Clinical and Urodynamic Predictors for Failure of Medical Management with Alpha Blockers in PBNO: A Retrospective Cohort Analysis

Abstract

To evaluate the clinical and urodynamic variables that may predict the failure of alpha-blockers in PBNO patients. Alpha-blockers are useful as a treatment option in patients with Primary Bladder Neck Obstruction (PBNO). Non-responders need to undergo Bladder Neck Incision (BNI). Little is known about the predictive factors determining success of treatment. The was a retrospective study, spanning over a period of 8 years. PBNO was diagnosed in the presence of a Bladder Outlet Obstruction Index (BOOI) >40 with video-urodynamic evidence of obstruction at the bladder neck. The patients were initially managed with alpha-blockers (alfuzosin/tamsulosin) for 3 to 6 months, and BNI contemplated when pharmacotherapy failed. The patients with upper tract changes managed with upfront BNI or Clean Intermittent Catheterization (CIC) were excluded. The data for the International Prostate Symptom Score (IPSS), uroflowmetry, urodynamic studies, and ultrasonography of pre and post-treatment periods were reviewed. Treatment outcomes were defined as complete response (>50% improvement in Qmax and IPSS score) and partial response (30-50% improvement in Qmax and IPSS score) at 3 or 6 months. Ninety-nine patients were analyzed. 21 patients underwent BNI for the failure of medical management and 31 for recurrence of symptoms at a mean follow-up of 18.8±3.5 months (12-70 months). Independent predictors of failure of pharmacotherapy with alpha-blockers were age (p = 0.021), Pdet@Qmax (p = 0.015), and BOOI (p = 0.019). Alpha-blockers are more likely to fail in PBNO in younger patients generating higher voiding pressures and BOOI > 60.