty M, Pugh R, Rathinam I, Simmonds J, Walker E, Forbes A, et al. The Role of α1-Adrenoceptor Antagonists in the Treatment of Prostate and Other Cancers. Int J Mol Sci. 2016 Aug 16;17(8):1339.
[12]. Jindan L, Xiao W, Liping X. Evolving Role of Silodosin for the Treatment of Urological Disorders - A Narrative Review. Drug Des Devel Ther. 2022;16:2861–84.
]13]. Roehrborn CG, Cruz F, Fusco F. α1-Blockers in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Obstruction: Is Silodosin Different? Adv Ther. 2017 Jan;33(12):2110–21.
[14]. Sica DA. Alpha1 ‐Adrenergic Blockers: Current Usage Considerations. J Clin Hypertens. 2005 Dec;7(12):757–62.
[15]. Mari A, Antonelli A, Cindolo L, Fusco F, Minervini A, De Nunzio C. Alfuzosin for the medical treatment of benign prostatic hyperplasia and lower urinary tract symptoms: a systematic review of the literature and narrative synthesis. Ther Adv Urol. 2021 Jan;13:1756287221993283.
[16]. Mantica G, Ambrosini F, Drocchi G, Zubko Z, Lo Monaco L, Cafarelli A, et al. Non-surgical management of BPH: An updated review of current literature and state of the art on natural compounds and medical therapy. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2024 Dec 18;96(4):13098.
[17]. Belkovsky M, Zogaib GV, Passerotti CC, Artifon EL de A, Otoch JP, da Cruz JAS. Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysis. Int Braz J Urol Off J Braz Soc Urol. 2023;49(6):668–76.
[18]. Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis. Indian J Urol. 2023 Jan;39(1):21–6.
[19]. Yu ZW, Wang RH, Zhang CC, Gao JG. The efficacy and safety of alpha-adrenergic blockers for medical expulsion therapy in patients with ureteral calculi: A meta-analysis of placebo-controlled trials. Medicine (Baltimore). 2021 Sept 17;100(37):e27272.
[20]. Alhamdani Z, Poppenbeek S, Bolton D, Wong LM, Sethi K. Do alpha blockers reduce the risk of urinary retention post-transperineal prostate biopsy? A systematic narrative review. World J Urol. 2024 May 17;42(1):332.
[21]. Jindan L, Xiao W, Liping X. Evolving Role of Silodosin for the Treatment of Urological Disorders - A Narrative Review. Drug Des Devel Ther. 2022;16:2861–84.
[22]. Jackson EM, Khooblall P, Lundy SD, Bajic P. A Review of Combined Phosphodiesterase-5-Inhibitors and α-Blockers versus Phosphodiesterase-5-Inhibitors Alone for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia. Arab J Urol. 2024 Jan 2;22(1):13–23.
[23]. Maluskova M, Vidlar A, Maresova K, Lounova V, Karhanova M. Floppy iris syndrome associated with specific medication intake: A narrative review. Biomed Pap Med Fac Univ Palacky Olomouc Czechoslov. 2023 Mar;167(1):9–15.
[24]. Zhou Z, Gan W, Li Z, Li Z, Zhou F, Li H, et al. Can prophylactic tamsulosin reduce the risk of urinary retention after surgery? A systematic review and meta-analysis of randomized control trials. Int J Surg Lond Engl. 2023 Mar 1;109(3):438–48.
[25]. Cheng C, Ma Y, Wen J, Xiang L, Jin X. The Effect of Preoperative Tamsulosin on Ureteral Navigation, Operation, and Safety: A Systematic Review and Meta-Analysis. Urol Int. 2023;107(6):557–63.
[26]. Lepor H, Auerbach S, Puras-Baez A, Narayan P, Soloway M, Lowe F, et al. A Randomized, Placebo-Controlled Multicenter Study of the Efficacy and Safety of Terazosin in the Treatment of Benign Prostatic Hyperplasia. J Urol. 1992 Nov;148(5 Part 1):1467–74.
[27]. Kirby RS, Roehrborn C, Boyle P, Bartsch G, Jardin A, Cary MM, et al. Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology. 2003 Jan;61(1):119–26.
[28]. Yuan JQ, Mao C, Wong SYS, Yang ZY, Fu XH, Dai XY, et al. Comparative Effectiveness and Safety of Monodrug Therapies for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: A Network Meta-analysis. Medicine (Baltimore). 2015 July;94(27):e974.
