Do we know everything about alpha-blockade in the management of lower urinary tract symptoms?

alpha(1)-Adrenoceptor antagonists such as tamsulosin relieve voiding and filling LUTS. Improvement of the voiding ('obstructive') symptoms is related to alpha(1A)-related desobstruction. Improvement of the filling ('irritative') symptoms may be related to reduction of alpha(1D) (and alpha(1A))-related obstruction. Blockade of alpha(1A)-adrenoceptors in the human prostate may be required for reduction of obstruction and improvement of related voiding symptoms and urinary flow. Blockade of alpha(1D) (and alpha(1A))-adrenoceptors in the human bladder may, in addition, be required to relieve filling LUTS. These concepts should be evaluated further before definitive conclusions can be drawn. If definitely proven, this could mean that alpha-blockers have to be considered to not only act on BPH (the causative disease) but also (and perhaps more) on the target organ, the bladder. Early treatment could have a protective effect on the bladder and chronic treatment could prevent hypertrophic bladder modification.