Witjes W P, Rosier P F, Caris C T, Debruyne F M, de la Rosette J J
Department of Urology, University Hospital Nijmegen, The Netherlands.
Urology. 1997 Feb;49(2):197-205; discussion 205-6. doi: 10.1016/S0090-4295(96)00490-6.
To evaluate clinical and urodynamic changes in patients with and without bladder outlet obstruction (BOO) and to compare the clinical and urodynamic results of terazosin treatment between patients with and without BOO.
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-evaluated with International Prostate Symptom Scores (IPSS), uroflowmetry, and urodynamic investigation with pressure-flow study analysis. Patients were stratified using the linear passive urethral resistance relation (lin-PURR) classification according to Schäfer. Patients with a lin-PURR of 3 or more were classified as patients with BOO and patients with a lin-PURR of 2 or less were classified as patients without BOO. The clinical and urodynamic changes within and between the groups with and without BOO were evaluated.
Terazosin resulted in significant symptomatic relief (9 points on the IPSS scale; P < 0.01) and a significant improvement of free urinary flow (3.0 mL/s; P < 0.01). In patients with BOO, a statistically significant improvement of all urodynamic obstruction variables (P < 0.01) was shown. In patients without BOO, a significant improvement of free urinary flow (4.4 mL/s; P < 0.01), a statistically significantly improved bladder capacity (increase of 70 mL; P = 0.01), and no statistically significant changes in urodynamic obstruction variables (P > 0.05) were shown. Patients with a hypoactive detrusor were more prone to early dropout. When comparing the changes of symptoms (P = 0.89), quality of life (P = 0.85), and the number of patients with improvements of free uroflow of at least 30% (P = 0.15), there appeared to be no significant difference between the groups with and without BOO.
Although there is a statistically significant difference in urodynamic response to terazosin treatment between patients with and without BOO, we cannot recommend the use of pressure-flow studies in the selection of patients for terazosin treatment because the clinical results of treatment appear not to be significantly different between patients with and without BOO. It seems more useful, and certainly less expensive and less invasive, to start alpha 1-blocker therapy if, on clinical grounds, the urologist considers the patient to be a candidate for alpha 1-blocker therapy, and to continue therapy in those who respond.
评估有无膀胱出口梗阻（BOO）患者的临床和尿动力学变化，并比较有、无BOO患者接受特拉唑嗪治疗的临床和尿动力学结果。
在一项前瞻性研究中，97例完成包括压力-流率研究分析的尿动力学检查在内的全面筛查程序的患者开始接受特拉唑嗪治疗。共有60例患者完成了6个月的治疗，并通过国际前列腺症状评分（IPSS）、尿流率测定以及压力-流率研究分析的尿动力学检查进行重新评估。根据舍费尔的线性被动尿道阻力关系（lin-PURR）分类对患者进行分层。lin-PURR为3或更高的患者被分类为BOO患者，lin-PURR为2或更低的患者被分类为无BOO患者。评估有、无BOO组内及组间的临床和尿动力学变化。
特拉唑嗪使症状显著缓解（IPSS评分降低9分；P<0.01），自由尿流率显著改善（增加3.0 mL/s；P<0.01）。在BOO患者中，所有尿动力学梗阻变量均有统计学显著改善（P<0.01）。在无BOO患者中，自由尿流率显著改善（增加4.4 mL/s；P<0.01），膀胱容量有统计学显著增加（增加70 mL；P = 0.01），尿动力学梗阻变量无统计学显著变化（P>0.05）。逼尿肌活动低下的患者更容易早期退出。比较有、无BOO组的症状变化（P = 0.89）、生活质量变化（P = 0.85）以及自由尿流率改善至少30%的患者数量（P = 0.15），似乎没有显著差异。
虽然有、无BOO患者对特拉唑嗪治疗的尿动力学反应存在统计学显著差异，但我们不建议在选择特拉唑嗪治疗患者时使用压力-流率研究，因为有、无BOO患者的治疗临床结果似乎没有显著差异。如果泌尿外科医生基于临床判断认为患者是α1受体阻滞剂治疗的候选者，开始α1受体阻滞剂治疗似乎更有用，而且肯定更便宜且侵入性更小，并且对有反应的患者继续治疗。