[29]. Yoosuf BT, Panda AK, Kt MF, Bharti SK, Devana SK, Bansal D. Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis. Sci Rep. 2024 May 15;14(1):11116.
[30]. Roehrborn CG, Boyle P, Bergner D, Gray T, Gittelman M, Shown T, et al. Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a four-year, randomized trial comparing finasteride versus placebo. Urology. 1999 Oct;54(4):662–9.
[31]. Nickel JC, Gilling P, Tammela TL, Morrill B, Wilson TH, Rittmaster RS. Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int. 2011 Aug;108(3):388–94.
[32]. Kim JH, Baek MJ, Sun HY, Lee B, Li S, Khandwala Y, et al. Efficacy and safety of 5 alpha-reductase inhibitor monotherapy in patients with benign prostatic hyperplasia: A meta-analysis. Rosier PFWM, editor. PLOS ONE. 2018 Oct 3;13(10):e0203479.
[33]. Oelke M, Giuliano F, Mirone V, Xu L, Cox D, Viktrup L. Monotherapy with Tadalafil or Tamsulosin Similarly Improved Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia in an International, Randomised, Parallel, Placebo-Controlled Clinical Trial. Eur Urol. 2012 May;61(5):917–25.
[34]. Sebastianelli A, Spatafora P, Frizzi J, Saleh O, Sessa M, De Nunzio C, et al. Tadalafil 5 mg Alone or in Combination with Tamsulosin 0.4 mg for the Management of Men with Lower Urinary Tract Symptoms and Erectile Dysfunction: Results of a Prospective Observational Trial. J Clin Med. 2019 July 29;8(8):1126.
[35]. Jackson EM, Khooblall P, Lundy SD, Bajic P. A Review of Combined Phosphodiesterase-5-Inhibitors and α-Blockers versus Phosphodiesterase-5-Inhibitors Alone for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia. Arab J Urol. 2024 Jan 2;22(1):13–23.
[36]. McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, 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 Dec 18;349(25):2387–98.
[37]. Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, et al. The Effects of Combination Therapy with Dutasteride and Tamsulosin on Clinical Outcomes in Men with Symptomatic Benign Prostatic Hyperplasia: 4-Year Results from the CombAT Study. Eur Urol. 2010 Jan;57(1):123–31.
[38]. Zhou Z, Cui Y, Wu J, Ding R, Cai T, Gao Z. Meta-analysis of the efficacy and safety of combination of tamsulosin plus dutasteride compared with tamsulosin monotherapy in treating benign prostatic hyperplasia. BMC Urol. 2019 Dec;19(1):17.
[39]. Yang F, Hashim R, Philippou J. Tamsulosin and Dutasteride Combination Therapy for Asian Men With Moderate-to-Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Systematic Review of Clinical Considerations That Influence the Prescription. J Clin Med Res. 2024 Sept;16(9):385–97.
[40]. Yan H, Zong H, Cui Y, Li N, Zhang Y. The Efficacy of PDE5 Inhibitors Alone or in Combination with Alpha-Blockers for the Treatment of Erectile Dysfunction and Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis. J Sex Med. 2014 June 1;11(6):1539–45.
[41]. Ma C, Zhang J, Cai Z, Xiong J, Li H. Defining the Efficacy and Safety of Phosphodiesterase Type 5 Inhibitors with Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia with or without Erectile Dysfunction: A Network Meta-Analysis. BioMed Res Int. 2020;2020:1419520.
[42]. Chen PC, Wang CC, Tu YK. Combination Alpha Blocker and Phosphodiesterase 5 Inhibitor Versus Alpha-Blocker Monotherapy for Lower Urinary Tract Symptoms Associated with Benign Prostate Hyperplasia: A Systematic Review and Meta-Analysis. Urol Sci. 2020;31(3):99–107.
[43]. MacDiarmid SA, Peters KM, Chen A, Armstrong RB, Orman C, Aquilina JW, et al. Efficacy and Safety of Extended-Release Oxybutynin in Combination With Tamsulosin for Treatment of Lower Urinary Tract Symptoms in Men: Randomized, Double-Blind, Placebo-Controlled Study. Mayo Clin Proc. 2008 Sept;83(9):1002–10.
[44]. Xin Z, Huang Y, Lu J, Zhang Q, Chen C. Addition of Antimuscarinics to Alpha-blockers for Treatment of Lower Urinary Tract Symptoms in Men: A Meta-analysis. Urology. 2013 Aug;82(2):270–7.
