Single‐blind, randomized controlled study of the clinical and urodynamic effects of an α‐blocker (naftopidil) and phytotherapy (eviprostat) in the treatment of benign prostatic hyperplasia

Abstract

Aim : The aim of our study was to examine the efficacy of naftopidil in terms of the international prostate symptom score (IPSS) and urodynamic parameters in the treatment of benign prostatic hyperplasia (BPH). Eviprostat was used as a control to study the efficacy of naftopidil. Methods : Forty-nine patients with BPH (mean age 67.9 ± 7.8 years) were involved in the study.Patients were randomly assigned either to the naftopidil group, which was treated with the a -blocker naftopidil (50-75 mg daily, 36 patients), or the eviprostat group, which was treated with phytotherapy (six tablets of eviprostat daily, 13 patients).Results : The mean total IPSS, the total storage and voiding symptom scores, and the quality of life score decreased significantly ( P < 0.0001 for each variable) in the naftopidil group, but not in the eviprostat group. In the naftopidil group, analyses showed significant increases in average and maximum flow rate and bladder capacity at first desire to void ( P < 0.001, P = 0.001 and P = 0.024, respectively), and significant decreases in the postvoid residual, the percent of residual and the Abrams-Griffiths number ( P = 0.009, P = 0.008 and P = 0.042, respectively). However, in the eviprostat group, no significant changes were noted in terms of these symptomatic and urodynamic parameters. In the pressure/flow study, an improvement in the International Continence Society nomogram grade was noted in 29% of the naftopidil group, but in only 16% of the eviprostat group. Among the 14 patients in the naftopidil group, detrusor overactivity disappeared in 21% and cystometric capacity increased in 36%, but no improvement in detrusor overactivity was noted in the eviprostat group.Conclusions : Naftopidil appears to have been effective in this short-term treatment of BPH.

Urodynamic effects of silodosin, a new α1A‐adrenoceptor selective antagonist, for the treatment of benign prostatic hyperplasia

“…It has been reported that a 1 -AR antagonists are effective for both storage and voiding symptoms because they decrease BOO and alleviate DO. [1][2][3][4]7 On the contrary, it has also been reported that a 1 -AR antagonists improve LUTS but fail to relieve BOO. 14,15 Therefore, it may be important to verify the effects of this new a 1A -AR antagonist by objective measures such as a urodynamic study including a pressure/flow study.…”

“…The urodynamically beneficial effects of silodosin on the DO appeared to be greater than those of naftopidil, an a 1A /a 1D -AR selective antagonist, in that the DO resolved completely or improved in 57% of the patients. 4 An inhibition of DO after intravenous administration of silodosin has also been reported in a rat model of hormone-induced BPH. 23 Most of the effect of silodosin in the clinical dose appeared to be due to the blockade of the a 1A -AR, suggesting that the a 1A -AR is predominantly involved in DO in BPH.…”

“…The urodynamic effects of a 1 -AR antagonists on LUTS suggestive of BPH (LUTS/BPH) are relief of bladder outlet obstruction (BOO) and detrusor overactivity (DO), thus they are effective for both voiding and storage symptoms. [2][3][4] It has been reported that a 1A -AR subtypes are predominantly found in the prostate. 5 However, recent study suggested an expression of both a 1A -and a 1D -ARs in human prostate tissue.…”

Clinical guideline for male lower urinary tract symptoms

“…85,86 Comparisons between naftopidil and tamsulosin have found no discernible differences between the two agents.…”

Management of benign prostatic hyperplasia with silodosin

“…[12][13][14][15][16][17] It has been reported that α 1 -AR antagonists are effective for both storage and voiding symptoms by decreasing bladder outlet obstruction and alleviating detrusor overactivity. 14,[18][19][20] The adrenergic receptors were originally divided into α-AR and β-AR categories, but application of molecular biological methods has since confirmed nine total AR subtypes: α 1a , α 1b , α 1d , α 2a , α 2b ,α 2c , β 1 , β 2 , and β 3 . 1,21,22 It was reported that the α 1A -AR subtype is predominant in the prostate; 23 but recent studies have detected the expression of both α 1A -and α 1D -ARs in human prostate tissue.…”