title: Symptom deterioration during treatment and history of AUR are the strongest predictors for AUR and BPH-related surgery in men with LUTS treated with alfuzosin 10 mg once daily.
abstract: OBJECTIVE
  To assess the predictors of acute urinary retention (AUR) and/or surgery related to benign prostatic hyperplasia (BPH) in 3514 men complaining of lower urinary tract symptoms and treated for 6 months with the selective alpha1-blocker alfuzosin at 10 mg once daily.
  
  
  METHODS
  The impact of baseline (age, prior AUR, prostate-specific antigen tertiles, lower urinary tract symptoms severity, and bother score) and dynamic (International Prostate Symptom Score [IPSS] worsening of 4 points or greater and bother greater than 3 during treatment) variables on the risk of AUR/BPH-related surgery was assessed using Kaplan-Meier curves and log-rank tests. Associated hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models.
  
  
  RESULTS
  Of the 3514 men analyzed, 140 (4%) experienced a first episode of conservatively managed AUR before inclusion. Of those 140 men, 5 (3.6%) had AUR relapse during alfuzosin treatment and 6 (4.3%) underwent BPH-related surgery. Of those 3374 men without prior AUR, 19 (0.6%) experienced AUR during treatment and 41 (1.2%) underwent BPH-related surgery. During treatment, the most important predictors of AUR were prior AUR (HR 6.35, 95% CI 2.31 to 17.40; P < 0.01), IPSS worsening of 4 or greater (HR 3.34, 95% CI 1.11 to 9.99; P = 0.03), and bother score greater than 3 (HR 3.32, 95% CI 1.29 to 8.53; P < 0.01) at endpoint. Other variables (age, PSA, baseline IPSS, and bother) had much less predictive value. Similar results were observed regarding the risk of AUR and/or BPH-related surgery.
  
  
  CONCLUSIONS
  The results of this 6-month real life practice study suggest that prior AUR and symptom deterioration during treatment with alfuzosin 10 mg once-daily (IPSS worsening of 4 or more points, bother score greater than 3) were the strongest predictors of AUR and AUR/BPH-related surgery in men with lower urinary tract symptoms.
authors.affiliation: Department of Urology, University College London, London, United Kingdom. memberton@dial.pipex.com
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
authors.forename: Mostafa
authors.initials: M
authors.lastname: Elhilali
authors.forename: Haim
authors.initials: H
authors.lastname: Matzkin
authors.forename: Niels
authors.initials: N
authors.lastname: Harving
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Moorselaar
authors.forename: Rudolf
authors.initials: R
authors.lastname: Hartung
authors.forename: Antonio
authors.initials: A
authors.lastname: Alcaraz
authors.forename: Guy
authors.initials: G
authors.lastname: Vallancien
mesh_terms: D000208:Acute Disease; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004334:Drug Administration Schedule; D006801:Humans; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D011799:Quinazolines / Q000008:administration & dosage*; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery*; D014555:Urination Disorders / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000317:Adrenergic alpha-Antagonists; D011799:Quinazolines; C047638:alfuzosin