Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
Fusco F, Palmieri A, Ficarra V, et al
Eur Urol 2016;69:1091–101.
Expert's summary:
A systematic review and meta-analysis of the urodynamic effects of α-blockers was undertaken [1], principally to evaluate changes in bladder outlet obstruction index (BOOI), but also maximum flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). α-Blockers were found to reduce the BOOI by –14.19. In addition PdetQmax fell by –11. 39 cm H2O and Qmax increased by 2.27 ml/s. Thus, there are clear-cut urodynamic responses to α-blockers, which go beyond simple increases in flow rate.
Expert's opinion:
α-Blockers are well recognised to improve lower urinary tract symptoms, but there is a common belief that they increase Qmax comparatively little, and hence do not greatly improve BOO. However, urodynamicists recognise that the relationship of pressure to flow is markedly dependent on the calibre of the outlet; a substantially occluded outlet (close to isovolumetric condition) ensures the detrusor contraction has maximal effect on intravesical pressure. A wide-open outlet will mean that flow occurs with barely-detectable intravesical pressure change (isotonic contraction)—a situation seen with voiding for some women. Increasing BOO pushes the individual's pressure-flow characteristics towards the isovolumetric end of the spectrum. The review by Fusco and colleagues [1] emphasises that the influence of α-blockers on the pressure-flow relationship is towards lower pressure. Since there is a clear-cut fall in BOOI with slightly enhanced Qmax, the urodynamic behaviour has shifted towards a more isotonic contraction. Notably, the meta-analysis included a study in which some men did not have BOO [2], and this has to be weighed up when interpreting the findings.
Most studies using α-blockers for lower urinary tract symptoms/benign prostatic enlargement evaluate noninvasive external parameters, notably free uroflowmetry, symptom score, and postvoid residual urine. Formal urodynamic calculation of the change in BOOI is rarely undertaken after initiating α-blockers, so this systematic review is a valuable pointer to the less evident effects. However, there was rather limited published information, and only three of the seven randomised controlled trials were high-quality studies.
α-Blockers should not be dismissed as merely improving symptoms, since they have urodynamic effects which are potentially beneficial even if they are not necessarily overtly evident to external evaluation. Partial BOO gives rise to impairment of blood flow during each void [3]. Reducing the intravesical pressure during voiding may reduce the severity of ischaemia, which intuitively is likely to be beneficial. However, this can only be surmised, since there is no published research to support the premise from real-life clinical populations.
Advisory Boards (speaker bureaux and researcher) for Allergan, Astellas, and Ferring.
