Is there a rationale to use alpha-blockers as an add-on therapy in patients with neurogenic lower urinary tract dysfunction?

INTRODUCTION: This article aims to review the literature on the use of alpha-blockers in patients with neurogenic lower urinary tract dysfunction (NLUTD).EVIDENCE ACQUISITION: A literature search was conducted, focusing on efficacy and side effects of alpha-blockers in patients with NLUTD. The search was performed in PubMed, using the following strategy: "neurogenic+bladder" and/or "neurogenic+symptoms" and/or "neurogenic+post-void residual urine" and/or "neurogenic+urinary" plus "alpha-blocker".EVIDENCE SYNTHESIS: Alpha-blocker medication successfully increased Qmax in 50% to 96% of patients with multiple sclerosis, according to a systematic review (SR). The α1-D/A adrenoceptor antagonist therapy significantly reduced both symptoms and improved urodynamic outcomes in patients with NLUTD due to spinal cord or peripheral injuries in a small open label study. Bladder contractility and PVR< 300 mL were predictive variables. Alpha-blocker medication in combination with antimuscarinics and/or tricyclic antidepressants (double / triple therapy) has demonstrated encouraging results in both a pilot research and a retrospective investigation. Despite their inherent limitations, both suggested that add-on therapy with alpha-blockers should be considered in patients with NLUTD in whom anticholinergics alone fail. At last, another SR aimed to assess the role of distinct treatments in patients with neurogenic detrusor overactivity and included 26 articles, comprising 2938 patients. Alpha-blockers were not statistically different compared to the placebo group in improving urodynamic outcomes.CONCLUSIONS: There is scarce evidence to support alpha-blockers efficacy and safety on distinct clinical scenarios in neuro-urological patients. Add-on therapy with alpha-blocker in patients who failed treatment with antimuscarinics looks promising, however further studies are still needed to better understand which patients benefit the most in the setting of randomized clinical trials.