The role of transrectal ultrasound measurement of urethral opening during micturition in men treated with doxazosin due to benign prostate hyperplasia
Article published in Urologia Polska 2007/60/4.
Marek Wyczółkowski, Andrzej Prajsner, Włodzimierz Klima, Lesław Malik, Tomasz Drewniak, Maciej Rzepecki
- Oddział Urologii Wojewódzkiego Szpitala Specjalistycznego im. L. Rydygiera w Krakowie
I Katedra i Klinika Urologii w Zabrzu ¦l±skiej Akademii Medycznej w Katowicach
urethra, BPH, transrectal ultrasound, doxazosyna
The aim of the study. The main role of alpha blockers in patients with benign prostatic hyperplasia (BPH) is to reduce the functional component of the bladder outlet obstruction (BOO) facilitating the opening of the bladder neck and prostatic urethra during micturition. The purpose of the study is to evaluate the usefulness of transrectal ultrasound (TRUS) as a tool of assessing the effectiveness of alpha blocker in BPH patients.
Material and method. 45 male patients between 45 to 80 years with BPH were treated with doxazosinum for 12 weeks. The diameter of the cross section of the prostatic urethra was taken during micturition using the ultrasonic probe introduced to the rectum in upright position. The maximal diameter of the cross section of the medial prostatic urethra and of the bladder neck was recorded. Simultaneously the urethra flow was analyzed on the uroflowmeter recording. Residual urine volume was calculated from ultrasound. Two measurements of the urethra taken in the saggital plane in the half way of the prostatic urethra and in the bladder neck and IPSS were taken and compared before and after the treatment. Material was statistically analyzed.
Results. After 12 weeks of treatment significant improvement was noticed in every value of the analyzed parameters except of the residual urine volume.
Conclusions. Simultaneous analysis of the urethral diameter and Q max during micturition can by useful in estimation of the efficiency of the alpha blockers treatment. Increase in the urethra diameter without the Q max improvement can suggest detrusor attenuation and lowering effect of alpha blockers treatment in this group of patients.
- Caine M, Perlberg S, Meretyk S: A placebo-controlled double-blind study of the effect of phenoxybenzamine in benign prostatic obstruction. Br J Urol 1978, 50, 551-554.
- Pool JL: Role of the sympathetic nervous system in hypertension and benign prostatic hyperplasia. Br J Clin Pract Suppl 1994,74, 13-17.
- Pool JL, Kirby RS: Clinical significance of alpha1-adrenoceptor selectivity in the management of benign prostatic hyperplasia. Int Urol Nephrol 2001, 33, 407-412 (Review).
- Andersson KE: Alpha-adrenoceptors and benign prostatic hyperplasia: basic principles for treatment with alpha-adrenoceptor antagonists. World J Urol 2002, 19, 390-396 (Review).
- Griffiths D, von Mastrigt R, Bosch R: Qantification of urethral resistance and bladder function during voiding with special reference to the effects of prostate size reduction on urethral obstruction due to benign prostatic hyperplasia. Neurourol Urodyn 1989, 8, 17-27.
- Kurita Y, Masuda H, Suzuki K et al: Transition zone ratio and prostate-
- specific antigen density as predictors of the response of benign prostatic hypertrophy to alpha blocker and anti-androgen therapy. Br J Urol 1997, 80, 78-83.
- Caine M: The preset role of alfa adrenergic blokers in the treatment of benign prostatic hypertrophy. J Urol 1986, 136, 1-4.
- Kirby S: Autonomic failure and the role of sympathetic nervous system in the control of lower urinary function. Clin Sci 1986, suppl. 14, 45-50.
- Kirby RS: Expanding role of alpha adrenoceptor blockade in the treatment of benign prostatic hyperplasia. Int J Clin Pract 1998, 52(6), 402-407. Review.
- Schafer W, Rubben H, Noppency R, Deutz F-J: Obstructed and unobstructed
- prostatic obstruction. A pleace for urodynamic objectivation of bladder outlet obstruction in benign prostatic hyperplasia. World J Urol 1989, 6, 198-203.
- Abrams PH, Griffiths DJ: The assessment of prostatic obstruction from urodynamic measurements and from urine residual. Br J Urol 1979, 51, 129-134.
