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The Diagnosis and Treatment of Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia with α-Blockers: Focus on Silodosin

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Abstract

Lower urinary tract symp toms due to benign prostatic hyperplasia (LUTS/BPH) are common in aging men and can progress to acute urinary retention. Among the classes of agents recommended for patients with moderate to severe symptoms are α-adrenergic receptor (adrenoceptor) antagonists (α-blockers) and 5α-reductase inhibitors (5ARIs). This review provides a brief overview of the diagnosis and management of LUTS/BPH, focusing on the efficacy and tolerability of α-blockers approved for the treatment of LUTS/BPH, with particular emphasis on silodosin, a novel α-blocker. Of the older α1-blockers, alfuzosin, doxazosin and terazosin show little selectivity for the α1-adrenoceptor subtypes, while tamsulosin is moderately and silodosin is highly selective for the α1A subtype in preference to the α1B subtype. Highly selective α1A-receptor antagonists such as silodosin were developed specifically for the treatment of LUTS because non-selective antagonists were associated with cardiovascular adverse effects. Since α1A is predominantly expressed in the prostate, higher selectivity for α1A may account for lower blood pressure-related adverse effects. Silodosin is administered once daily and provides rapid improvements in the signs and symptoms of moderate to severe LUTS/BPH in male patients. As with other α-blockers, silodosin is generally well-tolerated and the most common adverse events seen are abnormal ejaculation, dizziness, headache, diarrhoea, nasal congestion and orthostatic hypotension. Unlike 5ARIs, α-blockers do not impair libido. Given the prevalence of LUTS/BPH and the efficacy and tolerability concerns with existing therapies, silodosin is a welcome addition to the pharmacological options for these patients.

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Acknowledgments

Medical writing assistance was provided by Tracy Harrison, Nila Bhana, Mary Hines and Sheridan Henness of Springer Healthcare Communications and Ray Hill, on behalf of Springer Healthcare Communications, with funding provided by Tecnimede, S.A., Portugal.

Disclosure of interest statement

Júlio Fonseca is a physician at the Department of Urology, Hospital Beatriz Angelo, Loures and British Hospital, Lisbon, Portugal. He is an occasional unpaid lecturer at Tecnimede-sponsored events.

Carlos Martins da Silva is an employee of the Department of Urology, Hospital de S. João, Faculdade de Medicina do Porto, Porto, Portugal. He has received consultant honoraria from Tecnimede.

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  1. Department of Urology, Hospital Beatriz Angelo, Loures, Portugal

    Júlio Fonseca

  2. British Hospital, Lisbon, Portugal

    Júlio Fonseca

  3. Department of Urology, Faculdade de Medicina do Porto, Hospital de S. João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    Carlos Martins da Silva

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Fonseca, J., Martins da Silva, C. The Diagnosis and Treatment of Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia with α-Blockers: Focus on Silodosin. Clin Drug Investig 35 (Suppl 1), 7–18 (2015). https://doi.org/10.1007/s40261-014-0257-3

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