α1-Adrenergic Blockers in Young Men With Primary Bladder Neck Obstruction

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Aug 2002α1-Adrenergic Blockers in Young Men With Primary Bladder Neck Obstruction Stephen shei dei Yang, Chung cheng Wang, Cheng Hsing Hsieh, and Yung Tai Chen Stephen shei dei YangStephen shei dei Yang , Chung cheng WangChung cheng Wang , Cheng Hsing HsiehCheng Hsing Hsieh , and Yung Tai ChenYung Tai Chen View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64682-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed the efficacy and safety of the mid term use of α1-adrenergic blockers for treating primary bladder neck obstruction in young and middle-aged men. Materials and Methods: Between May 1998 and February 2001 primary bladder neck obstruction was diagnosed by videourodynamic study in 28 men younger than 55 years. The degree of obstruction was graded by the Schafer nomogram. Mean patient age and mean symptom duration were 39.3 years and 18.1 months, respectively. The presenting symptom was frequency in 22 cases (78.6%), urgency in 10 (35.7%), weak stream in 9 (32.1%), nocturia greater than 2 times in 7 (25%) and hesitancy in 7 (25%). A dose of 1 to 2 mg. doxazosin was administered at bedtime for at least 3 months. International Prostate Symptom Score (I-PSS), quality of life, uroflowmetry and post-void residual urine were assessed before and 3 months after medication. Improved urine flow was defined as at least a 2.5 ml. per second increase in the maximum flow rate. Improved symptoms was defined as more than a 50% decrease in I-PSS. Successful treatment was defined as improved urine flow and symptoms. Results: Followup data were available in 24 patients. The medication period and followup were 7 and 12 months, respectively. Mean I-PSS plus or minus standard deviation decreased from 18.3 ± 4.6 to 11.6 ± 5.2 (p <0.01) and mean quality of life decreased from 4.1 ± 1.1 to 2.6 ± 1.0 (p <0.01). Mean maximum flow increased from 11.8 ± 3.2 to 15.9 ± 3.9 ml. per second (p <0.01). Mean post-void residual urine decreased from 80.2 ± 17.1 to 48.5 ± 10.3 ml. (p <0.01). Treatment was successful in 13 patients (54.2%) and 3 (12.5%) were free of medication for at least 6 months. More successful outcomes were noted in patients with high grades III to IV obstruction than in those with low grades 0 to II obstruction (80% versus 35.7%, p = 0.03). Before treatment higher detrusor pressure at maximum flow (70.1 versus 47.8 cm. water, p = 0.01) and lower maximum flow (10.6 versus 13.3 ml. per second, p = 0.02) were observed in patients with successful versus unsuccessful treatment, respectively. Differences in patient age, I-PSS, quality of life, prostate size and post-void residual urine were not statistically significant. No significant adverse effects were noted. Conclusions: α1-Blockers were effective and safe for treating young men with primary bladder neck obstruction. References 1 : Urodynamic evidence of vesical neck obstruction in men with misdiagnosed chronic nonbacterial prostatitis and the therapeutic role of endoscopic incision of the bladder neck. J Urol1994; 152: 2063. Link, Google Scholar 2 : Functional bladder neck obstruction in males: a progressive disorder?. Eur Urol1992; 22: 123. Google Scholar 3 : Primary bladder neck obstruction. World J Urol1984; 2: 191. Google Scholar 4 : Long-term results of bladder neck incision in men. Urol Int1991; 46: 55. Google Scholar 5 : Bladder neck dysfunction: the effect of the α-adrenergic blocking agent phentolamine on bladder neck dysfunction and a fluorescent histochemical study of bladder neck smooth muscle. Invest Urol1980; 18: 212. Google Scholar 6 : An increase of neuropeptide Y but not nitric oxide synthase-immunoreactive nerves in the bladder neck from male patients with bladder neck dyssynergia. J Urol1995; 154: 1231. Link, Google Scholar 7 : Primary bladder neck obstruction: urodynamic finding and treatment results in 36 men. J Urol1996; 156: 1418. Link, Google Scholar 8 : Unsuspected proximal urethral obstruction in young and middle-aged men. J Urol1986; 135: 972. Link, Google Scholar 9 : The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Scand J Urol Nephrol1988; 114: 5. Google Scholar 10 : The evaluation of bladder neck dysfunction. J Urol1980; 123: 196. Link, Google Scholar 11 : Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple. World J Urol1995; 13: 47. Google Scholar 12 : The α-adrenoceptor subtype mediating the tension of human prostatic smooth muscle. Prostate1993; 22: 301. Google Scholar 13 : Effects of doxazosin in men with benign prostatic hyperplasia: urodynamic assessment. Int Urol Nephrol1999; 31: 471. Google Scholar 14 : The early effects of doxazosin on benign prostatic hyperplasia. Arch Ital Urol Androl1998; 