[45]. Pang R, Zhou XY, Wang X, Wang B, Yin XL, Bo H, et al. Anticholinergics combined with alpha-blockers for treating lower urinary tract symptoms related to benign prostatic obstruction. Cochrane Database Syst Rev. 2021 Feb 10;2(2):CD012336.
[46]. Gwon YN, Park JJ, Yang WJ, Doo SW, Kim JH, Kim DK. Comparing effects of alpha-blocker management on acute urinary retention secondary to benign prostatic hyperplasia: A systematic review and network meta-analysis. Prostate Int. 2023 June;11(2):91–9.
[47]. Hsu YP, Hsu CW, Bai CH, Cheng SW, Chen KC, Chen C. Silodosin versus tamsulosin for medical expulsive treatment of ureteral stones: A systematic review and meta-analysis. PloS One. 2018;13(8):e0203035.
[48]. Jung HD, Cho KS, Jun DY, Jeong JY, Moon YJ, Chung DY, et al. Silodosin versus Tamsulosin for Medical Expulsive Therapy of Ureteral Stones: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Med Kaunas Lith. 2022 Dec 6;58(12):1794.
[49]. Sharma G, Pareek T, Kaundal P, Tyagi S, Singh S, Yashaswi T, et al. Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int Braz J Urol Off J Braz Soc Urol. 2022;48(5):742–59.
[50]. Kwon JK, Cho KS, Oh CK, Kang DH, Lee H, Ham WS, et al. The beneficial effect of alpha-blockers for ureteral stent-related discomfort: systematic review and network meta-analysis for alfuzosin versus tamsulosin versus placebo. BMC Urol. 2015 June 24;15:55.
[51]. Visingardi J, Walia J, Jawiche J, Feustel PJ, De EJB. Surprising clinical differences among alpha blockers demonstrated in post-marketing event rates. Continence. 2024 Dec;12:101696.
[52]. Cindolo L, Pirozzi L, Sountoulides P, Fanizza C, Romero M, Castellan P, et al. Patient’s adherence on pharmacological therapy for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS) is different: is combination therapy better than monotherapy? BMC Urol. 2015 Dec;15(1):96.
[53]. Zitoun OA, Farhat AMn, Mohamed MA, Hamad MR, Aramini B, Haider KH. Management of benign prostate hyperplasia (BPH) by combinatorial approach using alpha-1-adrenergic antagonists and 5-alpha-reductase inhibitors. Eur J Pharmacol. 2020 Sept;883:173301.
[54]. Eisen C, Lulic Z, Palacios-Moreno JM, Adalig B, Hennig M, Cortes V, et al. Persistence and adherence to dutasteride/tamsulosin fixed-dose versus free-combination alpha blocker/5ARI therapy in patients with benign prostate hyperplasia in Germany. Int J Clin Pharmacol Ther. 2020 Jan;58(1):37–49.
[55]. Cindolo L, Pirozzi L, Fanizza C, Romero M, Tubaro A, Autorino R, et al. Drug Adherence and Clinical Outcomes for Patients Under Pharmacological Therapy for Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia: Population-based Cohort Study. Eur Urol. 2015 Sept;68(3):418–25.
[56]. van der Worp H, Jellema P, Hordijk I, Lisman-van Leeuwen Y, Korteschiel L, Steffens MG, et al. Discontinuation of alpha-blocker therapy in men with lower urinary tract symptoms: a systematic review and meta-analysis. BMJ Open. 2019 Nov 7;9(11):e030405.
[57]. Lepor H. Alpha blockers for the treatment of benign prostatic hyperplasia. Rev Urol. 2007;9(4):181–90.
[58]. Mantica G, Ambrosini F, Drocchi G, Zubko Z, Lo Monaco L, Cafarelli A, et al. Non-surgical management of BPH: An updated review of current literature and state of the art on natural compounds and medical therapy. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2024 Dec 18;96(4):13098.
[59]. Sun F, Bao X, Cheng D, Yao H, Sun K, Wang D, et al. Meta-Analysis of the Safety and Efficacy of α-Adrenergic Blockers for Pediatric Urolithiasis in the Distal Ureter. Front Pediatr. 2022 Apr 15;10:809914.
[60]. Mari A, Antonelli A, Cindolo L, Fusco F, Minervini A, De Nunzio C. Alfuzosin for the medical treatment of benign prostatic hyperplasia and lower urinary tract symptoms: a systematic review of the literature and narrative synthesis. Ther Adv Urol. 2021 Jan;13:1756287221993283.
