The Correlation Between the Treatment Efficacy and the Sympathetic Activity in Men With Lower Urinary Tract Symptoms

Abstract

PurposeIn this study, we examined the difference in the treatment efficacy depending on the sympathetic activity in men with lower urinary tract symptoms (LUTS).MethodsIn the current single-center, retrospective study, we evaluated a total of 66 male patients aged 40-70 years of age, presenting with LUTS, whose International Prostate Symptom Score (IPSS) exceeded 8 points. They had a past 3-month history of taking alfuzosin XL, and their heart rate variability (HRV) was measured before and after the treatment. In addition, we also recruited 39 healthy volunteers who visited a health promotion center for a regular medical check-up. They were aged between 40 and 70 years and had an IPSS of <8 points. We divided the patients with LUTS into two groups: the groups A and B, based on a low frequency/high frequency (LF/HF) ratio of 1.7, which was the mean value of the LF/HF ratio in the healthy volunteers. After a 3-month treatment with alfuzosin XL, we compared treatment outcomes, based on the IPSS and peak urine flow rate, between the two groups.ResultsA 3-month treatment with alfuzosin XL, comprising the measurement of the HRV, was performed for the 23 patients of the group A (23/38) and 17 of the group B (17/28). After a 3-month treatment with alfuzosin XL, total IPSS and IPSS questionnaire 2 and 5 were significantly lower in the group A as compared with the group B. But this was not seen in the group B. Furthermore, there were no significant differences in other parameters, such as maximal flow rate and IPSS storage subscore, between the two groups.ConclusionsOur results indicate that the treatment efficacy was lower in patients with sympathetic hyperactivity as compared with those with sympathetic hypoactivity. Thus, our results will provide a basis for further studies to clarify causes of LUTS in a clinical setting.

Association between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure: a single-center cross-sectional study

“…Sympathetic activity was not directly measured in this study, but our findings were compatible with those of other studies that measured sympathetic activity and suggested that sympathetic activity could be triggered via storage symptoms. 4,20,21,28 When the cutoff value was set at 40 g, we observed that the We did not find any relationship between postvoiding residual volume and SBP. This may be explained by the low residual urine volumes.…”

“…22 According to Jang et al, in patients with sympathetic hyperactivity, alpha blockers were less effective. 28 They commented that sympathetic hyperactivity was a negative prognostic factor for progression of benign prostate enlargement. However, this correlation was only observed in relation to the total International Prostate Symptom Score.…”

“…Sympathetic activity was not directly measured in this study, but our findings were compatible with those of other studies that measured sympathetic activity and suggested that sympathetic activity could be triggered via storage symptoms. 4 , 20 , 21 , 28 …”

“…Because heart rate variability can be assessed as a non-invasive indicator of sympathetic nervous system function, some researchers have used it to analyze sympathetic activity. 4 , 28 Thus, they synchronously evaluated the relationship between heart rate variability and lower urinary tract symptoms because heart rate variability reflected spontaneous changes in autonomic activity. In another study, changes to SBP and DBP were recorded one and five minutes after a tilt table test, respectively, to assess alterations in autonomic activity.…”

A Social Ecological Perspective of Lower Urinary Tract Symptoms and Other Urological Conditions

“…3 Other possible mechanisms include access to and utilization of health care, [4][5][6]8 as well as physiological stress responses to the experience of adverse SDoH and unmet social needs, particularly when those experiences are chronic or recurrent in nature. 9,10 These mechanisms may explain the association between food insecurity and LUTS if food insecurity is a proxy for the broader experience of social inequities. Basic science is important because findings can inform prevention strategies and treatments that target the mechanisms thought to be most influential in the development or maintenance of LUTS.…”