Do alpha-blockers have a role in lower urinary tract dysfunction in multiple sclerosis?

Lower urinary tract dysfunction is a major cause of morbidity in patients with multiple sclerosis. alpha 1-Adrenergic receptors are present at the bladder neck, where increased tone may be responsible for urinary retention and diminished flow rates. A randomized placebo controlled study was designed to test the hypothesis that blockade of these receptors using the selective alpha 1-adrenergic receptor antagonist indoramin would improve bladder emptying in patients with multiple sclerosis. Peak and mean urinary flow rates, residual volume and symptom score were evaluated at trial entry and again after 4 weeks in 18 men with multiple sclerosis. There was a mean 41% improvement in peak flow rate in the actively treated group compared with a 7.4% deterioration in the placebo group (p < 0.05). Residual volume improved in both groups. Patients taking indoramin reported a greater improvement in urinary symptoms. Modulation of the alpha 1-receptor may have a role in the management of lower urinary tract dysfunction in multiple sclerosis.