[61]. Yang D, Wu J, Yuan H, Cui Y. The efficacy and safety of silodosin for the treatment of ureteral stones: a systematic review and meta-analysis. BMC Urol. 2016 May 27;16(1):23.
[62]. Yu ZW, Wang RH, Zhang CC, Gao JG. The efficacy and safety of alpha-adrenergic blockers for medical expulsion therapy in patients with ureteral calculi: A meta-analysis of placebo-controlled trials. Medicine (Baltimore). 2021 Sept 17;100(37):e27272.
[63]. Halawani A, Paterson R, Zhong T, Du K, Ren R, Forbes CM. Risks and side effects in the medical management of benign prostatic hyperplasia. Prostate Int. 2024 June;12(2):57–64.
[64]. Li H, Xu TY, Li Y, Chia YC, Buranakitjaroen P, Cheng HM, et al. Role of α1-blockers in the current management of hypertension. J Clin Hypertens Greenwich Conn. 2022 Sept;24(9):1180–6.
[65]. Batty M, Pugh R, Rathinam I, Simmonds J, Walker E, Forbes A, et al. The Role of α1-Adrenoceptor Antagonists in the Treatment of Prostate and Other Cancers. Int J Mol Sci. 2016 Aug 16;17(8):1339.
[66]. Jackson EM, Khooblall P, Lundy SD, Bajic P. A Review of Combined Phosphodiesterase-5-Inhibitors and α-Blockers versus Phosphodiesterase-5-Inhibitors Alone for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia. Arab J Urol. 2024 Jan 2;22(1):13–23.
[67]. Mantica G, Ambrosini F, Drocchi G, Zubko Z, Lo Monaco L, Cafarelli A, et al. Non-surgical management of BPH: An updated review of current literature and state of the art on natural compounds and medical therapy. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2024 Dec 18;96(4):13098.
[68]. Ding H, Ning Z, Dai Y, Shang P, Yang L. The role of Silodosin as a new medical expulsive therapy for ureteral stones: a meta-analysis. Ren Fail. 2016 Oct;38(9):1311–9.
[69]. Ziaeefar P, Basiri A, Zangiabadian M, De La Rosette J, Zargar H, Taheri M, et al. Medical Expulsive Therapy for Pediatric Ureteral Stones: A Meta-Analysis of Randomized Clinical Trials. J Clin Med. 2023 Feb 10;12(4):1410.
[70]. Moon YJ, Chung DY, Kim DK, Jung HD, Jeon SH, Kang SH, et al. The Beneficial Effects of Alpha-Blockers, Antimuscarinics, Beta 3-Agonist, and PDE5-Inhibitors for Ureteral Stent-Related Discomfort: A Systematic Review and Meta-Analysis from KSER Update Series. Med Kaunas Lith. 2025 Jan 27;61(2):232.
[71]. De Nunzio C, Salonia A, Gacci M, Ficarra V. The Role of Combination Therapy with α-Blockers and Hexanic Extract of Serenoa repens in the Treatment of LUTS/BPH. J Clin Med. 2022 Dec 2;11(23):7169.
[72]. Pang R, Zhou XY, Wang X, Wang B, Yin XL, Bo H, et al. Anticholinergics combined with alpha-blockers for treating lower urinary tract symptoms related to benign prostatic obstruction. Cochrane Database Syst Rev. 2021 Feb 10;2(2):CD012336.
[2]. Ma C, Zhang J, Cai Z, Xiong J, Li H. Defining the Efficacy and Safety of Phosphodiesterase Type 5 Inhibitors with Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia with or without Erectile Dysfunction: A Network Meta-Analysis. BioMed Res Int. 2020;2020:1419520.
[3]. Ghanem AM. A REVIEW ON RECENT ADVANCES IN TRANSDERMAL DRUG DELIVERY SYSTEMS OF TAMSULOSIN. Int J Appl Pharm. 2024 Mar 7;28–33.
[4]. Yoosuf BT, Panda AK, Kt MF, Bharti SK, Devana SK, Bansal D. Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis. Sci Rep. 2024 May 15;14(1):11116.
[5]. Jindan L, Xiao W, Liping X. Evolving Role of Silodosin for the Treatment of Urological Disorders - A Narrative Review. Drug Des Devel Ther. 2022;16:2861–84.
