Terazosin for vesicosphincter dyssynergia in spinal cord-injured male patients.
OBJECTIVE
Evaluation of the role of the long-acting alpha-adrenergic blocker, terazosin, in the treatment of vesicosphincter dyssynergia (VSD) in spinal cord-injured male patients.


METHODS
Sixty spinal cord-injured male patients with VSD were recruited prospectively. Their mean age was 37 years (range 15-70 years). Baseline evaluation included a thorough medical history, clinical examination, blood pressure measurement, intravenous urogram, and videourodynamics. The patients received terazosin for a 90-day period. Videourodynamic evaluation after completion of the study included cystometrogram, sphincter electromyography, maximum urethral pressure gradient (MUPG), and measurement of post voiding residual (PVR) urine volume. The findings were compared with the pretreatment values.


RESULTS
Of the 60 patients, 35 completed the study. According to response to treatment, two groups were identified: Group A = responders (N = 17; 49%) and Group B = nonresponders (N = 18, 51%). In Group A, there was a significant decrease in the maximum detrusor pressure, from a mean of 105.3 to 73.9 cm H(2)O, and in MUPG, from a mean of 84.7 to 54.1 cm H(2)O. The bladder capacity and PVR did not change significantly in either group. The time since injury was significantly longer in Group A than in Group B.


CONCLUSIONS
Terazosin in a dose of 10 mg/day was well tolerated and effective in reducing bladder outlet obstruction in many spinal cord-injured patients, as reflected by a decrease in maximum detrusor pressure and MUPG in 49% of the patients. Patients with a weak or negative response initially may respond later. Terazosin should be considered a first-line treatment of VSD prior to contemplating surgery.
Bennett
J K
JK
Department of Surgery and Division of Urology, Emory School of Medicine and Shepherd Center, Atlanta, Georgia 30322, USA.
Foote
J
J
El-Leithy
T R
TR
Saleem
M D
MD
Green
B
B
Archer
C L
CL
Gray
M
M
D000293:Adolescent; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001259:Ataxia / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011224:Prazosin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000628:therapy*; D013997:Time Factors; D014521:Urethra / Q000187:drug effects; D014570:Urologic Diseases / Q000188:drug therapy*
D000317:Adrenergic alpha-Antagonists; C041226:Terazosin; D011224:Prazosin