- Abrams P, Buzelin JM, Griffiths D et al: The urodynamic assessment of lower urinary tract symptoms. In Denis L., Griffiths K, Khoury S et al. Proceedings of the Fourth International Consulatation on Benign Prostatic Hypertrophy. Plymouth: Health Publications Ltd, 1998, 323-378.
- Griffiths D, Hofner K, van Mastrigt R et al: Standarisation of terminology of lower urinary tract function: Pressure-flow studies of voiding, urethral resistance and urethral obstruction. Neurolog Urodyn 1997, 16, 1-8.
- Wyczółkowski M, Prajsner A, Piasecki Z, Pawlicki B: Functional evaluation of the prostatic urethra using transrectal ultrasound. Br J Urol 2000, 86 suppl. 3 AP1502, 33-34.
- Gillenwater JY, Conn RL, Chrystans SG et al: from the multicenter Study Group: Doxazosin for the treatment of benign prostatic hyperplasia in patients with mild to moderate essentaial hypertension: a double blind, placebo controlled, dose-response multicenter study. J Urol 1995, 154, 110-115.
- Abrams P: Urodynamic effects of doxazosin in men with lower urinary tract symptoms and benign prostatic obstruction. Results from three double-blind placebo-controlled studies. Eur Urol 1997, 32(1), 39-46.
- Abrams P: Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. Br J Urol Int 1999, 84(1), 14-21.
- Kirby RS, Andersen M, Gratzke P et al: A combined analysis of double-
- blind trials of the efficacy and tolerability of doxazosin-gastrointestinal therapeutic system, doxazosin standard and placebo in patients with benign prostatic hyperplasia. Br J Urol Int. 2001, 87(3), 192-200.
- Kirby RS, Roehrborn C, Boyle P et al: Prospective European Doxazosin and Combination Therapy Study Investigators. Efficacy and tolerability of doxazosin
- and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology 2003, 61(1), 119-126.
- Kirby RS: A randomized, double-blind crossover study of tamsulosin and controlled-release doxazosin in patients with benign prostatic hyperplasia. Br J Urol Int 2003, 91(1), 41-44.
- Marks LS, Roehrborn CG, Gittelman M et al: First dose efficacy of alfuzosin once daily in men with symptomatic benign prostatic hyperplasia. Urology 2003, 62(5), 888-893.
- Chon JK, Borkowski A, Partin AW et al: Alpha 1-adrenoceptor antagonists terazosin and doxazosin induce prostate apoptosis without affecting cell proliferation in patients with benign prostatic hyperplasia. J Urol 1999, 161(6), 2002-2008.
- Shapiro E, Hartanto V, Lepor H: The response to alpha blockade in benign prostatic hyperplasia is related to the percent area density of prostate smooth muscle. Prostate 1992, 21(4), 297-307.
- Mimata H, Nomura Y, Kasagi Y et al: Prediction of alpha-blocker response in men with benign prostatic hyperplasia by magnetic resonance imaging. Urology 1999 , 54(5), 829-833.
- Mimata H, Satoh F, Ohno H et al: Related Articles: Clinical characteristics of alpha-blocker responders in men with benign prostatic hyperplasia. Urol Int 2002, 68(4), 237-242.
- Roesnick NM, Yalla SV: Detrusor hyperactivity with imapired contractility. An unrecognized but common cause of incontinence in elderly patients. JAMA 1987, 257 (22), 3076-3081.
- Ghoniem GM: Impaired bladder contractility in association with detrusor instability. Underestimated occurence in benign prostatic obstruction. Neurourol Urodyn 1991, 10, 111-118.
- Yamanishi T, Yasuda K, Kamai T et al: Combination of a cholinergic drug and an alpha-blocker is more effective than monotherapy for the treatment
- of voiding difficulty in patients with underactive detrusor. Int J Urol 2004, 11(2), 88-96.
- Holme JB, Christensen MM, Rasmussen PC: 9-weeks doxazosin treatment
- in patients with symptomatic benign prostatic hyperplasia. Scand J Urol Nephrol 1994, 28, 77-82.
- Kaplan SA, Stifelman M, Avillo C et al: Detrusor contraction duration may predict response to alpha-blocker therapy for lower urinary tract symptoms. Eur Urol 2000, 37(3), 314-317.
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