[6]. Cheng C, Ma Y, Wen J, Xiang L, Jin X. The Effect of Preoperative Tamsulosin on Ureteral Navigation, Operation, and Safety: A Systematic Review and Meta-Analysis. Urol Int. 2023;107(6):557–63.
[7]. Calpin GG, O’Neill AM, Davey MG, Miller P, Joyce WP. Administering prophylactic alpha-blockade to reduce urinary retention post inguinal hernia repair: A systematic review and meta-analysis of randomised control trials. Surg Pract Sci. 2023 Sept;14:100204.
[8]. Campschroer T, Zhu X, Vernooij RW, Lock MT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2018 Apr 5;4(4):CD008509.
[9]. Hollingsworth JM, Canales BK, Rogers MAM, Sukumar S, Yan P, Kuntz GM, et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ. 2016 Dec 1;355:i6112.
[10]. Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D, et al. Effect of alpha-adrenoceptor antagonists on sexual function. A systematic review and meta-analysis. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2022 June 30;94(2):252–63.
[11]. Batty M, Pugh R, Rathinam I, Simmonds J, Walker E, Forbes A, et al. The Role of α1-Adrenoceptor Antagonists in the Treatment of Prostate and Other Cancers. Int J Mol Sci. 2016 Aug 16;17(8):1339.
[12]. Jindan L, Xiao W, Liping X. Evolving Role of Silodosin for the Treatment of Urological Disorders - A Narrative Review. Drug Des Devel Ther. 2022;16:2861–84.
]13]. Roehrborn CG, Cruz F, Fusco F. α1-Blockers in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Obstruction: Is Silodosin Different? Adv Ther. 2017 Jan;33(12):2110–21.
[14]. Sica DA. Alpha1 ‐Adrenergic Blockers: Current Usage Considerations. J Clin Hypertens. 2005 Dec;7(12):757–62.
[15]. Mari A, Antonelli A, Cindolo L, Fusco F, Minervini A, De Nunzio C. Alfuzosin for the medical treatment of benign prostatic hyperplasia and lower urinary tract symptoms: a systematic review of the literature and narrative synthesis. Ther Adv Urol. 2021 Jan;13:1756287221993283.
[16]. Mantica G, Ambrosini F, Drocchi G, Zubko Z, Lo Monaco L, Cafarelli A, et al. Non-surgical management of BPH: An updated review of current literature and state of the art on natural compounds and medical therapy. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2024 Dec 18;96(4):13098.
[17]. Belkovsky M, Zogaib GV, Passerotti CC, Artifon EL de A, Otoch JP, da Cruz JAS. Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysis. Int Braz J Urol Off J Braz Soc Urol. 2023;49(6):668–76.
[18]. Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis. Indian J Urol. 2023 Jan;39(1):21–6.
[19]. Yu ZW, Wang RH, Zhang CC, Gao JG. The efficacy and safety of alpha-adrenergic blockers for medical expulsion therapy in patients with ureteral calculi: A meta-analysis of placebo-controlled trials. Medicine (Baltimore). 2021 Sept 17;100(37):e27272.
[20]. Alhamdani Z, Poppenbeek S, Bolton D, Wong LM, Sethi K. Do alpha blockers reduce the risk of urinary retention post-transperineal prostate biopsy? A systematic narrative review. World J Urol. 2024 May 17;42(1):332.
[21]. Jindan L, Xiao W, Liping X. Evolving Role of Silodosin for the Treatment of Urological Disorders - A Narrative Review. Drug Des Devel Ther. 2022;16:2861–84.
[22]. Jackson EM, Khooblall P, Lundy SD, Bajic P. A Review of Combined Phosphodiesterase-5-Inhibitors and α-Blockers versus Phosphodiesterase-5-Inhibitors Alone for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia. Arab J Urol. 2024 Jan 2;22(1):13–23.
[23]. Maluskova M, Vidlar A, Maresova K, Lounova V, Karhanova M. Floppy iris syndrome associated with specific medication intake: A narrative review. Biomed Pap Med Fac Univ Palacky Olomouc Czechoslov. 2023 Mar;167(1):9–15.
[24]. Zhou Z, Gan W, Li Z, Li Z, Zhou F, Li H, et al. Can prophylactic tamsulosin reduce the risk of urinary retention after surgery? A systematic review and meta-analysis of randomized control trials. Int J Surg Lond Engl. 2023 Mar 1;109(3):438–48.
