Predictive factors for the effect of the α1-D/A adrenoceptor antagonist naftopidil on subjective and objective criteria in patients with neurogenic lower urinary tract dysfunction.
OBJECTIVE
• To assess the effect of α1-D/A adrenoceptor antagonist naftopidil on patients with neurogenic lower urinary tract dysfunction (NLUTD) and voiding difficulty. • To explore the effectiveness of naftopidil in these patients by using urodynamic variables, including pressure flow study (PFS), and to find good and simple parameters (International Prostate Symptom Score (IPSS), Post-void residual urine (PVR), and uroflowmetry (UFM) parameters) as substitution of PFS for predicting the effect of naftopidil.


METHODS
• The main inclusion and exclusion criteria were, IPSS ≥8, voiding symptoms with IPSS ≥5, IPSS-quality of life (QOL) ≥2, PVR ≥50 mL, and without prostatic enlargement ≥ 20 mL. • After initial assessment, patients were stepwisely administered for 12 weeks with the following: placebo for 2 weeks, naftopidil 25 mg/day for 2 weeks, naftopidil 50 mg/day for 2 weeks, and naftopidil 75 mg/day for 6 weeks. At the end of both placebo and 6 weeks' naftopidil 75 mg/day, their IPSS, UFM, PVR, and PFS were assessed. • A total of 82 Japanese patients (men 40, women 42) with lower urinary tract symptoms complicated by NLUTD, with a mean age of 63.9 years, were included from private or institutional clinics. • The lesions were spinal cord 42, and peripheral nervous system 40. The spinal cord lesions were all lumbar spine (injury or lumbar canal stenosis).


RESULTS
• In all patients, pressure at maximum urinary flow rate (P(det) Q(max) ) in PFS significantly decreased (P < 0.05), and maximum urinary flow rate in UFM significantly increased (P < 0.01). Analysis of data for men and for women also showed a significant decrease in PVR, %PVR, and total IPSS score. • The degree of improvement of voided volume, PVR (%), and IPSS in patients with PVR <300 mL was significantly greater than those in patients with PVR ≥300 mL. • The degree of improvement of P(det) Q(max) in PFS, and IPSS in patients with bladder contractility was significantly greater than that in patients without bladder contractility.


CONCLUSIONS
• α1-D/A adrenoceptor antagonist naftopidil has a significant effect on both symptoms and urodynamic variables of patients of both genders with NLUTD in Japan. • PVR <300 mL and bladder contractility are predictive factors for the efficacy of naftopidil on patients with NLUTD.
Department of Urology, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan. matakeda@yamanashi.ac.jp
Masayuki
M
Takeda
Yukio
Y
Homma
Isao
I
Araki
Hidehiro
H
Kakizaki
Tomonori
T
Yamanishi
Takashi
T
Yokota
Momokazu
M
Gotoh
Yasuhiko
Y
Igawa
Narihito
N
Seki
Mineo
M
Takei
Masaki
M
Yoshida
Kimio
K
Sugaya
Osamu
O
Nishizawa
D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use*; D009422:Nervous System Diseases / Q000150:complications*; D010879:Piperazines / Q000627:therapeutic use*; D018340:Receptors, Adrenergic, alpha-1 / Q000187:drug effects* / Q000502:physiology; D012212:Rheology; D016896:Treatment Outcome; D014563:Urodynamics / Q000187:drug effects* / Q000502:physiology; D014570:Urologic Diseases / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
D058668:Adrenergic alpha-1 Receptor Antagonists; D009281:Naphthalenes; D010879:Piperazines; D018340:Receptors, Adrenergic, alpha-1; C064357:naftopidil