DO ALPHA-BLOCKERS HAVE A ROLE IN LOWER URINARY-TRACT DYSFUNCTION IN MULTIPLE-SCLEROSIS

Lower urinary tract dysfunction is a major cause of morbidity in patie nts with multiple sclerosis. alpha 1-Adrenergic receptors are present at the bladder neck, where increased tone may be responsible for urina ry retention and diminished flow rates. A randomized placebo controlle d study was designed to test the hypothesis that blockade of these rec eptors using the selective alpha 1-adrenergic receptor antagonist indo ramin would improve bladder emptying in patients with multiple scleros is. Peak and mean urinary flow rates, residual volume and symptom scor e were evaluated at trial entry and again after 4 weeks in 18 men with multiple sclerosis. There was a mean 41% improvement in peak flow rat e in the actively treated group compared with a 7.4% deterioration in the placebo group (p < 0.05). Residual volume improved in both groups. Patients taking indoramin reported a greater improvement in urinary s ymptoms. Modulation of the alpha 1-receptor may have a role in the man agement of lower urinary tract dysfunction in multiple sclerosis.