[25]. Cheng C, Ma Y, Wen J, Xiang L, Jin X. The Effect of Preoperative Tamsulosin on Ureteral Navigation, Operation, and Safety: A Systematic Review and Meta-Analysis. Urol Int. 2023;107(6):557–63.
[26]. Lepor H, Auerbach S, Puras-Baez A, Narayan P, Soloway M, Lowe F, et al. A Randomized, Placebo-Controlled Multicenter Study of the Efficacy and Safety of Terazosin in the Treatment of Benign Prostatic Hyperplasia. J Urol. 1992 Nov;148(5 Part 1):1467–74.
[27]. Kirby RS, Roehrborn C, Boyle P, Bartsch G, Jardin A, Cary MM, et al. Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology. 2003 Jan;61(1):119–26.
[28]. Yuan JQ, Mao C, Wong SYS, Yang ZY, Fu XH, Dai XY, et al. Comparative Effectiveness and Safety of Monodrug Therapies for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: A Network Meta-analysis. Medicine (Baltimore). 2015 July;94(27):e974.
[29]. Yoosuf BT, Panda AK, Kt MF, Bharti SK, Devana SK, Bansal D. Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis. Sci Rep. 2024 May 15;14(1):11116.
[30]. Roehrborn CG, Boyle P, Bergner D, Gray T, Gittelman M, Shown T, et al. Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: results of a four-year, randomized trial comparing finasteride versus placebo. Urology. 1999 Oct;54(4):662–9.
[31]. Nickel JC, Gilling P, Tammela TL, Morrill B, Wilson TH, Rittmaster RS. Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int. 2011 Aug;108(3):388–94.
[32]. Kim JH, Baek MJ, Sun HY, Lee B, Li S, Khandwala Y, et al. Efficacy and safety of 5 alpha-reductase inhibitor monotherapy in patients with benign prostatic hyperplasia: A meta-analysis. Rosier PFWM, editor. PLOS ONE. 2018 Oct 3;13(10):e0203479.
[33]. Oelke M, Giuliano F, Mirone V, Xu L, Cox D, Viktrup L. Monotherapy with Tadalafil or Tamsulosin Similarly Improved Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia in an International, Randomised, Parallel, Placebo-Controlled Clinical Trial. Eur Urol. 2012 May;61(5):917–25.
[34]. Sebastianelli A, Spatafora P, Frizzi J, Saleh O, Sessa M, De Nunzio C, et al. Tadalafil 5 mg Alone or in Combination with Tamsulosin 0.4 mg for the Management of Men with Lower Urinary Tract Symptoms and Erectile Dysfunction: Results of a Prospective Observational Trial. J Clin Med. 2019 July 29;8(8):1126.
[35]. Jackson EM, Khooblall P, Lundy SD, Bajic P. A Review of Combined Phosphodiesterase-5-Inhibitors and α-Blockers versus Phosphodiesterase-5-Inhibitors Alone for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia. Arab J Urol. 2024 Jan 2;22(1):13–23.
[36]. McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, 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 Dec 18;349(25):2387–98.
[37]. Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, et al. The Effects of Combination Therapy with Dutasteride and Tamsulosin on Clinical Outcomes in Men with Symptomatic Benign Prostatic Hyperplasia: 4-Year Results from the CombAT Study. Eur Urol. 2010 Jan;57(1):123–31.
[38]. Zhou Z, Cui Y, Wu J, Ding R, Cai T, Gao Z. Meta-analysis of the efficacy and safety of combination of tamsulosin plus dutasteride compared with tamsulosin monotherapy in treating benign prostatic hyperplasia. BMC Urol. 2019 Dec;19(1):17.
[39]. Yang F, Hashim R, Philippou J. Tamsulosin and Dutasteride Combination Therapy for Asian Men With Moderate-to-Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Systematic Review of Clinical Considerations That Influence the Prescription. J Clin Med Res. 2024 Sept;16(9):385–97.
[40]. Yan H, Zong H, Cui Y, Li N, Zhang Y. The Efficacy of PDE5 Inhibitors Alone or in Combination with Alpha-Blockers for the Treatment of Erectile Dysfunction and Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis. J Sex Med. 2014 June 1;11(6):1539–45.
[41]. Ma C, Zhang J, Cai Z, Xiong J, Li H. Defining the Efficacy and Safety of Phosphodiesterase Type 5 Inhibitors with Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia with or without Erectile Dysfunction: A Network Meta-Analysis. BioMed Res Int. 2020;2020:1419520.
