title: Benign Prostatic Obstruction Relief in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Enlargement Undergoing Endoscopic Surgical Procedures or Therapy with Alpha-Blockers: A Review of Urodynamic Studies.
abstract: Benign prostatic obstruction (BPO) contributes to the genesis of lower urinary tract symptoms as well as to pathologic remodeling of the lower and upper urinary tract in patients with benign prostate enlargement. Urodynamic studies demonstrate that both medical therapy with alpha-blockers (ABs) and endoscopic surgical procedures provide BPO relief. However, the magnitude of improvement is higher after surgery. Among ABs, silodosin is associated with the highest improvement of bladder outlet obstruction index (BOOI). A complex relationship exists between BOOI improvement and variations of both maximum urinary flow (Qmax) and detrusor pressure. When the reduction of BOOI is small, the improvement of Qmaxis clinically irrelevant and the BOOI is mainly influenced by a decrease of detrusor pressure. In contrast, when the magnitude of BOOI reduction is robust, a meaningful improvement of both detrusor pressure and urinary flow is evident. When clustering ABs according to their receptor pharmacologic selectivity and urodynamic efficacy, three subgroups can be identified,with silodosin being the only member of a subgroup characterized by the highest levels of BOOI improvement and α-1A/α-1B receptor affinity ratio.
authors.affiliation: Department of Urology, University Federico II of Naples, Naples, Italy. ferdinando-fusco@libero.it.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Fusco
authors.affiliation: Urology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Creta
authors.affiliation: Urology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Imperatore
authors.affiliation: Department of Urology, University Federico II of Naples, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Longo
authors.affiliation: Department of Urology, University Federico II of Naples, Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Imbimbo
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Lepor
authors.affiliation: Department of Urology, University Federico II of Naples, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D004724:Endoscopy; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D011470:Prostatic Hyperplasia / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D001748:Urinary Bladder Neck Obstruction / Q000188:drug therapy / Q000628:therapy*; D014563:Urodynamics
chemical_list: D000317:Adrenergic alpha-Antagonists; D007211:Indoles; C095285:silodosin
keywords: Alpha-blockers; Benign prostatic obstruction; Surgery; Urodynamics