70: 41. Google Scholar 15 : The effectiveness of terazosin, an alpha1-blocker, on bladder neck obstruction as assessed by urodynamic hydraulic energy. BJU Int2000; 85: 249. Google Scholar 16 : Primary bladder neck obstruction in men: variation in detrusor response. J Urol1982; 128: 957. Abstract, Google Scholar 17 : Impact of different sized catheters on pressure-flow studies in patients with benign prostatic hyperplasia. Neurourol Urodyn1996; 15: 473. Google Scholar 18 Combs, A. J., Horowitz, M. and Glassberg, K. I.: Primary bladder neck dysfunction and dysfunctional voiding in children: similar clinical presentation, different clinical and urodynamic consequences. Presented at Section on Urology, American Academy of Pediatrics, San Francisco, California, October 20–22, 2001, abstract 95 Google Scholar 19 Yang, S. S. D., Chen, S. C., Wang, C. C., Chem, Y. T. and Hsieh, C. H.: The efficacy and safety of alpha-1 blockers in the treatment of enuresis associated with low peak flow rate. Presented at Section on Urology, American Academy of Pediatrics, San Francisco, California, October 20–22, 2001, abstract 91 Google Scholar 20 : A comparative study of terazosin and tamsulosin for symptomatic benign prostatic hyperplasia in Japanese patients. BJU Int2000; 85: 676. Google Scholar 21 : [A randomized comparative study assessing once versus twice a day treatment of benign prostatic hyperplasia with terazosin]. Hinyokika Kiyo2001; 47: 77. Google Scholar 22 : Doxazosin for the treatment of benign prostatic hyperplasia in patients with mild to moderate essential hypertension: a double-blind, placebo-controlled, dose-response multicenter study. J Urol1995; 154: 110. Link, Google Scholar 23 : Doxazosin in the treatment of benign prostatic hyperplasia in normotensive patients: a multicenter study. J Urol1995; 154: 105. Link, Google Scholar 24 : A three month double-blind study of doxazosin as treatment for benign prostatic bladder outlet obstruction. Br J Urol1994; 74: 50. Google Scholar 25 : A 12-week placebo-controlled double-blind study of prazosin in the treatment of prostatic obstruction due to benign prostatic hyperplasia. Br J Urol1992; 70: 285. Google Scholar 26 : The relevance of preoperative cystometrography in patients with benign prostatic hyperplasia: correlating the findings with clinical features and outcomes after prostatectomy. J Urol1994; 152: 443. Abstract, Google Scholar 27 : α-Adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction. J Urol1999; 162: 1064. Link, Google Scholar 28 : Acute effects of urinary bladder distention on the coronary circulation in patients with early atherosclerosis. J Am Coll Cardiol2000; 36: 453. Google Scholar 29 : Alpha blockade for the treatment of benign prostatic hyperplasia. Urol Clin North Am1995; 22: 375. Google Scholar 30 : Adrenergic receptor antagonist. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. Edited by . New York: Pergamon Press1990: 221. Google Scholar From the Department of Urology, En Chu Kong Hospital, College of Medicine, National Taiwan University and Taipei Medical University, Taiwan, Republic of China© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByKajbafzadeh A, Baradaran N, Sadeghi Z, Tourchi A, Saeedi P, Madani A, Ataei N, Taghavinejad A and Mohsseni M (2018) Vesicoureteral Reflux and Primary Bladder Neck Dysfunction in Children: Urodynamic Evaluation and Randomized, Double-Blind, Clinical Trial on Effect of α-Blocker TherapyJournal of Urology, VOL. 184, NO. 5, (2128-2133), Online publication date: 1-Nov-2010.COMBS A, GRAFSTEIN N, HOROWITZ M and GLASSBERG K (2018) PRIMARY BLADDER NECK DYSFUNCTION IN CHILDREN AND ADOLESCENTS I: PELVIC FLOOR ELECTROMYOGRAPHY LAG TIME—A NEW NONINVASIVE METHOD TO SCREEN FOR AND MONITOR THERAPEUTIC RESPONSEJournal of Urology, VOL. 173, NO. 1, (207-211), Online publication date: 1-Jan-2005.KRAMER S, RATHBUN S, ELKINS D, KARNES R and HUSMANN D (2018) DOUBLE-BLIND PLACEBO CONTROLLED STUDY OF α-ADRENERGIC RECEPTOR ANTAGONISTS (DOXAZOSIN) FOR TREATMENT OF VOIDING DYSFUNCTION IN THE PEDIATRIC POPULATIONJournal of Urology, VOL. 173, NO. 6, (2121-2124), Online publication date: 1-Jun-2005.YANG S, WANG C and CHEN Y (2018) Home Uroflowmetry for the Evaluation of Boys with Urinary IncontinenceJournal of Urology, VOL. 169, NO. 4, (1505-1507), Online publication date: 1-Apr-2003. Volume 168Issue 2August 2002Page: 571-574 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsurodynamicsage groupsadrenergic alpha-antagonistsbladder neck obstructionbladderMetricsAuthor Information Stephen shei dei Yang More articles by this author Chung cheng Wang More articles by this author Cheng Hsing Hsieh More articles by this author Yung Tai Chen More articles by this author Expand All Advertisement PDF DownloadLoading ...