TURP was associated with greater improvements in heart rate variability (SDNN increase 14.70 vs 6.73 ms) and symptom relief (IPSS reduction 10.2 vs 5.3 points) compared to tamsulosin (p<0.01).
Cohort (n=452)
Does surgical de-obstruction (TURP) improve heart rate variability and symptoms compared to tamsulosin in men with benign prostatic hyperplasia and bladder outlet obstruction?
Surgical de-obstruction with TURP provides greater restoration of autonomic nervous system equilibrium (measured by HRV) and symptom relief than tamsulosin in men with BPH.
Absolute Event Rate: 14.7% vs 6.73%
p-value: p=<0.01
Background: Benign prostatic hyperplasia (BPH) can be associated with lower urinary tract symptoms (LUTS) and potential avlterations in autonomic nervous system function, as reflected by heart rate variability (HRV). This observational study was designed to generate hypotheses regarding the differential impacts of surgical de-obstruction versus uroselective pharmacological blockade on autonomic nervous system equilibrium, HRV restoration, and symptomatic outcomes in men with BPH and bladder outlet obstruction. Methods: Data from a prospective cohort of 242 men undergoing TURP and 210 men receiving tamsulosin were analyzed. HRV parameters (standard deviation of normal-to-normal intervals SDNN, low-frequency/high-frequency LF/HF ratio, total power TP, very low frequency VLF) and International Prostate Symptom Score (IPSS) was assessed at baseline and 12 weeks. Propensity score matching (PSM) was used to address baseline differences in age, prostate volume, IPSS, and baseline SDNN. Inter-group comparisons used ANCOVA with baseline as a covariate. Results: After TURP, SDNN increased by 14.70 ms (40%; 36.97 ± 22.80 to 51.67 ± 27.59 ms; p = 0.032; paired Cohen’s d = 0.58), LF/HF decreased by 0.90 (55%; 1.63 ± 1.60 to 0.73 ± 0.52; p = 0.028; d = −0.76), TP increased by 1303 ms2 (95%; 1367 ± 820 to 2670 ± 1420 ms2; p = 0.025; d = 1.12), and VLF increased by 810 ms2 (85%; 950 ± 560 to 1760 ± 980 ms2; p = 0.030; d = 1.01). For tamsulosin, SDNN increased by 6.73 ms (18%; 38.12 ± 12.50 to 44.85 ± 11.20 ms; p = 0.004; d = 0.57), LF/HF decreased by 0.16 (8%; 1.95 ± 0.65 to 1.79 ± 0.55; p = 0.012; d = −0.27), TP increased by 559 ms2 (39%; 1453 ± 620 to 2012 ± 580 ms2; p = 0.006; d = 0.93), and VLF increased by 355 ms2 (35%; 1020 ± 450 to 1375 ± 420 ms2; p = 0.010; d = 0.82). Secondary p-values (LF/HF, TP, VLF) were adjusted via the Benjamini–Hochberg method; adjusted p > 0.05 was used for some. Inter-group differences in changes were significant (ANCOVA p < 0.01; partial η2 = 0.12–0.22 for group factor). TURP was associated with greater IPSS reduction (−10.2 points; 18.5 ± 6.2 to 8.3 ± 4.1; p < 0.001) compared to tamsulosin (−5.3 points; 15.8 ± 5.6 to 10.5 ± 4.8; p < 0.001; d = −1.02; inter-group p < 0.001). PSM confirmed these associations with p < 0.01 for HRV changes. Change in SDNN was associated with IPSS improvement in multivariate regression (standardized β = −0.42, p < 0.01). Conclusions: In this observational study, TURP was associated with greater changes in HRV parameters and symptomatic improvement compared to tamsulosin. These findings are hypothesis-generating and require confirmation in long-term randomized trials.
Chen et al. (Sat,) conducted a cohort in Benign prostatic hyperplasia with bladder outlet obstruction (n=452). Surgical de-obstruction (TURP) vs. Tamsulosin was evaluated on Change in standard deviation of normal-to-normal intervals (SDNN) at 12 weeks (p=<0.01). TURP was associated with greater improvements in heart rate variability (SDNN increase 14.70 vs 6.73 ms) and symptom relief (IPSS reduction 10.2 vs 5.3 points) compared to tamsulosin (p<0.01).