[42]. Chen PC, Wang CC, Tu YK. Combination Alpha Blocker and Phosphodiesterase 5 Inhibitor Versus Alpha-Blocker Monotherapy for Lower Urinary Tract Symptoms Associated with Benign Prostate Hyperplasia: A Systematic Review and Meta-Analysis. Urol Sci. 2020;31(3):99–107.
[43]. MacDiarmid SA, Peters KM, Chen A, Armstrong RB, Orman C, Aquilina JW, et al. Efficacy and Safety of Extended-Release Oxybutynin in Combination With Tamsulosin for Treatment of Lower Urinary Tract Symptoms in Men: Randomized, Double-Blind, Placebo-Controlled Study. Mayo Clin Proc. 2008 Sept;83(9):1002–10.
[44]. Xin Z, Huang Y, Lu J, Zhang Q, Chen C. Addition of Antimuscarinics to Alpha-blockers for Treatment of Lower Urinary Tract Symptoms in Men: A Meta-analysis. Urology. 2013 Aug;82(2):270–7.
[45]. Pang R, Zhou XY, Wang X, Wang B, Yin XL, Bo H, et al. Anticholinergics combined with alpha-blockers for treating lower urinary tract symptoms related to benign prostatic obstruction. Cochrane Database Syst Rev. 2021 Feb 10;2(2):CD012336.
[46]. Gwon YN, Park JJ, Yang WJ, Doo SW, Kim JH, Kim DK. Comparing effects of alpha-blocker management on acute urinary retention secondary to benign prostatic hyperplasia: A systematic review and network meta-analysis. Prostate Int. 2023 June;11(2):91–9.
[47]. Hsu YP, Hsu CW, Bai CH, Cheng SW, Chen KC, Chen C. Silodosin versus tamsulosin for medical expulsive treatment of ureteral stones: A systematic review and meta-analysis. PloS One. 2018;13(8):e0203035.
[48]. Jung HD, Cho KS, Jun DY, Jeong JY, Moon YJ, Chung DY, et al. Silodosin versus Tamsulosin for Medical Expulsive Therapy of Ureteral Stones: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Med Kaunas Lith. 2022 Dec 6;58(12):1794.
[49]. Sharma G, Pareek T, Kaundal P, Tyagi S, Singh S, Yashaswi T, et al. Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int Braz J Urol Off J Braz Soc Urol. 2022;48(5):742–59.
[50]. Kwon JK, Cho KS, Oh CK, Kang DH, Lee H, Ham WS, et al. The beneficial effect of alpha-blockers for ureteral stent-related discomfort: systematic review and network meta-analysis for alfuzosin versus tamsulosin versus placebo. BMC Urol. 2015 June 24;15:55.
[51]. Visingardi J, Walia J, Jawiche J, Feustel PJ, De EJB. Surprising clinical differences among alpha blockers demonstrated in post-marketing event rates. Continence. 2024 Dec;12:101696.
[52]. Cindolo L, Pirozzi L, Sountoulides P, Fanizza C, Romero M, Castellan P, et al. Patient’s adherence on pharmacological therapy for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS) is different: is combination therapy better than monotherapy? BMC Urol. 2015 Dec;15(1):96.
[53]. Zitoun OA, Farhat AMn, Mohamed MA, Hamad MR, Aramini B, Haider KH. Management of benign prostate hyperplasia (BPH) by combinatorial approach using alpha-1-adrenergic antagonists and 5-alpha-reductase inhibitors. Eur J Pharmacol. 2020 Sept;883:173301.
[54]. Eisen C, Lulic Z, Palacios-Moreno JM, Adalig B, Hennig M, Cortes V, et al. Persistence and adherence to dutasteride/tamsulosin fixed-dose versus free-combination alpha blocker/5ARI therapy in patients with benign prostate hyperplasia in Germany. Int J Clin Pharmacol Ther. 2020 Jan;58(1):37–49.
[55]. Cindolo L, Pirozzi L, Fanizza C, Romero M, Tubaro A, Autorino R, et al. Drug Adherence and Clinical Outcomes for Patients Under Pharmacological Therapy for Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia: Population-based Cohort Study. Eur Urol. 2015 Sept;68(3):418–25.
[56]. van der Worp H, Jellema P, Hordijk I, Lisman-van Leeuwen Y, Korteschiel L, Steffens MG, et al. Discontinuation of alpha-blocker therapy in men with lower urinary tract symptoms: a systematic review and meta-analysis. BMJ Open. 2019 Nov 7;9(11):e030405.
