Increased bladder apoptosis with alpha-1 adrenoceptor antagonists in benign prostatic hyperplasia.
OBJECTIVE
To determine whether preoperative usage of alpha-1 adrenoceptor antagonists (alpha-1ARA) prevents the alterations in bladder wall components due to obstruction via changing apoptotic and/or proliferative activity and provides an advantage for improvement of irritative symptoms following removal of bladder outlet obstruction.


METHODS
A total of 39 patients were enrolled to the present study. According to preoperative medical treatment, patients were divided into 2 groups as preoperative untreated (n = 15) and medically treated patients with alpha-1ARA (n = 24). Apoptotic and proliferative indices of bladder wall were determined with TUNEL assay and proliferating cell nuclear antigen immunoreactivity, respectively.


RESULTS
While the mean apoptotic indexes (AI) of lamina propria were 0.293 +/- 0.163 vs 0.978 +/- 0.194 in untreated and treated patients, the mean AI of myofibroblast cells were 0.10 +/- 0.06 and 0.90 +/- 0.23 in untreated and treated patients, respectively. There were statistically significant differences between lamina propria (p = 0.0067) and myofibroblast cells (p = 0.0280) AI in the two groups. However, there were no significant differences between postoperative symptom indices in preoperatively treated and untreated groups.


CONCLUSIONS
alpha 1-ARA treatment might have an effect on hypertrophy and supersensitivity of bladder wall due to increased outlet obstruction via prevention of the imbalance between cell proliferation and apoptosis, providing normal homeostatic control mechanisms, through the interval between the onset of the lower urinary tract symptoms and time surgical intervention. However, further studies should be organized to demonstrate the impact of long-term alpha 1-ARA medication for post-operative significant improvement on irritative symptom index.
Department of Urology, Akdeniz University Faculty of Medicine, Antalya, Turkey. drtibet@netone.com.tr
T
T
Erdoğru
K H
KH
Gülkesen
E
E
Kukul
M
M
Yalçinkaya
G
G
Karpuzoğlu
M
M
Baykara
D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D017209:Apoptosis / Q000187:drug effects*; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D008297:Male; D008875:Middle Aged; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D001743:Urinary Bladder / Q000737:chemistry / Q000187:drug effects* / Q000473:pathology; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000473:pathology
D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists; D018809:Proliferating Cell Nuclear Antigen