Detrusor contraction duration may predict response to alpha-blocker therapy for lower urinary tract symptoms
Kaplan, S.A.; Stifelman, M.; Avillo, C.; Reis, R.B.; Te, A.E.
European Urology 37(3): 314-317
2000
ISSN/ISBN: 0302-2838 PMID: 10720858 Document Number: 517161
Objectives: Baseline pressure/flow parameters have not correlated well with response to medical therapy for lower urinary tract symptoms (LUTS). This open-label, nonrandomized retrospective study was designed to evaluate whether the urodynamic parameter duration (in seconds) of the detrusor contraction (DCD) correlates better with alpha-blocker response than previously described urodynamic parameters. Methods: 93 men (mean age 62.6+-8.5) with LUTS underwent urodynamic evaluation prior to initiating therapy with doxazosin titrated to 8 mg and followed for 6 months. Parameters of evaluation included the AUA symptom score (AUASx), peak urinary flow rate (Qmax), maximal detrusor pressure (Pmax), detrusor pressure at maximal flow (Pdet) and DCD. The correlation and predictive value of therapeutic response and baseline urodynamic parameters were assessed. Results: 85 patients were evaluable at 6 months. For the entire group, AUASx decreased from 15.1+-6.9 to 9.7+-5.1 (-36%) and Qmax increased from 9.3+-3.7 to 11.9+-5.7 ml/s (+28%). Baseline Pmax was 74.8+-19.6 cm H2O, Pdet was 61.6+-18.9 cm H2O and DCD was 107.6+-28.6 s. There was weak correlation between either baseline Pmax or Pdet and therapeutic response (defined as a decrease in AUASx of 40% and an increase in Qmax of 30%). Utilizing a baseline DCD of 90 s or more, there was a significant correlation to therapeutic response (r = 0.48, p = 0.002). Conclusions: These preliminary data suggest that DCD may be a useful urodynamic parameter to predict and optimize therapy with a-blockade. The potential utility and cost-effectiveness of DCD remains to be determined.