Tolerability of alpha-blockade with doxazosin as a therapeutic option for symptomatic benign prostatic hyperplasia in the elderly patient: a pooled analysis of seven double-blind, placebo-controlled studies.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a common disorder in males, and its incidence increases with age. Safety results from trials with doxazosin therapy in elderly patients were collated and described. METHODS: Safety data were collated from seven completed multicenter, double-blind, placebo-controlled studies of doxazosin in the treatment of BPH in older patients and analyzed according to age group (< 65 and > or = 65 years) and blood pressure status. RESULTS: Data for 341 patients aged > or = 65 years (217 normotensive, 124 hypertensive) and 322 patients aged < 65 years (207 normotensive, 115 hypertensive) were available. In normotensive subjects a statistically nonsignificant smaller percentage of elderly patients reported adverse events than younger patients in both doxazosin (42% compared with 47%) and placebo (38% compared with 44%) groups. The most common adverse events were fatigue, headache, and dizziness whereas withdrawals due to adverse events were 6% (elderly) and 7% (younger) for doxazosin patients and 9% and 5% for placebo patients, respectively. In hypertensive patients 43% of elderly doxazosin patients reported adverse events compared with 30% of elderly placebo patients, the most common events in both groups being dizziness, headache, fatigue, and dyspnea. Incidence of withdrawal due to adverse events was 11% with doxazosin and 4% with placebo. Very few serious adverse events were reported throughout these trials in any group. Nonsignificant reductions in mean blood pressure were seen in all normotensive patients. Fewer elderly patients had a clinically significant reduction in blood pressure than younger patients (26% vs 30%, respectively). CONCLUSIONS: These studies show doxazosin to be equally well tolerated in young and old, normotensive and hypertensive patients with BPH.

Pseudodyssynergia (contraction of the external sphincter during voiding) misdiagnosed as chronic nonbacterial prostatitis and the role of biofeedback as a therapeutic option.

PURPOSE: Chronic lower urinary tract symptoms in young men are often attributed to misdiagnosed chronic nonbacterial prostatitis. We analyzed contraction of the external urinary sphincter during voiding (pseudodyssynergia) as an etiology of voiding dysfunction in men with misdiagnosed chronic prostatitis. MATERIALS AND METHODS: The video urodynamic studies of 43 men 23 to 50 years old with chronic voiding dysfunction secondary to pseudodyssynergia performed between January 1990 and June 1996 were retrospectively analyzed. Pseudodyssynergia was diagnosed based on several criteria, including electrical activity of the external sphincter during voiding in the absence of abdominal straining, and brief and intermittent closing of the membranous urethra during voiding detected by electromyography and fluoroscopy. Patients with bacterial infection or excessive leukocytes in expressed prostatic secretions were excluded from the study. RESULTS: Of the patients 39 (91%) were firstborn men. Duration of symptoms ranged from 17 to 146 months (mean 43.6). Average number of previous antibiotic days ranged from 53 to 186 (mean 67.6). In addition, empirical trials of alpha-blockers were unsuccessful. Mean American Urological Association symptom score plus or minus standard deviation was 17.5 +/- 3.7, mean maximum flow rate was 13.3 +/- 4.2 ml. per second, mean detrusor pressure at maximum flow was 46.3 +/- 13.7 cm. water and mean detrusor contraction duration was 132.8 +/- 27.7 seconds. Behavior modification and biofeedback were successful in decreasing symptoms in 35 patients (83%) at 6 months. CONCLUSIONS: These results indicate that some men who are categorized as having and empirically treated for chronic nonbacterial prostatitis are misdiagnosed and, in fact, have functional bladder outlet obstruction. Urodynamics are helpful in diagnosing and predicting success with behavior modification and biofeedback in these patients.

Etiology of voiding dysfunction in men less than 50 years of age.

OBJECTIVES: Chronic lower urinary tract symptoms in young men are often attributed to misdiagnosed chronic nonbacterial prostatitis. The purpose of this study was to analyze etiology of chronic voiding dysfunction in men less than 50 years of age. METHODS: The videourodynamic studies of 137 men 50 years of age or less with chronic voiding dysfunction, performed between January 1990 and October 1995, were retrospectively analyzed. RESULTS: The distribution of urodynamic abnormalities included 74 (54%) patients with primary vesical neck obstruction, 33 (24%) with obstruction localized to membranous urethra (pseudodyssnergia), 23 (17%) with impaired bladder contractility, and the remaining 7 (5%) with an acontractile bladder. Detrusor instability was present in 67 men (49%). CONCLUSIONS: Voiding dysfunction among young men is common and is often misdiagnosed. Videourodynamic evaluation is very useful in establishing the correct diagnosis and ultimately in delivery of appropriate therapy.