title: Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease.
abstract: OBJECTIVE
  To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease.
  
  
  METHODS
  In a prospective study, 33 consecutive men (mean age 59.2 ± 7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated.
  
  
  RESULTS
  Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4 ± 7.5 to 11.1 ± 6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8 ± 1.1 to 1.0 ± 1.0 (p<0.001) and the maximum urinary flow varied from 9.3 ± 4.4 to 11.2 ± 4.6 ml/s (p=0.025). The severity of neurological impairment was the only predictor of the clinical response. Additionally, patients with a Unified Parkinson's Disease Rating Scale score lower than 70 had a significantly higher chance of clinical improvement with doxazosin treatment than those with higher Unified Parkinson's Disease Rating Scale scores did (RR=3.10, 95% CI=[1.15 to 5.37], p=0.011).
  
  
  CONCLUSIONS
  Doxazosin resulted in the improvement of lower urinary tract symptoms and the maximum flow rate and was well tolerated in men with Parkinson's disease. The response to treatment is dependent on the severity of neurological disability.
authors: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil.
authors: Cristiano M
authors: CM
authors: Gomes
authors: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil.
authors: Zein M
authors: ZM
authors: Sammour
authors: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil.
authors: Jose de
authors: Jd
authors: Bessa Junior
authors: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo, SP, Brazil.
authors: Egberto R
authors: ER
authors: Barbosa
authors: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil.
authors: Roberto I
authors: RI
authors: Lopes
authors: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo, SP, Brazil.
authors: Flávio S
authors: FS
authors: Sallem
authors: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil.
authors: Flavio E
authors: FE
authors: Trigo-Rocha
authors: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil.
authors: Homero
authors: H
authors: Bruschini
authors: New York University, Department of Urology, New York, USA.
authors: Victor W
authors: VW
authors: Nitti
authors: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Urology, São Paulo, SP, Brazil.
authors: Miguel
authors: M
authors: Srougi
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D017292:Doxazosin / Q000627:therapeutic use*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology*; D011446:Prospective Studies; D011788:Quality of Life; D012372:ROC Curve; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014563:Urodynamics / Q000502:physiology
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D000978:Antiparkinson Agents; D017292:Doxazosin
references: J Neurol Neurosurg Psychiatry. 2000 Apr;68(4):429-33
references: 10727477
references: Eur Urol. 2013 Jul;64(1):118-40
references: 23541338
references: J Urol. 2000 Dec;164(6):1948-55
references: 11061889
references: J Urol. 2001 Jan;165(1):38-41
references: 11125359
references: Neurourol Urodyn. 2001;20(1):105-13
references: 11135387
references: Am J Physiol Regul Integr Comp Physiol. 2001 May;280(5):R1414-9
references: 11294762
references: Auton Neurosci. 2001 Sep 17;92(1-2):76-85
references: 11570707
references: J Neurol Neurosurg Psychiatry. 2001 Nov;71(5):600-6
references: 11606669
references: Funct Neurol. 2001 Jul-Sep;16(3):277-82
references: 11769873
references: J Urol. 2002 Mar;167(3):1513-21
references: 11832780
references: Urology. 2003 Jul;62(1):1-9
references: 12837408
references: J Urol. 2003 Aug;170(2 Pt 1):498-502
references: 12853808
references: Lancet Neurol. 2004 Jun;3(6):362-8
references: 15157851
references: Lancet. 2004 May 29;363(9423):1783-93
references: 15172778
references: Neurourol Urodyn. 2004;23(7):689-96
references: 15382192
references: J Urol. 1983 Jan;129(1):80-3
references: 6827689
references: Br J Urol. 1983 Dec;55(6):691-3
references: 6652440
references: J Urol. 1988 Jul;140(1):117-8
references: 2454326
references: Lancet. 1988 Dec 24-31;2(8626-8627):1451-3
references: 2904571
references: Urol Clin North Am. 1990 Aug;17(3):553-66
references: 1695782
references: Neurourol Urodyn. 2006;25(2):116-22
references: 16402391
references: J Urol. 2009 May;181(5):2209-13
references: 19296974
references: Neurourol Urodyn. 2009;28(6):510-5
references: 19191278
references: Eur Urol. 2009 Jul;56(1):81-8
references: 19403235
references: J Urol. 2000 Nov;164(5):1640-3
references: 11025724