α1-Blockers Improve Benign Prostatic Obstruction in Men with Lower Urinary Tract Symptoms: A Systematic Review and Meta-analysis of Urodynamic Studies

• Published in: European urology 2016-06, Vol.69 (6), p.1091-1101
• Main Authors: Fusco, Ferdinando, Palmieri, Alessandro, Ficarra, Vincenzo, Giannarini, Gianluca, Novara, Giacomo, Longo, Nicola, Verze, Paolo, Creta, Massimiliano, Mirone, Vincenzo
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-1 Receptor Antagonists - pharmacology; Adrenergic alpha-1 Receptor Antagonists - therapeutic use; Benign prostatic hyperplasia; Benign prostatic obstruction; Bladder outlet obstruction index; Clinical Trials as Topic; Doxazosin - therapeutic use; Humans; Indoles - therapeutic use; Lower urinary tract symptoms; Male; Meta-analysis; Naphthalenes - therapeutic use; Piperazines - therapeutic use; Prazosin - analogs & derivatives; Prazosin - therapeutic use; Prostatism - drug therapy; Quinazolines - therapeutic use; Severity of Illness Index; Sulfonamides - therapeutic use; Urodynamics; Urodynamics - drug effects; Urology; α1-Blockers
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2015.12.034

Abstract Context The urodynamic outcomes for α1-blockers (ABs) treatment in patients with lower urinary tract symptoms related to benign prostatic enlargement (LUTS/BPE) is a matter of debate. Objective To perform a systematic review and meta-analysis of studies evaluating the ABs urodynamic outcomes in patients with LUTS/BPE. The primary endpoint was variation in bladder outlet obstruction index (BOOI). Secondary endpoints were the maximum urinary flow rate ( Qmax ) and detrusor pressure at Qmax ( Pdet Qmax ). A meta-analysis of placebo-controlled randomized clinical trials (RCTs) was performed to compare ABs with placebo. Evidence acquisition A systematic review of PubMed/Medline, ISI Web of Knowledge, and Scopus databases was performed in May 2015. Seventeen studies were selected for inclusion. Evidence synthesis The overall pooled data showed a mean BOOI change of –14.19 ( p < 0.0001), a mean Pdet Qmax change of –11. 39 cm H2 O ( p < 0.0001), and a mean Qmax improvement of 2.27 ml/s ( p < 0.0001). Subgroup analysis showed a mean BOOI change of –14.88 ( p = 0.01) for alfuzosin, –19.41 ( p = 0.01) for doxazosin, –16.47 ( p < 0.0001) for naftopidil, –30.45 ( p < 0.0001) for silodosin, –14.27 ( p = 0.002) for tamsulosin, and –6.69 ( p = 0.005) for terazosin. Subanalysis of RCTs containing a placebo arm showed a significant improvement in BOOI in patients undergoing ABs treatment. Meta-regression revealed a significant positive association between the percentage of patients with obstruction at baseline and the improvement in BOOI after treatment with ABs. Conclusion ABs improve BOOI in patients with LUTS/BPE mainly by reducing Pdet Qmax , and this effect is higher in patients presenting with urodynamic obstruction at baseline. The free Qmax variation underestimates the real effect of ABs on benign prostatic obstruction. Patient summary Results of this meta-analysis suggest that α1-blockers objectively improve urinary voiding function in patients with benign prostatic obstruction.