The following is a summary of “Clinical and Urodynamic Predictors for Failure of Medical Management with Alpha Blockers in PBNO: A Retrospective Cohort Analysis,” published in the September 2023 issue of Urology by Sureka, et al.

For a study, researchers sought to assess the clinical and urodynamic factors that might predict the ineffectiveness of alpha-blockers as a treatment for primary bladder neck obstruction (PBNO).

The study was conducted retrospectively over an 8-year period. PBNO was diagnosed based on a bladder outlet obstruction index (BOOI) exceeding 40, along with video-urodynamic evidence of obstruction at the bladder neck. Initially, patients were managed with alpha-blockers (specifically alfuzosin and tamsulosin) for a duration of 3-6 months. If pharmacotherapy proved ineffective, bladder neck incision (BNI) was considered as the next step. Patients exhibiting upper urinary tract changes who underwent upfront BNI or required clean intermittent catheterization were excluded from the analysis. The study reviewed data pertaining to the international prostate symptom score (IPSS), uroflowmetry, urodynamic studies, and pre- and post-treatment ultrasonography. Treatment outcomes were classified as complete response (>50% improvement in maximum flow rate [Qmax] and IPSS score) and partial response (30%-50% improvement in Qmax and IPSS score) at either 3 or 6 months.

The study included 99 patients, with 21 patients undergoing BNI due to the failure of medical management and 31 undergoing BNI for symptom recurrence at a mean follow-up of 18.8 ± 3.5 months (ranging from 12 to 70 months). Independent predictors of alpha-blocker treatment failure included the patient’s age (P = .021), detrusor pressure at Qmax (P = .015), and BOOI (P = .019).

Alpha-blockers were more likely to be ineffective in the treatment of PBNO in younger patients who experience higher voiding pressures and possess a BOOI exceeding 60.

Source: goldjournal.net/article/S0090-4295(23)00505-8/fulltext