Obstructive Primary Bladder Neck Disease: Evaluation of the Efficacy and Safety of α₁-Blockers

Abstract

Objective: The efficacy and safety of using α₁-adrenergic blockers for treating primary bladder neck obstruction in young and middle-aged men was assessed as the first therapeutic step, before surgery, in a symptomatic non-neurogenic selected group of patients. Materials and Methods: From January 1995 to December 2001, primary bladder neck obstruction was diagnosed in 41 men whose average age was 43 years. All of them were evaluated by a complete clinical history, American Urological Association (AUA) symptom score index, physical examination, uroflowmetry, transabdominal ultrasound prostatic volume determination, ultrasound post-void residual determination, videourodynamics including pressure-flow analysis and upper urinary tract screening with renal ultrasound or an excretory urogram. A full daily dose of α₁-adrenergic blockers (alfuzosin or tamsulosin) was administered for at least 6 months. Successful treatment was defined as improved symptoms, voiding diary, maximum flow rate and pressure-flow parameters. Patients who did not gain improvement of symptoms with pharmacological treatment were offered surgery. Results: Overall, pharmacological treatment was successful in 29/41 patients (70.7%) whereas bladder neck endoscopic incision was mandatory in 12/41 (29.3%). Conclusions: α₁-Blockers were effective and safe for treating young and middle-aged men with symptomatic bladder neck obstruction.

Urodynamic outcomes of tamsulosin in the treatment of primary bladder neck obstruction in men

“…Following diagnosis, all of them were started on tamsulosin, as this was the most commonly used alpha blocker at the time of study in our hospital. Other studies on the subject, both retrospective[ 3 4 10 ] and prospective,[ 5 7 ] are compared with the present study. The number of patients enrolled varied from 9 to 41.…”

“…had attempted to see if there were any urodynamic predictors of success. [ 7 10 ] Cisternino et al . did not find any clinical or urodynamic baseline parameters which would predict the outcome of alpha blockers in their study group.…”

“…Based on available studies in literature,[ 4 7 10 ] mean P det Q max before and after intervention were assumed at 71 cm and 60 cm of water, respectively. Keeping alpha and beta errors at 5% and 20%, respectively, sample size calculated using two-sided test was 28 patients.…”

“…There are few studies which have reported pressure flow study outcomes after alpha blockers. [ 9 10 ] This study aims to objectively study the efficacy of alpha blockers in primary bladder neck obstruction and its impact on urodynamic parameters.…”

Diagnosis and Management of Bladder Outlet Obstruction in Women

“…Treatment options of clean intermittent catheterization (CIC), alpha‐blockers, transurethral incision of the bladder neck, botulinum toxin A (Botox) injection at the bladder neck, and neuromodulation were mentioned in the literatures, while the therapeutic effect varies between these therapies. About 50–64% of women with PBNO responded well to alpha‐blocker therapy . In these patients the flow rates increased, and the PVR volume decreased.…”