Effects of Selective Alpha-1-Adrenergic Receptor Blockers on Bladder Weight

Abstract

Introduction: This study was undertaken to investigate the effects of two different α₁-adrenergic blockers on bladder hypertrophy using ultrasound-estimated bladder weight (UEBW) and to assess the relation between changes in UEBW and other objective and subjective parameters of disease severity in patients with benign prostatic hyperplasia (BPH). Materials and Methods: 41 men were enrolled in the study and they were subjected to either watchful waiting (group 1) or α₁-adrenergic receptor blocker therapy (group 2 with alfuzosin; group 3 with tamsulosin). The patients were investigated by symptom evaluation using the International Prostate Symptom Score (IPSS) and quality of life score (QOL), uroflowmetry and UEBW. The parameters were assessed again 3 months after initiation of treatment and compared with the initial values. Results: While the mean UEBW increased in group 1 (42.2 ± 10.3 to 52.5 ± 12.2 g), it decreased in both the other groups that received α-blocker therapy (61.3 ± 18.7 to 41.1 ± 13.2 and 59.4 ± 17.2 to 43.5 ± 17.6 g, respectively). In groups 2 and 3, the mean UEBW, post-void residual urine, IPSS and QOL values decreased, and the mean maximum flow rate increased. All of the changes in group 2 and all except QOL in group 3 were statistically significant (p < 0.05). The changes correlated well with each other with regard to treatment success. The highest decreases in UEBW were encountered in patients with heavier bladders. Conclusions: UEBW decreases with α₁-adrenergic receptor blockers. When used together with the other objective and subjective parameters, UEBW is a promising quantitative parameter as a follow-up tool and can be useful in monitoring the therapeutic effects of α₁-adrenergic receptor blockers.

International consultation on incontinence‐research society (ICI‐RS) report on non‐invasive urodynamics: The need of standardization of ultrasound bladder and detrusor wall thickness measurements to quantify bladder wall hypertrophy

“…23 Ultrasound studies in men with lower urinary tract symptoms (LUTS) due to BPH showed during a-blocker treatment a decrease of symptoms and postvoid residual urine as well as increase of maximum urinary flow rate which correlated well with decrease of bladder wall hypertrophy. 26,27 Studies on women with detrusor overactivity showed that antimuscarinic drugs can also reduce BWT quickly. 28,29 Children with myelomeningoceles and an unfavorable urodynamic pattern have increased BWT; 17 however, children with sufficient treatment and regular follow-up investigations have DWTs similar to healthy controls.…”

The relationship between bladder wall thickness and lower urinary tract symptoms: Does bladder wall thickness change after alpha-blocker therapy with alfuzosin?

“…This causes proliferation in mucosa, submucosa, detrusor, and serosa and a decrease in bladder compliance affecting the response of the bladder to filling and contraction. [12][13][14] …”

“…10 Alpha-blocker treatment with tamsulosin in men with prostatic hyperplasia decreased the ultrasound-estimated bladder weight (from 65 to 28 g). 13,14 In another study, the authors found that BWT was associated with intravesical prostatic protrusion and worsening storage symptom scores in BPH patients with LUTS. They found that alpha-blocker therapy did not improve irritative symptoms in BPH patients and that their BWT increased.…”

Diagnostic Potential of Imaging Modalities in the Assessment of Lower Urinary Tract Dysfunctions

“…In addition, measurement of DWT or BWT with US can used to examine the response to surgical or medical treatment of BOO. For instance, reduced BWT is detected after treatment with α-1 receptor blockers and transvesical prostatectomy [29,30]. The ultrasonographic sections of the urinary bladder are defined from outside-in as bladder hyperechoic (adventitia), hypoechoic (detrusor muscle) and hyperechoic (bladder mucosa) [31,32].…”