Review article
Urologic complications of nonurologic medications

https://doi.org/10.1016/S0094-0143(02)00111-8Get rights and content

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Voiding dysfunction

The coordination of bladder filling, storage, and emptying, relies on intact sympathetic, parasympathetic, and somatic neural pathways [1]. The smooth muscle of the bladder body has the greatest density of muscarinic cholinergic receptors and β-adrenoceptors, whereas the bladder neck and proximal urethra contain a preponderance of α-adrenergic receptors [2], [3]. Neurologically, the micturition center is located in the midbrain and coordinates ascending input from the spinal cord and descending

Erectile dysfunction

All phases of sexual function in the male, including libido, penile erections, orgasm, and ejaculation are dependent on anatomic, physiologic, and psychologic factors. Thus, drugs that interfere with any of these processes can adversely affect sexual function in the male [11], [12]. Erectile dysfunction affects a significant proportion of men and in up to 25% of cases it can be attributed, to some degree, to drug therapy [13].

Drugs that interfere with central neuroendocrine or local

Infertility

Fertility in the male is dependent on the production of viable sperm by the testes and the successful delivery of the sperm in sufficient numbers to the female genital tract, and ultimately, the ovum. Infertility can result from disruption or alterations in spermatogenesis, or dysfunctions of penile erection, emission, or ejaculation. Drug effects on penile erection, emission, or ejaculation were discussed previously. Drug actions on the neuroendocrine relationship between the hypothalamus,

Urolithiasis

Medication-induced urolithiasis was first recognized during World War II when dehydrated patients were given sulfa medications and formed sulfa precipitates in ureters and developed uremia [52]. Sulfa drugs, including acetylsulfamethoxazole, acetylsulfasoxazole, acetylsulfaguanidine, and sulfadiazine may lead to precipitation of sulfa if the urine becomes oversaturated with the drug at a specific pH [52]. As with many cases of urolithiasis, sulfa stones can be avoided with adequate hydration.

Retroperitoneal fibrosis

Retroperitoneal fibrosis or Ormond's disease is an uncommon entity. While most cases are idiopathic, retroperitoneal fibrosis has been associated with the medication methysergide, used in the treatment of migrane headaches, in 12.4% of cases [62]. Other medications that have been implicated in the development of retroperitoneal fibrosis include methyldopa [63], amphetamines, beta-adrenergic blocking agents [64], and lysergic acid diethylamide (LSD) [65].

Epididymitis

Noninfectious epididymitis may result

Summary

A physician must be aware of common drug side effects and interactions before prescribing a certain agent. In addition to the drugs that we, as urologists, prescribe, we must also be aware of the urologic side effects of drugs that are commonly prescribed by nonurologists. The mechanisms of the pharmacologic causes for voiding dysfunction, erectile and sexual dysfunction, infertility, and urolithiasis are often mutifactorial and incompletely understood. The recognition and association of a

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