Alpha adrenoreceptor antagonists – have we reached the optimum balance of safety/efficacy?

Alpha adrenoreceptor antagonists used in lower urinary tract symptoms (LUTS)/benign prostatic enlargement (BPE) have potentially many more uses than those for which they were originally created. Devised 40 years ago for the treatment of hypertension, more selective forms were later developed to treat LUTS/BPE with good clinical outcomes although associated with side effects. Although we know that these α-blockers work on receptors mainly found in the bladder and prostate these receptors are also found elsewhere and this has widened the therapeutic options available to the urologist. Further selectivity would not necessarily add anything new until we fully understand the underlying pathophysiology of LUTS.