PDF
ePub
Citation
Print
Abstract
Purpose
Adding anticholinergics to the treatment regimen of benign prostatic hyperplasia (BPH) patients with overactive bladder (OAB) elicits concern about deterioration of obstructive symptoms and the possibility of urine retention. We evaluated the risk factors increasing post-voiding residual (PVR) volume with long-term anticholinergics therapy of over 1 year in patients with BPH and OAB.
Materials and Methods
We selected patients with BPH and OAB from 2005 to 2007 who were more than 40 years old, were treated with α-blockers, had an International Prostate Symptom Score (IPSS) of 8 or more, and had an IPSS urgency score of 2 or more for OAB. The 98 patients selected were evaluated by age, diabetes mellitus, central nervous system (CNS) disease above the brain stem, prostate volume, uroflowmetry, PVR volume, prostate-specific antigen (PSA) level, and IPSS retrospectively. We evaluated risk factors for increasing PVR volume over 50 ml and 100 ml after treatment and analyzed the risk factors both univariately and multi-variately.
Results
Age, diabetes mellitus, CNS disease, PSA level, prostate volume, initial PVR volume, peak urine flow rate (≤15 ml/s), use of anticholinergics, and no use of 5-α-reductase inhibitor, which were regarded as risk factors for increasing PVR volume, were analyzed for their relation with PVR volume over 50 ml and 100 ml, respectively. Age, initial PVR volume, CNS disease, and use of anticholinergics were significantly associated with an increased PVR volume over 100 ml in the univariate analysis. In multivariate analysis, age, initial PVR volume, CNS disease, and use of anticholinergics remained significantly associated with an increased PVR volume over 100 ml.
REFERENCES
1.Rosier PF., de la Rosette JJ., Wijkstra H., Van Kerrebroeck EV., Debruyne FM. Is detrusor instability in elderly males related to the grade of obstruction? Neurourol Urodyn. 1995. 14:625–33.
2.Peters TJ., Donovan JL., Kay HE., Abrams P., de la Rosette JJ., Porru D, et al. The International Continence Society “Benign Prostatic Hyperplasia” Study: the bothersomeness of urinary symptoms. J Urol. 1997. 157:885–9.
3.Mitterberger M., Pallwein L., Gradl J., Frauscher F., Neuwirt H., Leunhartsberger N, et al. Persistent detrusor overactivity after transurethral resection of the prostate is associated with reduced perfusion of the urinary bladder. BJU Int. 2007. 99:831–5.
4.Kaplan SA., Wein AJ., Staskin DR., Roehrborn CG., Steers WD. Urinary retention and post-void residual urine in men: separating truth from tradition. J Urol. 2008. 180:47–54.
5.Gratzke C., Reich O., Staehler M., Seitz M., Schlenker B., Stief CG. Risk assessment and medical management of acute urinary retention in patients with benign prostatic hyperplasia. Eau-Ebu Update Series. 2006. 4:109–16.
6.Jacobsen SJ., Jacobson DJ., Girman CJ., Roberts RO., Rhodes T., Guess HA, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol. 1997. 158:481–7.
7.Abrams P., Cardozo L., Fall M., Griffiths D., Rosier P., Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002. 21:167–78.
8.Irwin DE., Milsom I., Hunskaar S., Reilly K., Kopp Z., Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006. 50:1306–14.
9.Hyman MJ., Groutz A., Blaivas JG. Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings. J Urol. 2001. 166:550–2.
10.Knutson T., Edlund C., Fall M., Dahlstrand C. BPH with coexisting overactive bladder dysfunction-an everyday urological dilemma. Neurourol Urodyn. 2001. 20:237–47.
11.Oelke M., Baard J., Wijkstra H., de la Rosette JJ., Jonas U., Höfner K. Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur Urol. 2008. 54:419–26.
12.Lee JC., Yang SK., Kim HS. The influence of TURP on detrusor instability in patients with BPH: a clinical and urodynamic analysis. Korean J Urol. 1997. 38:275–82.
13.Rovner ES., Kreder K., Sussman DO., Kaplan SA., Carlsson M., Bavendam T, et al. Effect of tolterodine extended release with or without tamsulosin on measures of urgency and patient reported outcomes in men with lower urinary tract symptoms. J Urol. 2008. 180:1034–41.
14.Kaplan SA., Walmsley K., Te AE. Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol. 2005. 174:2273–5.
