Do α1-adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance?
Do α1-adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance?
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DOI：
10.1002/nau.20481
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发表时间：
2008-01-01
影响因子：
2
通讯作者：
Michell, Martin C.
中科院分区：
文献类型：
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作者：
Barendrecht, Maurits M.;Abrams, Paul;Michell, Martin C.
目的：验证α -阻滞剂治疗后下尿路症状（IPSS）的改善是由于膀胱出口梗阻的减少（以膀胱出口梗阻指数（BOOI）评估）的假设；还探讨了两者与自由流Q（max）的关系。方法：回顾性分析a受体阻滞剂坦索罗辛的大型安慰剂对照、随机、双盲研究数据库。根据基线IPSS、Q（max）或BOOI及其治疗相关改变将患者分为上下半部分。在这些分层中，分析其他两个参数值之间的差异，例如，比较BOOI改善低于中位数和高于中位数的患者的IPSS改善和Q（max）。结果：某一参数（如IPSS）低于和高于中位基线的患者，其其他两个参数（如Qmax和BOOI）的值相当相似。同样，基于一个参数的基线分层的患者在其他两个参数上也有相当相似的改善。最重要的是，在治疗相关的一个参数（例如，BOOI）的改善中位数低于或高于中位数的患者，在其他两个参数（例如，IPPS和Q(max)）的改变中仅表现出很小的差异。结论：我们得出IPSS，自由流量Q（max）和BOOI在基线时只是松散相关的结论。更重要的是，治疗诱导的这些参数的改善也只是松散相关。这些数据确实质疑了α -受体阻滞剂通过减轻膀胱出口梗阻在很大程度上改善下尿路症状的假设，并表明它们也可能独立于前列腺平滑肌张力起作用。
Aims: To test the hypothesis that improvements of lower urinary tract symptoms (IPSS) upon treatment with an alpha-blocker are due to reduction of bladder outlet obstruction (assessed as the bladder outlet obstruction index, BOOI); relationships of either with free flow Q(max) were also explored. Methods: The database of a large placebo-controlled, randomized, double-blind study with the a-blocker tamsulosin was analyzed retrospectively. Patients were stratified into lower and upper halves according to baseline IPSS, Q(max) or BOOI and treatment-associated alterations thereof. In these strata differences between values for the other two parameters were analyzed, for example, improvement of IPSS and Q(max) were compared in patients with below and above median improvement of BOOI. Results: Patients with below and above median baseline for one parameter, for example, IPSS had rather similar values for the other two parameters, for example, Qmax and BOOI. Likewise, patients based upon baseline strata for one parameter had rather similar improvements of the other two parameters. Most importantly, patients with below and above median treatment-associated improvements of one parameter, for example, BOOI exhibited only small if any difference for alterations of the other two parameters, for example, IPPS and Q(max). Conclusions: We conclude that IPSS, free flow Q(max) and BOOI are only loosely related at baseline. More importantly, treatment-induced improvements of these parameters are also only loosely related. These data do question the hypothesis that alpha-blockers largely improve lower urinary tract symptoms by reducing bladder outlet obstruction and suggest that they may also act independent of prostatic smooth muscle tone.