【优质】Alpha1-adrenoceptorsandBPH.pptVIP

Urinary Symptoms in Men Urinary Symptoms in Women Innervation of Lower Urinary Tract Distribution of Alpha1-Adrenoceptors Reduces Severity and Bothersomeness of SymptomsImprovement in Key Urinary Symptoms of BPH with Doxazosin Correlation Plots The Sympathetic Cascade and the Pathophysiology of Disease Treatment of the Whole PatientA Balancing Act * Alpha1-adrenoceptors and BPH A.G. Ramage D.Sc. Department of Pharmacology University College London Royal Free Campus 80 70 60 50 40 30 20 10 0 -49 50-59 60-69 70-79 80-84 Weak Stream Urgency Frequency Nocturia ? Homma et al 1994 Prevalence (%) 60 50 30 20 10 0 -49 50-59 60-69 70-79 80-84 Weak Stream Urgency Frequency Nocturia ? Homma et al 1994 Prevalence (%) 40 Sympathetic Nerves from T10 to L2 Hypogastric Nerve PelvicNerve Pudental Nerve T10 T11 T12 L1 L2 L3 L4 L5 Parasympathetic and Somatic Nerves from the 2nd, 3rd and 4th Sacral Segments ProstateGland External Urethral Sphincter Role of the Sympathetic Not essential - for either storage or release - role in the control of bladder capacity and outlet resistance during storage Sympathetic input to the bladder is tonically active during filling Surgical or pharmacological blockade of sympathetic pathways to the bladder urethral resistance bladder capacity bladder wall compliance frequency and amplitude of bladder contractions mediate by alpha adrenoceptors Pelvic Floor External Sphincter Internal Sphincter Trigone Detrusor Prostate Gland Physiological Consequence of a-adrenoceptor blockade FALL IN BLOOD PRESSURE POSTURAL HYPOTENSION NASAL STUFFINESS FAILURE OF EJACTULATION MIOSIS Urinary incontinence ? Reflex to BP Fall - Tachycardia - Sodium Water retention (Renin) b1-adrenoceptor antagonists Alpha Adrenoceptor Classification a - a1 and a2 adrenoceptors Observation - phenoxybenzamine caused an increase in the release of noradrenaline from sympathetic nerves Ph