Impact of alpha1-blockers in men with spinal cord injury and upper tract stasis.
OBJECTIVE
Our objective was to determine the effectiveness of alpha1-blockers on upper tract stasis in men with spinal cord injury (SCI) who use reflex voiding for bladder management.


METHODS
A retrospective chart review of men with SCI at or above T6, who used reflex voiding for bladder management and had upper tract stasis diagnosed by renal scan. Inclusion was based on the availability of the following tests both before and after alpha1-receptor blockade: renal scan, urodynamic studies, and arterial pressures. Part I evaluated the impact of alpha1-blockers on upper tract stasis. Part II evaluated the impact of alpha1-blockers on urodynamic parameters in those with and without resolution of stasis.


METHODS
Chi-square test was used to determine the statistical significance of resolution of upper tract stasis. Student's t test for 2-paired samples was used to evaluate whether urodynamic parameters differed significantly before and after treatment with alpha1-blockers.


METHODS
Urodynamic parameters evaluated included mean changes in opening pressure, maximum detrusor voiding pressure, and duration of uninhibited contraction.


RESULTS
Ten men with upper tract stasis were identified (15 renal units). After >6 months on alpha1-receptor antagonist therapy, upper tract stasis resolved in 8 of the 10 men (11 renal units) and persisted in 2 men (4 renal units). (P = .00026). The only urodynamic parameter that significantly changed in those with resolution of upper tract stasis was the duration of the uninhibited contraction (resolution of stasis: -57 seconds; P < .001), persistence of stasis: +12 seconds (P < .05). No significant change in opening pressures occurred in either those with resolution of stasis or persistent stasis (P < .78). Maximum arterial pressures during voiding statistically decreased with the use of alpha1-blockers (152 mmHg vs 135 mmHg; P < .01).


CONCLUSIONS
alpha1-Receptor-antagonist therapy improved upper tract stasis in men with SCI. The urodynamic parameter that changed in those with resolution of upper tract stasis was the duration of uninhibited contractions, which decreased significantly.
Linsenmeyer
Todd A
TA
Department of Urology, Kessler Institute for Rehabilitation, West Orange, New Jersey 07052, USA. tlinsenmeyer@kessler-rehab.com
Horton
John
J
Benevento
Joseph
J
D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D006801:Humans; D008297:Male; D011224:Prazosin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use*; D018340:Receptors, Adrenergic, alpha-1 / Q000627:therapeutic use*; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014551:Urinary Tract / Q000187:drug effects / Q000503:physiopathology; D014563:Urodynamics / Q000187:drug effects / Q000502:physiology; D014570:Urologic Diseases / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology
D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists; D018340:Receptors, Adrenergic, alpha-1; C041226:Terazosin; D011224:Prazosin