Detrusor contraction duration may predict response to alpha-blocker therapy for lower urinary tract symptoms

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 whet her the urodynamic parameter duration (in seconds) of the detrusor contract ion (DCD) correlates better with alpha-blocker response than previously des cribed urodynamic parameters. Methods: 93 men (mean age 62.6+/-8.5) with LUTS underwent urodynamic evalua tion prior to initiating therapy with doxazosin titrated to 8 mg and follow ed for 6 months. Parameters of evaluation included the AUA symptom score (A UASx), peak urinary flow rate (Q(max)), maximal detrusor pressure (P-max), detrusor pressure at maximal flow (P-det) and DCD. The correlation and pred ictive value of therapeutic response and baseline urodynamic parameters wer e assessed. Results: 85 patients were evaluable at 6 months. For the entire group, AUAS x decreased from 15.1+/-6.9 to 9.7+/-5.1 (-36%) and Q(max) increased from 9 .3+/-3.7 to 11.9+/-5.7 ml/s (+28%). Baseline P-max was 74.8+/-19.6 cm H2O, P-det was 61.6+/-18.9 cm H2O and DCD was 107.6+/-28.6 s. There was weak cor relation between either baseline P-max or P-det and therapeutic response (d efined as a decrease in AUASx of 40% and an increase in Q(max) of 30%). Uti lizing 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 urodyn amic parameter to predict and optimize therapy with a-blockade. The potenti al utility and cost-effectiveness of DCD remains to be determined. Copyrigh t (C) 2000 S. Karger AG, Basel.