title: Role of Bladder Neck and Urethral Sphincter Dysfunction in Men with Persistent Bothersome Lower Urinary Tract Symptoms after α-1 Blocker Treatment.
abstract: OBJECTIVE
  To analyze the video-urodynamic results of voiding dysfunction in men of all ages with bothersome lower urinary tract symptoms (LUTS) after α-1 adrenoceptor blocker therapy.
  
  
  METHODS
  A total of 930 consecutive men over 45 years of age with LUTS who were failure treated with α-1 blocker therapy for at least one month were retrospectively studied. Patients underwent video-urodynamic studies to evaluate the cause of lower urinary tract dysfunction (LUTD). Clinical symptoms, prostatic measurements, and video-urodynamic findings were compared among different LUTD groups.
  
  
  RESULTS
  After video-urodynamic studies, 653 (70.2%) men were diagnosed with voiding dysfunction and 277 (29.8%) were with bladder dysfunction. Among patients with voiding dysfunction, bladder neck dysfunction (BND) occurred in 242 (37.1%), benign prostatic obstruction (BPO) in 298 (45.6%), and poor relaxation of the external sphincter (PRES) in 113 (17.3%). The symptom score did not differ significantly among the three subgroups. The mean age, total prostate volume (TPV), transition zone index, and prostate-specific antigen were also significantly higher in BPO patients compared with the other two subgroups, but no difference was noted between BND and PRES patients. BPO patients had significantly higher voiding pressure, higher Abrams-Griffiths number, lower Qmax, and a higher rate of detrusor overactivity than did patients in the other two subgroups.
  
  
  CONCLUSIONS
  Bladder neck dysfunction and PRES play important roles in male LUTS. In men younger than 70 years with small TPV and persistent LUTS after α-1 blocker therapy, video-urodynamic studies should be performed to make an accurate diagnosis before invasive surgery is planned.
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan.
authors.forename: Qian-Sheng
authors.initials: QS
authors.lastname: Ke
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan.
authors.forename: Yuan-Hong
authors.initials: YH
authors.lastname: Jiang
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan.
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014521:Urethra / Q000503:physiopathology*; D001743:Urinary Bladder / Q000503:physiopathology*; D014555:Urination Disorders / Q000209:etiology; D014563:Urodynamics; D014570:Urologic Diseases / Q000139:chemically induced / Q000209:etiology / Q000503:physiopathology*; D014741:Video Recording
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists
keywords: benign prostatic hyperplasia; bladder outlet obstruction; detrusor overactivity; video-urodynamic studies; voiding dysfunction