Urodynamic outcomes of tamsulosin in the treatment of primary bladder neck obstruction in men

Abstract

Introduction:Alpha blockers are widely used in the treatment of primary bladder neck obstruction; however, evidence for objective urodynamic efficacy is scarce. We studied the effect of the uroselective α1-blocker tamsulosin on urodynamic parameters in male patients with type I primary bladder neck obstruction.Methods:A single center prospective observational study was carried out from July 2013 to February 2015. Male patients (18–50 years) with type 1 primary bladder neck obstruction were recruited. Selected patients were started on tablet tamsulosin 0.4 mg once daily for 3 months. International prostate symptom score (IPSS), uroflow and urodynamic studies were done pre- and post-treatment. Primary outcome was decreased in minimum detrusor pressure at maximum flow rate by 15%. Wilcoxon-matched pair signed-rank test was used.Results:Of 39 patients recruited, 21 patients completed the follow-up as per protocol and were analyzed. Mean age was 41 years. 57% patients achieved the primary outcome (median detrusor pressure pre- and post-treatment were 71 and 56 cm of water, P < 0.001). Similarly, median values for bladder outlet obstruction index (BOOI) and IPSS decreased from 59 to 38 (P < 0.001) and 22 to 12 (P < 0.001), respectively. Median maximum flow rate increased from 8 to 10 ml (P = 0.05). Pretreatment BOOI of >60 was associated with poor outcomes.Conclusions:Tamsulosin 0.4 mg once a day is effective in reducing bladder outlet obstruction on pressure flow studies in patients with primary bladder neck obstruction type 1.

Primary bladder neck obstruction in men: The importance of urodynamic assessment and cystourethrography in measuring its severity

“…Sudrania et al objectified the efficacy of tamsulosin 0.4 mg once a day in reducing the BOOI of patients in a cohort of 21 subjects from 59 to 38. 15 Contrary to alpha-blockers, mirabegron was found noninferior to placebo and had no impact on urodynamic parameters. 16 Preliminary results in rat models suffering from partial bladder outlet obstruction indicate that oral Metformin is a possible solution to decrease bladder inflammation and remodeling due to the obstruction and alleviate bladder dysfunction.…”

“…Despite the effectiveness of transurethral bladder neck incision, our study sheds light on the possibility of a more conservative approach in patients with a partial bladder neck obstruction (Group B), such as medical treatments. Sudrania et al objectified the efficacy of tamsulosin 0.4 mg once a day in reducing the BOOI of patients in a cohort of 21 subjects from 59 to 38 15 . Contrary to alpha‐blockers, mirabegron was found noninferior to placebo and had no impact on urodynamic parameters 16 .…”

Management Modalities of Primary Bladder Neck Obstruction in Young Adult Men: A Systematic Review and Meta-analysis

“…However, the alpha-blocker’s success rate is variable and not comparable to that of older men with presumptive benign prostatic obstruction. 20 This review summarizes the impact of alpha-adrenergic blockers on IPSS, Q max , and PVR after 3 and 12 months. Although alpha-adrenergic blockers improve IPSS and Q max at 3 and 12 months, the results appear inferior to surgical treatment at 12 months.…”

Mirabegron Add-On Tamsulosin for Men with Overactive Bladder Symptoms: A Pooled Analysis of Four Randomized Controlled Trials

“…However, the pooled analysis also showed that mirabegron might have increased the incidence of PVR, which is inconsistent with the results of the four RCTs included. β3-AR agonists do not affect the voiding contraction, consequently diminishing the occurrence of urinary retention [22], which accounted for the mutual antagonistic role of mirabegron and tamsulosin in bladder emptying [23]. In another study, tamsulosin was used to reduce the risk of urinary retention after operation [24].…”