URODYNAMIC AND CLINICAL EFFECTS OF TERAZOSIN THERAPY IN SYMPTOMATIC PATIENTS WITH AND WITHOUT BLADDER OUTLET OBSTRUCTION - A STRATIFIED ANALYSIS

Objectives. To evaluate clinical and urodynamic changes in patients wi th and without bladder outlet obstruction (BOO) and to compare the cli nical and urodynamic results of terazosin treatment between patients w ith and without BOG. Methods. In a prospective study, 97 patients who completed a full screening program including urodynamic investigation with pressure-flow study analysis started treatment with terazosin. A total of 60 patients completed 6 months of treatment and were re-evalu ated with International Prostate Symptom Scores (IPSS), uroflowmetry, and urodynamic investigation with pressure-flow study analysis. Patien ts were stratified using the linear passive urethral resistance relati on (lin-PURR) classification according to Schafer. Patients with a tin -PURR of 3 or more were classified as patients with BOO and patients w ith a tin-PURR of 2 or less were classified as patients without BOG. T he clinical and urodynamic changes within and between the groups with and without BOO were evaluated.Results. Terazosin resulted in signific ant symptomatic relief (9 points on the IPSS scale; P < 0.01) and a si gnificant improvement of free urinary flow (3.0 mL/s; P < 0.01). In pa tients with BOO, a statistically significant improvement of all urodyn amic obstruction variables (P < 0.01) was shown. In patients without B OO, a significant improvement of free urinary flow (4.4 mL/s; P < 0.01 ), a statistically significantly improved bladder capacity (increase o f 70 mt; P = 0.01), and no statistically significant changes in urodyn amic obstruction variables (P > 0.05) were shown. Patients with a hypo active detrusor were more prone to early dropout. When comparing the c hanges of symptoms (P = 0.89), quality of life (P = 0.85), and the num ber of patients with improvements of free uroflow of at least 30% (P = 0.15), there appeared to be no significant difference between the gro ups with and without BOO. Conclusions. Although there is a statistical ly significant difference in urodynamic response to terazosin treatmen t between patients with and without BOG, we cannot recommend the use o f pressure-flow studies in the selection of patients for terazosin tre atment because the clinical results of treatment appear not to be sign ificantly different between patients with and without BOG. It seems mo re useful, and certainly less expensive and less invasive, to start al pha(1)-blocker therapy if, on clinical grounds, the urologist consider s the patient to be a candidate for alpha(1)-blocker therapy, and to c ontinue therapy in those who respond. Copyright 1997 by Elsevier Scien ce Inc.