Use of novel urodynamic parameters, detrusor contraction duration and detrusor contraction index, in men with lower urinary tract symptoms.

The aim of this study was to correlate the results of the urodynamic measures, detrusor contraction duration (DCD) and detrusor contraction index (DCI), with voiding symptoms in untreated men with lower urinary tract symptoms (LUTS) and in men treated with doxazosin. Ninety-one men with untreated LUTS underwent urodynamic evaluation. DCD (duration of detrusor contraction in seconds), DCI (interval, in seconds, that urine is passed divided by the total duration of the bladder contraction), and standard urodynamic measures of obstruction were determined. The urodynamic findings were correlated with the severity of voiding symptoms as assessed by the International Prostate Symptom Score (I-PSS). Fifty of these men were treated subsequently with 4 mg of doxazosin for 3 months and then underwent repeat urodynamic evaluation, in which changes in symptom score and urodynamic results were analyzed. DCD was the only urodynamic measure that correlated significantly with the I-PSS results in untreated patients. Although DCD, detrusor pressure at maximum flow, and the Abrams-Griffiths number decreased in men treated with doxazosin, only DCI and symptom score improved significantly after treatment for 3 months. No urodynamic parameter was useful in predicting the likelihood of a favorable response to treatment with doxazosin. DCD and DCI may be useful urodynamic measures in untreated men with LUTS and in those treated with doxazosin. Further study of these parameters is warranted.

Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms.

OBJECTIVES: To assess the effects of saw palmetto on voiding symptoms and urodynamic parameters in men with lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH). METHODS: Fifty men with previously untreated LUTS and a minimum International Prostate Symptom Score (IPSS) of 10 or greater were treated with a commercially available form of saw palmetto (160 mg twice per day) for 6 months. The initial evaluation included measurement of peak urinary flow rate, postvoid residual urine volume, pressure-flow study, and serum prostate-specific antigen (PSA) level. Patients completed an IPSS, serum PSA was determined, and flow rate was measured every 2 months during the course of the study. A urodynamic evaluation was repeated at the completion of the 6-month trial. RESULTS: The mean IPSS (+/-SD) improved from 19.5+/-5.5 to 12.5+/-7.0 (P <0.001) among the 46 men who completed the study. Significant improvement in the symptom score was noted after treatment with saw palmetto for 2 months. An improvement in symptom score of 50% or greater after treatment with saw palmetto for 2, 4, and 6 months was noted in 21% (10 of 48), 30% (14 of 47), and 46% (21 of 46) of patients, respectively. There was no significant change in peak urinary flow rate, postvoid residual urine volume, or detrusor pressure at peak flow among patients completing the study. No significant change in mean serum PSA level was noted. CONCLUSIONS: Saw palmetto is a well-tolerated agent that may significantly improve lower urinary tract symptoms in men with BPH. However, we were unable to demonstrate any significant improvement in objective measures of bladder outlet obstruction. Placebo-controlled trials of saw palmetto are needed to evaluate the true effectiveness of this compound.

Doxazosin in men with lower urinary tract symptoms: urodynamic evaluation at 15 months.

OBJECTIVES: To assess the results of doxazosin treatment in men with lower urinary tract symptoms (LUTS) treated for 15 months and to correlate symptomatic changes with alterations in urodynamic measures. METHODS: After an initial 3-month treatment period with doxazosin 4 mg/day, 50 men with LUTS were given the choice of continued treatment with this agent or other therapeutic options. All patients were evaluated by International Prostate Symptom Score (IPSS) questionnaires and urodynamic evaluation initially and after 3 months of treatment. Patients were followed for an additional 12 months and those who continued doxazosin treatment underwent repeat urodynamic testing. RESULTS: Among the original 50 patients, 24 men (48%) continued doxazosin treatment for 15 months, 18 men (36%) discontinued therapy, and 8 men (16%) were either dead or lost to follow-up or had been diagnosed and treated for prostate cancer. Comparison of values at 3 and 15 months of follow-up (9.4 versus 13.4, P = 0.03) showed significant worsening of voiding symptoms, as assessed by the IPSS, in the 24 men still receiving doxazosin. This deterioration of subjective results with doxazosin occurred despite continued improvements in peak urinary flow rate (Qmax), detrusor pressure at peak flow (PdetQmax), and objective measures of obstruction (Abrams-Griffiths number) from 3 to 15 months of follow-up. CONCLUSIONS: Relief of voiding symptoms in men with LUTS treated with doxazosin over prolonged intervals of 15 months does not correlate well with changes in urodynamic measures.

Ambulatory urodynamic evaluation of men with lower urinary tract symptoms treated with doxazosin.

We investigate the results of ambulatory urodynamic evaluation of men with lower urinary tract symptoms (LUTS) believed secondary to benign prostatic hyperplasia (BPH) treated with doxazosin and compare these results to conventional urodynamic study. Ten men with previously untreated LUTS underwent conventional urodynamic evaluation, which was repeated after treatment with doxazosin (4 mg daily) for 3 months. All patients continued on doxazosin and subsequently underwent ambulatory urodynamic evaluation. All men completed an International Prostate Symptom Score (I-PSS) questionnaire with a decrease in score from a mean of 20.4 initially to 8.7 after treatment with doxazosin for 3 months. The mean maximum urinary flow rate increased from 11.9 to 15.3 cc/s and the mean detrusor pressure at peak flow decreased from 99 to 82 cm H2O. The mean duration of ambulatory study was 5 h and 8 minutes (mean 6 voiding cycles). The mean ambulatory voiding pressure in the ten patients treated with doxazosin was 75 cm H2O. Ambulatory urodynamic monitoring is well tolerated by most men with LUTS. Intravesical voiding pressures remain in the obstructed range in most men treated with doxazosin despite marked improvement in urinary symptoms. Ambulatory urodynamic evaluation demonstrates that these elevated detrusor pressures are present during routine daily activities. The long-term effect of increased voiding pressures on urinary tract function is unclear.

An observational urodynamic evaluation of men with lower urinary tract symptoms treated with doxazosin.

OBJECTIVES: To assess the urodynamic changes in men with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction treated with doxazosin and to correlate these changes with voiding symptoms. METHODS: Fifty patients with LUTS were treated with doxazosin at a dose of 4 mg/day for 3 months. All men were initially evaluated by International Prostate Symptom Score (I-PSS) questionnaires, measurements of urinary flow rate, and complex urodynamic study. Those patients completing the 3-month study underwent repeat testing. RESULTS: Forty-four (88%) men underwent initial and follow-up urodynamic evaluation. The mean I-PSS improved from 20.6 to 10.5 (P < 0.001), mean peak urinary flow rate increased for 11.7 to 13.2 cc/s (P = 0.20), mean detrusor pressure at peak flow decreased from 9 3.6 to 83.0 cm H20 (P = 0.15), and mean cystometric bladder capacity increased from 266 to 304 cc (P = 0.07). Using the Abrams-Griffiths nomogram and number, more than 58% of patients remained obstructed after treatment with doxazosin for 3 months. Men with and without objective evidence of bladder outlet obstruction at the outset of the study had similar improvement in voiding symptoms. Most patients elected to continue treatment with doxazosin at the completion of the study (41/44, 93%). CONCLUSIONS: The majority of patients had objective evidence of persistent bladder outlet obstruction after treatment with doxazosin for 3 months despite significant benefit. The results of complex urodynamic evaluation did not predict treatment response in men with LUTS suggestive of bladder outlet obstruction. Urodynamic study does not appear to be helpful in the evaluation of patients with uncomplicated LUTS prior to treatment with doxazosin.