title: A Slow Stream Is Pathophysiologically Related to a Poor Response to α1-Adrenoceptor Therapy in the Treatment of Storage Symptoms Associated With Benign Prostatic Hyperplasia.
abstract: OBJECTIVE
  To investigate the etiology of overactive bladder (OAB) symptoms during secondary treatment following initial unsuccessful therapy with α1-blockers in benign prostatic hyperplasia (BPH)/OAB patients.
  
  
  METHODS
  BPH/OAB patients were selected if urinary urgency did not improve with initial α1-blocker therapy and if dose escalation was required as secondary treatment for a period of 8 weeks. The overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), and uroflowmetry were evaluated. On the basis of the OABSS at the end of secondary therapy, we divided patients into two groups: patients in whom OAB symptoms improved ("resolved OAB group") and patients in whom OAB symptoms persisted ("persistent OAB group"). Differences in subjective symptoms and objective parameters between the groups were analyzed.
  
  
  RESULTS
  OAB symptoms improved in 33 of 79 patients (42%) after secondary treatment. The changes in the total OABSS and International Prostate Symptom Score from the beginning of the secondary treatment were -2.15 and -3.97, respectively, in the resolved OAB group, indicating a significant decrease in the OABSS compared to that in the persistent OAB group (-0.91 and -1.11, respectively). The change in average flow rate (Qave; +1.34) from the beginning of secondary treatment in the resolved OAB group was significantly greater than the change in the persistent OAB group (+0.58). Improvements in urgency and Qave were significantly correlated (r = -0.264, P = .031).
  
  
  CONCLUSIONS
  Improvement in urinary stream contributed to the resolution of OAB symptoms in BPH/OAB patients. In the management of OAB symptoms in BPH/OAB patients, examination and therapy for both urinary stream and OAB symptoms could be substantially important.
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: yoshi44@med.nagoya-u.ac.jp.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Matsukawa
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Takai
authors.affiliation: Department of Urology, Handa Municipal Hospital, Handa, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Asai
authors.affiliation: Department of Urology, Kasugai Municipal Hospital, Kasugai, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Kasugai
authors.affiliation: Narita Clinic, Nagoya, Japan.
authors.forename: Harunori
authors.initials: H
authors.lastname: Narita
authors.affiliation: Department of Urology, Chukyo Hospital, Nagoya, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Komatsu
authors.affiliation: Department of Urology, Okazaki Municipal Hospital, Okazaki, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Kashiwagi
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Urology, Tsushima Municipal Hospital, Tsushima, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Tokunori
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Momokazu
authors.initials: M
authors.lastname: Gotoh
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000008:administration & dosage; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000008:administration & dosage*; D010879:Piperazines / Q000008:administration & dosage*; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014554:Urination / Q000187:drug effects / Q000502:physiology*
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D009281:Naphthalenes; D010879:Piperazines; C064357:naftopidil