alpha 1-Blockers Improve Benign Prostatic Obstruction in Men with Lower Urinary Tract Symptoms: A Systematic Review and Meta-analysis of Urodynamic Studies

作者：Fusco Ferdinando^*; Palmieri Alessandro; Ficarra Vincenzo; Giannarini Gianluca; Novara Giacomo; Longo Nicola; Verze Paolo; Creta Massimiliano; Mirone Vincenzo

来源：European Urology, 2016, 69(6): 1091-1101.

DOI：10.1016/j.cururo.2015.12.034

• alpha 1-Blockers
• Benign prostatic hyperplasia
• Benign prostatic obstruction
• Bladder outlet obstruction index
• Lower urinary tract symptoms
• Meta-analysis
• Urodynamics

Context: The urodynamic outcomes for alpha 1-blockers (ABs) treatment in patients with lower urinary tract symptoms related to benign prostatic enlargement (LUTS/BPE) is a matter of debate.
Objective: To perform a systematic review and meta-analysis of studies evaluating the ABs urodynamic outcomes in patients with LUTS/BPE. The primary endpoint was variation in bladder outlet obstruction index (B001). Secondary endpoints were the maximum urinary flow rate (Q(max)) and detrusor pressure at Q(max) (P(det)Q(max)). A meta analysis of placebo-controlled randomized clinical trials (RCTs) was performed to compare ABs with placebo.
Evidence acquisition: A systematic review of PubMed/Medline, ISI Web of Knowledge, and Scopus databases was performed in May 2015. Seventeen studies were selected for inclusion.
Evidence synthesis: The overall pooled data showed a mean B001 change of-14.19 (p < 0.0001), a mean P(det)Q(max) change of-11. 39 cm H2O (p < 0.0001), and a mean Q(max) improvement of 2.27 ml/s (p < 0.0001). Subgroup analysis showed a mean B001 change of-14.88 (p = 0.01) for alfuzosin,-19.41 (p = 0.01) for doxazosin,-16.47 (p < 0.0001) for naftopidil,-30.45 (p < 0.0001) for silodosin,-14.27 (p = 0.002) for tamsulosin, and-6.69 (p = 0.005) for terazosin. Subanalysis of RCTs containing a placebo arm showed a significant improvement in B001 in patients undergoing ABs treatment. Meta-regression revealed a significant positive association between the percentage of patients with obstruction at baseline and the improvement in B001 after treatment with ABs.
Conclusion: ABs improve B001 in patients with LUTS/BPE mainly by reducing PdetQmax, and this effect is higher in patients presenting with urodynamic obstruction at baseline. The free Q(max) variation underestimates the real effect of ABs on benign prostatic obstruction.
Patient summary: Results of this meta-analysis suggest that al-blockers objectively improve urinary voiding function in patients with benign prostatic obstruction.

• 出版日期2016-6