Flomax® (tamsulosin) for Urinary Issues in Women


The use of alpha-blockers (tamsulosin, alfuzosin, terazosin, doxazosin) has been the mainstay of treatment for men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), but little data has been published supporting the use of alpha-blockers in women with voiding dysfunction.  Some urologists are now prescribing alpha-blockers for women with lower urinary tract symptoms associated with bladder outlet obstruction (BOO) or underactive detrusor muscle, but are they doing any good? 
Alpha-blockers can help increase urine flow by acting on receptors in the bladder neck and urethra leading to relaxation.  The majority of the receptors are located within the prostate, which is why alpha-blockers have been studied and used for BPH and LUTS in men.  Since some of these receptors are also located in other parts of the urinary tract, it is presumed that alpha-blockers should have an effect in females as well. 
Recent studies have been done evaluating the use of tamsulosin in women with bladder outlet obstruction and detrusor underactivity.  The results have shown some promise, but with inconclusive results.  Most studies have been outside of the United States and using a dose of tamsulosin 0.2mg, which is not available in the US.  Another problem with the studies, is they were only ran for a few short weeks and they were not compared to a placebo.  Despite the weaknesses in study design, the majority of female participants reported that treatment with tamsulosin had a good clinical response and an improved quality of life. 
Even though strong evidence may be lacking, tamsulosin and other alpha-blockers seem to be the first line medication choice of some urologists.  Alpha-blockers as a class are associated with minimal side effects, mostly those related to orthostatic hypotension.  Tamsulosin is the most well tolerated, with the most prominent side effect noted being dizziness.  In some cases, alpha-blockers lead to worsened stress incontinence, so they may want to be avoided in female patients with stress incontinence.  Tamsulosin is also commonly being prescribed for short-term use in women with kidney stones.  In this case, tamsulosin should only be used until the kidney stones are passed and then discontinued. 
Urinary retention can impair quality of life and potentially lead to recurrent UTI’s and upper urinary tract damage, so if there is an effective treatment, it should be used.  Women prescribed tamsulosin or other alpha-blockers for voiding dysfunction should be monitored for efficacy.  At this point, most studies have been done with tamsulosin, so it will most likely be the preferred agent used in women. 

References:
1. Lee KS, Han DH, Lee YS, et al. Efficacy and safety of tamsulosin for the treatment of non-neurogenic voiding dysfunction in females; a 8-week prospective study. J Korean Med Sci 2010;25:117-22.
2. Chang SJ, Chiang IN, Yu HJ. The effectiveness of tamsulosin in treating women with voiding difficulty. Int J Urol 2008;15:981-5.
3. Nitti VW. Primary bladder neck obstruction in men and women. Rev Urol 2005;7 (Suppl 8):S12-S17.
4. Constantini E, Lazzeri M, Bini V, et al. Open-label, longitudinal study of tamsulosin for functional bladder outlet obstruction in women. Urol Int 2009;83:311-15.


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