Alpha-adrenergic treatments in urology.

Neuropharmacology is a rapidly expanding field due to the regular discovery of new neurotransmitters or neuroreceptors. Hopes have now been raised for the treatment of vesicosphincteric disorders by developing molecules with a potential selective clinical action on the detrusor or the urethra. After a brief review of the neuroanatomy and general neuropharmacology of the sy mpathetic nervous system, the current indications for alpha agonists are re viewed and discussed. These indications include the treatment of priapism, retrograde ejaculation, and incontinence due to sphincter incompetence. The more recent use of agents with a central mechanism of action is also discu ssed (detrusor hyperactivity of spinal cord injury patients). The authors r eview the current indications and note that, although the use of these drug s is very specific and limited in the field of urology, it is nevertheless based on an interesting concept. Like molecules at the stage of clinical tr ials for peripheral or central targets, the mechanism of action of these mo lecules on the sympathetic adrenergic system needs to be more fully elucida ted. Their adverse effects remain the limiting factor for use on peripheral targets.