From the Guidelines
Tamsulosin (Flomax) has limited usefulness in treating neurogenic bladder associated with thoracic syrinx. While tamsulosin is effective for benign prostatic hyperplasia by relaxing smooth muscles in the prostate and bladder neck, neurogenic bladder from thoracic syrinx involves different pathophysiology. The syrinx disrupts normal spinal cord function, affecting bladder innervation and causing detrusor-sphincter dyssynergia or detrusor overactivity.
Key Considerations
- First-line treatments typically include anticholinergics (oxybutynin, solifenacin) to reduce detrusor overactivity, or clean intermittent catheterization for emptying problems.
- Alpha-blockers like tamsulosin may provide modest benefit in some patients by reducing outlet resistance, but they're generally considered adjunctive therapy rather than primary treatment.
- The standard tamsulosin dose is 0.4 mg daily, which can be increased to 0.8 mg if needed, as noted in the AUA guideline on management of benign prostatic hyperplasia 1.
Comprehensive Management
Management should be comprehensive, addressing the underlying syrinx while optimizing bladder function through a combination of medications, catheterization techniques, and possibly neurosurgical intervention for the syrinx itself.
Diagnostic Approach
Urodynamic testing is essential to characterize the specific bladder dysfunction pattern before determining the most appropriate treatment approach, as emphasized in the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation 1.
Guideline Recommendations
The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up 1 provides recommendations for the management of neurogenic lower urinary tract dysfunction, including the use of anticholinergics, clean intermittent catheterization, and botulinum toxin therapy. However, the guideline does not specifically recommend the use of alpha-blockers like tamsulosin as a primary treatment for neurogenic bladder associated with thoracic syrinx.
From the Research
Efficacy of Flomax in Treating Neurogenic Bladder
- Flomax (tamsulosin) has been studied for its efficacy in treating neurogenic lower urinary tract dysfunction due to suprasacral spinal cord injury 2.
- The study found that tamsulosin decreased maximum urethral pressure, improved several cystometry parameters related to bladder storage and emptying, and increased mean voided volume based on the micturition diary.
- Tamsulosin also improved the International Prostate Symptom Score Quality of Life, as well as several questions about symptoms related to urinary leakage, and 1 question on bladder emptying and frequency, bother and severity of symptoms of autonomic dysreflexia.
Urodynamic Effects of Tamsulosin
- Tamsulosin has been shown to reduce functional urethral resistance during voiding and improve flow rate in patients with neurogenic bladder 3.
- The study found that tamsulosin had more beneficial urodynamic effects in patients with detrusor contraction during voiding than in patients with detrusor areflexia.
- Tamsulosin improved average flow rate, maximum flow rate, and residual urine rate in patients with neurogenic bladder.
Safety and Efficacy in Specific Populations
- Tamsulosin has been studied in children with nonneurogenic dysfunctional voiding, and found to be safe and effective in improving lower urinary tract symptoms 4.
- The study found that tamsulosin did not have a clinically significant effect on blood pressure in children.
- Tamsulosin has also been studied in women with lower urinary tract symptoms, and found to be effective in improving symptoms and quality of life 5.
Potential Adverse Effects
- Tamsulosin can cause life-threatening hypotension in patients with spinal cord injury, and caution is needed when administering the medication in this population 6.