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New alpha blockers to treat male lower urinary tract symptoms

Hwang, Eu Changa,b,c; Gandhi, Shreyasd; Jung, Jae H.b,c,e,f

doi: 10.1097/MOU.0000000000000488
EVIDENCE-BASED MANAGEMENT OF LUTS: Edited by Philipp Dahm and Jae H. Jung

Purpose of review To date it is unclear whether the selectivity of new alpha-blockers to alpha-adrenergic receptor subtypes translates into more clinical benefits and less adverse effects in clinical practice. We performed a systematic review of the two new Abs silodosin and naftopidil. With the availability of numerous alpha-blockers to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, the findings of this review will be highly relevant to the field of urology.

Recent findings Silodosin was found to be more effective than placebo in improving International Prostate Symptom Score (IPSS) and quality of life scores and as effective as other alpha-blockers. Although the incidence of cardiovascular adverse events of silodosin was similar compared with placebo and other alpha-blockers (tamsulosin, naftopidil, alfuzosin), the sexual adverse events were more common with silodosin. No placebo-controlled randomized trial exists investigating the effects of naftopidil in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Naftopidil had similar efficacy with regards to IPSS and quality of life compared with tamsulosin. The rate of adverse events was similar compared with tamsulosin.

Summary The two new selective alpha-blockers, silodosin, and naftopidil showed similar efficacy in IPSS and quality of life compared with other alpha-blockers. However, silodosin has more sexual adverse events.

aDepartment of Urology, Chonnam National University Medical School, Gwangju, Republic of Korea

bDepartment of Urology, University of Minnesota

cUrology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA

dDepartment of Urology, Dalhousie University, Halifax, Nova Scotia, Canada

eDepartment of Urology

fInstitute of Evidence-Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea

Correspondence to Jae H. Jung, Department of Urology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26420, Republic of Korea. Tel: +82 33 741 0652; e-mail:

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