Detrusor contraction duration may predict response to alpha-blocker therapy for lower urinary tract symptoms.
OBJECTIVE
Baseline pressure/flow parameters have not correlated well with response to medical therapy for lower urinary tract symptoms (LUTS). This open-label, nonrandomized retrospective study was designed to evaluate whether the urodynamic parameter duration (in seconds) of the detrusor contraction (DCD) correlates better with alpha-blocker response than previously described urodynamic parameters.


METHODS
93 men (mean age 62.6+/-8.5) with LUTS underwent urodynamic evaluation prior to initiating therapy with doxazosin titrated to 8 mg and followed for 6 months. Parameters of evaluation included the AUA symptom score (AUASx), peak urinary flow rate (Q(max)), maximal detrusor pressure (P(max)), detrusor pressure at maximal flow (P(det)) and DCD. The correlation and predictive value of therapeutic response and baseline urodynamic parameters were assessed.


RESULTS
85 patients were evaluable at 6 months. For the entire group, AUASx decreased from 15.1+/-6.9 to 9.7+/-5.1 (-36%) and Q(max) increased from 9.3+/-3.7 to 11.9+/-5.7 ml/s (+28%). Baseline P(max) was 74.8+/-19.6 cm H(2)O, P(det) was 61.6+/-18.9 cm H(2)O and DCD was 107.6+/-28.6 s. There was weak correlation between either baseline P(max) or P(det) and therapeutic response (defined as a decrease in AUASx of 40% and an increase in Q(max) of 30%). Utilizing a baseline DCD of 90 s or more, there was a significant correlation to therapeutic response (r = 0.48, p = 0.002).


CONCLUSIONS
These preliminary data suggest that DCD may be a useful urodynamic parameter to predict and optimize therapy with a-blockade. The potential utility and cost-effectiveness of DCD remains to be determined.
Kaplan
S A
SA
Department of Urology, Columbia Presbyterian Medical Center, New York, NY 10032, USA. sk46@columbia.edu
Stifelman
M
M
Avillo
C
C
Reis
R B
RB
Te
A E
AE
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D017292:Doxazosin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects / Q000502:physiology; D011237:Predictive Value of Tests; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D001743:Urinary Bladder / Q000187:drug effects* / Q000503:physiopathology; D014555:Urination Disorders / Q000188:drug therapy* / Q000209:etiology; D014563:Urodynamics / Q000187:drug effects*
D000317:Adrenergic alpha-Antagonists; D017292:Doxazosin