[57]. Lepor H. Alpha blockers for the treatment of benign prostatic hyperplasia. Rev Urol. 2007;9(4):181–90.
[58]. Mantica G, Ambrosini F, Drocchi G, Zubko Z, Lo Monaco L, Cafarelli A, et al. Non-surgical management of BPH: An updated review of current literature and state of the art on natural compounds and medical therapy. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2024 Dec 18;96(4):13098.
[59]. Sun F, Bao X, Cheng D, Yao H, Sun K, Wang D, et al. Meta-Analysis of the Safety and Efficacy of α-Adrenergic Blockers for Pediatric Urolithiasis in the Distal Ureter. Front Pediatr. 2022 Apr 15;10:809914.
[60]. Mari A, Antonelli A, Cindolo L, Fusco F, Minervini A, De Nunzio C. Alfuzosin for the medical treatment of benign prostatic hyperplasia and lower urinary tract symptoms: a systematic review of the literature and narrative synthesis. Ther Adv Urol. 2021 Jan;13:1756287221993283.
[61]. Yang D, Wu J, Yuan H, Cui Y. The efficacy and safety of silodosin for the treatment of ureteral stones: a systematic review and meta-analysis. BMC Urol. 2016 May 27;16(1):23.
[62]. Yu ZW, Wang RH, Zhang CC, Gao JG. The efficacy and safety of alpha-adrenergic blockers for medical expulsion therapy in patients with ureteral calculi: A meta-analysis of placebo-controlled trials. Medicine (Baltimore). 2021 Sept 17;100(37):e27272.
[63]. Halawani A, Paterson R, Zhong T, Du K, Ren R, Forbes CM. Risks and side effects in the medical management of benign prostatic hyperplasia. Prostate Int. 2024 June;12(2):57–64.
[64]. Li H, Xu TY, Li Y, Chia YC, Buranakitjaroen P, Cheng HM, et al. Role of α1-blockers in the current management of hypertension. J Clin Hypertens Greenwich Conn. 2022 Sept;24(9):1180–6.
[65]. Batty M, Pugh R, Rathinam I, Simmonds J, Walker E, Forbes A, et al. The Role of α1-Adrenoceptor Antagonists in the Treatment of Prostate and Other Cancers. Int J Mol Sci. 2016 Aug 16;17(8):1339.
[66]. Jackson EM, Khooblall P, Lundy SD, Bajic P. A Review of Combined Phosphodiesterase-5-Inhibitors and α-Blockers versus Phosphodiesterase-5-Inhibitors Alone for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia. Arab J Urol. 2024 Jan 2;22(1):13–23.
[67]. Mantica G, Ambrosini F, Drocchi G, Zubko Z, Lo Monaco L, Cafarelli A, et al. Non-surgical management of BPH: An updated review of current literature and state of the art on natural compounds and medical therapy. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2024 Dec 18;96(4):13098.
[68]. Ding H, Ning Z, Dai Y, Shang P, Yang L. The role of Silodosin as a new medical expulsive therapy for ureteral stones: a meta-analysis. Ren Fail. 2016 Oct;38(9):1311–9.
[69]. Ziaeefar P, Basiri A, Zangiabadian M, De La Rosette J, Zargar H, Taheri M, et al. Medical Expulsive Therapy for Pediatric Ureteral Stones: A Meta-Analysis of Randomized Clinical Trials. J Clin Med. 2023 Feb 10;12(4):1410.
[70]. Moon YJ, Chung DY, Kim DK, Jung HD, Jeon SH, Kang SH, et al. The Beneficial Effects of Alpha-Blockers, Antimuscarinics, Beta 3-Agonist, and PDE5-Inhibitors for Ureteral Stent-Related Discomfort: A Systematic Review and Meta-Analysis from KSER Update Series. Med Kaunas Lith. 2025 Jan 27;61(2):232.
[71]. De Nunzio C, Salonia A, Gacci M, Ficarra V. The Role of Combination Therapy with α-Blockers and Hexanic Extract of Serenoa repens in the Treatment of LUTS/BPH. J Clin Med. 2022 Dec 2;11(23):7169.
[72]. Pang R, Zhou XY, Wang X, Wang B, Yin XL, Bo H, et al. Anticholinergics combined with alpha-blockers for treating lower urinary tract symptoms related to benign prostatic obstruction. Cochrane Database Syst Rev. 2021 Feb 10;2(2):CD012336.
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