Do we know everything about alpha-blockade in the management of lower urinary tract symptoms?

alpha (1)-Adrenoceptor antagonists such as tamsulosin relieve voiding and f illing LUTS. Improvement of the voiding ('obstructive') symptoms is related to alpha (1A)-related desobstruction. Improvement of the filling ('irritat ive') symptoms may be related to reduction of alpha (1D) (and alpha (1a))-r elated obstruction. Blockade of alpha (1A)-adrenoceptors in the human prost ate may be required for reduction of obstruction and improvement of related voiding symptoms and urinary flow, Blockade of alpha (1D) (and alpha (1A)) -adrenoceptors in the human bladder may, in addition, be required to reliev e filling LUTS. These concepts should be evaluated further before definitiv e conclusions can be drawn. If definitely proven, this could mean that alph a -blockers have to be considered to not only act on BPH (the causative dis ease) but also (and perhaps more) on the target organ, the bladder. Early t reatment could have a protective effect on the bladder and chronic treatmen t could prevent hypertrophic bladder modification, Copyright (C) 2001 S. Ka rger AG, Basel.