Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease

Abstract

OBJECTIVES: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.

Lower urinary tract symptoms in Parkinson's disease: Prevalence, aetiology and management

“…These drugs are thought to reduce resistance throughout the bladder outlet by relaxing the smooth muscle activity in the prostate, urethra and bladder neck. In a 12 week open label study, Gomez et al found that doxazocin, a selective alpha-adrenoceptor agonist, was associated with significant improvement in LUTS severity and on quality of life [97]. It should be noted that alpha adrenoceptors may worsen or induce orthostatic hypotension in PD.…”

Current Surgical Treatment for Neurogenic Lower Urinary Tract Dysfunction in Patients with Chronic Spinal Cord Injury

“…Reflex voiding and voiding by abdominal pressure should be avoided unless the intravesical pressure remains within 40 cmH2O [ 133 ]. Alpha-adrenergic antagonists and urethral sphincter botulinum toxin A injection may be effective in decreasing urethral resistance and improve voiding [ 134 , 135 , 136 , 137 ]. Surgeries such as external sphincterotomy may be considered to reduce urethral resistance in patients’ refractory to conservative treatments.…”

Clinical Perspectives of Parkinson's Disease for Ophthalmologists, Otorhinolaryngologists, Cardiologists, Dentists, Gastroenterologists, Urologists, Physiatrists, and Psychiatrists

“… 11 111 α-Adrenergic blockers (tamsulosin, doxazosin, or terazosin) can be used for the sensation of incomplete bladder emptying and an intermittent urinary stream. 111 119 Phosphodiesterase inhibitors (sildenafil, tadalafil, or vardenafil) are used to treat sexual dysfunction in patients with PD, but they are not generally recommended for patients with cardiovascular disease. 11 111 …”