15.Novara G., Galfano A., Ficarra V., Artibani W. Anticholinergic drugs in patients with bladder outlet obstruction and lower urinary tract symptoms: a systematic review. Eur Urol. 2006. 50:675–83.
16.Lee KS., Choo MS., Kim DY., Kim JC., Kim HJ., Min KS, et al. Combination treatment with propiverine hydrochloride plus doxazosin controlled release gastrointestinal therapeutic system formulation for overactive bladder and coexisting benign prostatic obstruction: a prospective, randomized, controlled multicenter study. J Urol. 2005. 174:1334–8.
17.Han DS., Kim HS., Sul CK. The effects of combined therapy with propiverine (BUP-4Ⓡ) after α-blocker on the improvements or quality of life scores in patients with benign prostatic hyperplasia accompanied with overactive bladder. Korean J Urol. 2003. 44:409–13.
18.Lee KC., Cho IR. A study on the efficacy of combination therapy with alpha-blockers and anticholinergics in the lower urinary tract symptoms patients accompanied with overactive bladder symptoms. J Korean Continence Soc. 2007. 11:63–7.
19.Lee JY. Combination of α-blocker and anticholinergic of BPH/OAB in real life practice: 2 years follow-up. Eur Urol. 2008. 7(Suppl):): 171, abstract 402.
20.Vallancien G., Emberton M., Alcaraz A., Matzkin H., van Moorselaar RJ., Hartung R, et al. ALF-ONE Study Group. Alfuzosin 10 mg once daily for treating benign prostatic hyperplasia: a 3-year experience in real-life practice. BJU Int. 2008. 101:847–52.
21.Rule AD., Jacobson DJ., McGree ME., Girman CJ., Lieber MM., Jacobsen SJ. Longitudinal changes in post-void residual and voided volume among community dwelling men. J Urol. 2005. 174:1317–21.
22.Roehrborn CG., McConnell JD., Lieber M., Kaplan S., Geller J., Malek GH, et al. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology. 1999. 53:473–80.
23.Klarskov P., Andersen JT., Asmussen CF., Brenoe J., Jensen SK., Jensen IL, et al. Symptoms and signs predictive of the voiding pattern after acute urinary retention in men. Scand J Urol Nephrol. 1987. 21:23–8.
Table 1.
The baseline demographics and characteristics of the patient groups according to use of anticholinergics
Table 2.
The baseline demographics and characteristics of the patient groups according to use of 5-α-reductase inhibitor
Table 3.
The univariate and multivariate analysis of risk factors associated with benign prostatic hyperplasia and overactive bladder medication for residual urine volume≥50 ml
| Risk factors | p-valuea | p-valueb | Odds ratiob |
95%CI for odds ratiob |
|
|---|---|---|---|---|---|
| Lower | Upper | ||||
| Age≥65 years | 0.22 | ||||
| Prostate volume≥30 ml | 0.16 | ||||
| PSA≥4.0 ng/ml | 0.73 | ||||
| Urine peak flow rate≤15 ml/s | 0.64 | ||||
| Initial PVR volume≥50 ml | 0.01 | ||||
| Diabetes mellitus | 0.43 | ||||
| Central nervous system disease | ＜0.01 | ＜0.01 | 17.37 | 2.97 | 101.61 |
| 5-α reductase inhibitor: not used | 0.61 | ||||
| Anticholinergics: used | ＜0.01 | ＜0.01 | 12.41 | 3.04 | 50.64 |
Table 4.
The univariate and multivariate analysis of risk factors associated with benign prostatic hyperplasia and overactive bladde medication for residual urine volume≥100 ml
| Risk factors | p-valuea | p-valueb | Odds ratiob |
95%CI for odds ratiob |
|
|---|---|---|---|---|---|
| Lower | Upper | ||||
| Age≥65 years | 0.02 | 0.04 | 38.22 | 3.85 | 134.85 |
| Prostate volume≥30 ml | 0.46 | ||||
| PSA≥4.0 ng/ml | 0.59 | ||||
| Urine peak flow rate≤15 ml/s | 0.78 | ||||
| Initial PVR volume≥50 ml | 0.01 | 0.03 | 90.69 | 1.58 | 5,217.93 |
| Diabetes mellitus | 0.50 | ||||
| Central nervous system disease | ＜0.01 | 0.02 | 29.60 | 1.55 | 566.37 |
| 5-α reductase inhibitor: not used | 0.09 | ||||
| Anticholinergics: used | ＜0.01 | 0.02 | 37.15 | 1.92 | 718.69 |
XML Download