title: Urodynamic effects of dutasteride add-on therapy to alpha-adrenergic antagonist for patients with benign prostatic enlargement: prospective pressure-flow study.
abstract: OBJECTIVE
  We prospectively investigated the effect of dutasteride on clinical and urodynamic parameters in patients with benign prostatic enlargement (BPE).
  
  
  METHODS
  A prospective study was conducted in consecutive 52 patients with BPE who had not been satisfied with alpha-adrenergic antagonist monotherapy. Inclusion criteria were prostate volume (PV) ≥30 ml and the International Prostate Symptom Score (IPSS) ≥8 or QOL index ≥3 under administration of an alpha-adrenergic antagonist without anticholinergic agent. Before and 24 weeks after dutasteride (0.5 mg daily) add-on treatment with preceding alpha-adrenergic antagonist, we assessed IPSS, uroflowmetry (UFM), filling cystometry, and pressure-flow study (PFS).
  
  
  RESULTS
  Dutasteride add-on treatment significantly improved IPSS (from 18.4 ± 7.5 to 13.8 ± 7.3) and maximum flow rate (from 11.4 ± 5.6 to 13.0 ± 6.8 ml/sec). Maximum cystometric capacity on filling cystometry did not change significantly by dutasteride add-on treatment (221 ± 97 and 240 ± 104 ml before and after dutasteride add-on, respectively). All of the 41 patients with detrusor overactivity (DO) before dutasteride add-on treatment showed apparent reduction in the amplitude of involuntary detrusor contraction after dutasteride add-on treatment, including seven in whom DO disappeared. Dutasteride significantly reduced PV from 66.4 ± 31.9 to 47.6 ± 26.1 ml. In PFS, detrusor pressure at maximum flow rate (PdetQmax) significantly decreased from 71.5 ± 30.1 to 59.1 ± 24.9 cmH2O after dutasteride add-on treatment. Bladder outlet obstruction index (BOOI) also decreased significantly from 55.2 ± 31.9 to 42.3 ± 27.9, and obstruction grade assessed by the Schäfer nomogram significantly improved.
  
  
  CONCLUSIONS
  Dutasteride can improve lower urinary tract symptoms by improving storage bladder function and relieving obstruction.
authors.affiliation: Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Wada
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kita
authors.forename: Kazumi
authors.initials: K
authors.lastname: Hashizume
authors.forename: Seiji
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kakizaki
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D001378:Azasteroids / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D000068538:Dutasteride; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000188:drug therapy* / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics / Q000187:drug effects* / Q000502:physiology; D064804:Urological Agents / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000317:Adrenergic alpha-Antagonists; D001378:Azasteroids; D064804:Urological Agents; D000068538:Dutasteride
keywords: benign prostatic hyperplasia; benign prostatic obstruction; dutasteride; lower urinary tract symptoms; urodynamics