[Analysis of doxazosin efficacy in the treatment of the benign prostatic enlargement].
OBJECTIVE
to analyze doxazosin efficacy in the treatment of patients with proved benign prostatic enlargement (BPE), according to the reduction of the level of symptoms and urodynamic obstruction as well as reduction in detrusor contraction duration (DCD).


METHODS
31 BPE patients after fulfilling International Prostatic Symptom score, undergone complete urodynamic measurement (uroflowmetry, cystometry and pressure/flow studies). All methodology of urodynamic measurement and definitions were based on the definitions of the International Continence Society. Three months therapy with doxazosin (4 mg daily) was prescribed to each patient, and the same control examinations were done after the treatment with analysis of all relevant data.


RESULTS
A reduction of the symptoms (T-paired test) (I-PSS from average of 12.6 decreased to 6.2; p < 0.0001), has been noticed, improvement of quality of life (from average 2.5 decreased to 1.5; p < 0.0001), as well as increasing of the maximal flow (average Q(max) grew for 1.9 ml/sec; p < 0.05). URA dropped from 39,6 cmH2O to 34,1 cmH2O (p < 0.01), remaining in the obstructive region, although 32% of the patients experienced absolute reduction of obstruction (URA < 29 cmH2O). The most prominent result was a drastic reduction in the duration of the detrusor contraction (average DCD from 105 sec. dropped to average 73.4 sec. with p < 0.0001). Other urodynamic parameters, as well as post void residual urine, were not changed significantly. Than patients were allocated in the two groups based on the pre treatment detrusor contraction duration with cut-off point of 90 sec. and the post treatment characteristics were examined (Wilcoxon test). Both groups were shown reduction regarding I-PSS, (its irritative and obstructive domain), but reduction of 54% for DCD > 90 sec group is better than for the 46% for the other group. Further, there is a difference among groups regarding several important characteristics. DCD > 90 sec. group showed increasing in urinary flow for 21% (p < 0.05), decreasing of URA for 13% (p < 0.05), improvement in the quality of life for the 46% (p < 0.001) as well as reduction in DCD for 32% (p < 0.001), what was not shown in the pretreatment DCD < 90 sec. group.


CONCLUSIONS
Doxazosin is a potent reducer of the symptoms in the treatment of the BPE, enhancing urinary flow and reducing DCD in the first place. Albeit, possibility of urodynamic obstruction reduction and influence to the volume of post void residual urine is limited, thus doxazosin is recommended to the patient with moderate obstruction, prolonged detrusor contraction duration and moderate levels of the symptoms. Patients with pretreatment prolonged DCD will be better responders to the therapy. This finding implicates necessity ofurodynamic measurements before treatment in order to optimize therapeutic effect of drug for individual patient.
Aganović
Damir
D
Uroloska Klinika, Kliniki Centar Univerziteta u Sarajevu.
Aganović
Kenana
K
Prcić
Alden
A
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D017292:Doxazosin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics
D000317:Adrenergic alpha-Antagonists; D017292:Doxazosin