Abrams et al. 2003
UK
PEDro=8
RCT
Study 1 Initial N=263
Study 1 Final N=244
Study 2 Initial N=186
Study 2 Final N=134

Population: SCI: Mean age = 18 yrs; Time since injury: 85-103 mths.
Treatment: Subjects were randomized to one of three groups; the 0.4 mg tamsulosin, the 0.8mg tamsulosin or the placebo group.  Medication or placebo were given once daily (after breakfast).  Assessment for the groups was 2 and 4 weeks after treatment.
Outcome Measures:  Urethral closure pressure.

• No significant change-maximal urethral closure pressure.
• Significant patient micturition diary change – 1) incontinence episode frequency and pad change freq reduced with tamsulosin:  0.04 mg  (p=0.009); 2)  increase in mean void volume was seen in the 0.08mg group (p=0.003); however not in the 0.04 group.

Costa et al. 1993
France
PEDro=8
RCT
N=20

Population: SCI: Age = 18-60 yrs; Gender: males = 20; Severity of injury: complete, incomplete; Time since injury = 4mths-7yrs.
Treatment: Moxisylyte @ .25, .50, .75 mg or placebo on different days separated by 4 to 7 days.  According to the balance incomplete block design (3 treatments/patient).
Outcome Measures: Maximum urethral closure pressure (trapezoidal rule used on tracings); pre/post arterial blood pressure and heart rate; pharmacodynamic analysis.

• Treatment effects at 10 mins. (p=0.0106)
• Decrease in diastolic blood pressure of 17.8%, 14%, 5.2% after .75 mg, .50 mg, .25 mg. 
• Significant heart rate increases at 5, 10*, 15, 20, 30, 60 minutes    (p= 0.0016*) *=max 
• For .50 & .75 mg/kg, significant difference at 20 min (p<0.02) but not at 15 min (p=0.0598). 
• Urethral closure pressure dose related – max  of 47.6% reduction at 10 min after .75mg/kg.

Linsenmeyer et al. 2002 USA
Downs & Black score=14
Case Series
Study 1: n=10
Study 2: n=7

Population: Study 1: Mean age = 28 yrs; Gender: males = 10; Severity of injury: AIS: A, B; Study 2: Gender: males = 7.
Treatment: Study 1: impact of alpha blockers on upper tract stasis. Study 2: the impact of alpha blockers on urodynamic parameters in those with and without resolution of stasis.
Outcome Measures: Urodynamic parameters: mean changes in opening pressure, maximum detrusor voiding pressure and duration uninhibited contraction.

•  Pre-treatment: 6 subjects taking prazosin, 4 taking terazosin. 
• Three month treatment with alpha blockers resolves upper tract stasis (p<0.0003).
• Study 2: Uninhibited bladder contraction duration decreased with alpha-blocker usage (p<0.001). 
• Mean arterial pressure during uninhibited contraction significantly decreased during alpha-blocker treatment (p<0.01).

Al-Ali et al. 1999
Iraq
Downs & Black score=12
Case Series
Initial N=46; Final N=41

Population: SCI: Age = 13-49 yrs; Severity of injury: complete, incomplete.
Treatment: Phenoxybenzamine 10mg daily increased to 10 mg/twice daily and then 10 mg/3 x daily for 3 wks to 6 mos. 
Outcome measures: Urethral closure pressure.

• No statistically significant results reported. 
• Improved max urethral closure pressure in 19 patients with reflex bladders.
• Non-responders=22 (9=areflexive bladders; 13=reflex bladders).

Chancellor et al. 1993 USA
Downs & Black score=12
Case Series
Study 1:n=15
Study 2: n=9

Population: SCI: Age = 18-45 yrs; Gender: males = 15.
Treatment: Once Detrusor External Sphincter Dysynergia (DESD) without obstruction of the bladder neck or prostate was documented, therapy with terazosin (5mg daily) was initiated.
Outcome Measures: Voiding pressure.

• No significant differences in DESD voiding pressure after 4-12 weeks initial terazosin  treatment (p=.48) 
• Voiding pressure was reduced (p<0.001) after subsequent external sphincterotomy or sphincter stent placement. 
• Out of 9 subjects who experienced persistent voiding symptoms after sphincterotomy following initial terazosin treatment, subsequent terazosin treatment improved voiding in patients with only bladder neck obstruction while the other 4 who did not improve had obstruction only at the external sphincter. 

Perkash 1995
USA
Downs & Black score=10
Pre-post
N=28

Population: SCI: Age: 20-74 yrs; Severity of injury: Frankel: A, C-D.
Treatment: Terazosin for voiding.
Outcome Measures: Subjective assessment and detrusor voiding pressure (urodynamics).

• Subjective assessment – 50% improved voiding, 50% no difference.
• Occasional autonomic dysreflexia in 39% of patients
• Decreased voiding pressure in 42%, no change in 37%, increased pressure in 21%.