| Abstrakt: |
There has been much interest in recent years in the role played by the adrenergic receptors in the urinary tract and a certain amount of work has been done in our department on this subject. Amongst other investigations we have studied the adrenergic receptors in the rat prostate (Raz, Zeigler and Caine, 1973) and subsequently in the human prostate (Caine, Raz and Zeigler, 1975). The latter was performed on tissue obtained from patients undergoing operations for benign prostatic obstruction, and separate studies were made of the receptors in the prostatic capsule, the enucleated 'adenoma' and selected parts of the bladder neck and trigone. It was found that the prostatic capsule was extremely rich in α-adrenergic receptors, the prostatic adenoma moderately rich and the bladder neck region showed variable results, the maximal α-receptor response being in the region of the trigone. In the case of the rat prostate there was evidence of additional β-adrenergic activity but for practical purposes this was negligible in the human material. As a consequence of the above findings, and having regard to known clinical and pharmacological causative factors, it was suggested in those papers that certain cases of acute retention urine in patients with benign hypertrophy of the prostate may be due to sudden stimulation the α-adrenergic receptors, causing an increase in tone of the smooth muscle tissue in the prostate and prostatic capsule, hence resulting in an increase in the closure pressure on the urethra. Further consideration suggested that if this be the case, variations in a-adrenergic activity lesser degree might be responsible for at least some of the variations in the severity of the obstructive symptoms, which is so typical of many patients suffering from prostatic enlargement. As a corollary, if this hypothesis be true, one could anticipate a beneficial effect from the use α-adrenergic blocking agents in such patients with retention or obstructive symptoms. It was accordingly decided to carry out a trial of such agents, to see if they would be of help to these patients. During the course of the trial it soon became evident that the majority of the patients were deriving considerable benefit from the treatment and that they fell into a number of clinical groups, which will be discussed below. A few illustrative cases from the different groups will briefly described. [ABSTRACT FROM AUTHOR] |
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