Introduction: To determine the pre-treatment factors related to the improvement of overactive bladder (OAB) symptom after alpha-1 blocker monotherapy in patients with benign prostatic hyperplasia complicated by OAB (BPH/OAB). Methods: Post-hoc analysis of a prospective study in patients with BPH/OAB, randomized to receive silodosin 8 mg (n = 157) or naftopidil 75 mg (n = 157) treatment for 12 weeks, was performed. At 12 weeks post-administration, patients were divided into 2 groups (good responder [GR] group and poor responder [PR] group), according to the improvement in the OAB symptom score (OABSS). We compared the pre-administration parameters between both groups and evaluated the factors related to OAB improvement. Results: Of 314 patients, 159 patients (50.6%) were classified into the GR and 155 (49.4%) into the PR. International Prostate Symptom score, total OABSS, OABSS urgency-score, OABSS urgency urinary incontinence (UUI)-score, post-void residual urine volume (PVR), and selection rate of naftopidil were significantly higher in the PR than in the GR. On multivariate logistic regression analysis, larger PVR, higher OABSS-UUI-score, and the choice of naftopidil were significant risk factors for insufficient improvement of OAB symptoms. Conclusions: Pre-treatment PVR, UUI severity, and the choice of treatment agent are predicting factors related to OAB improvement after alpha-1 blocker monotherapy in patients with BPH/OAB.

Keywords:
Overactive bladder, Alpha-1 blocker treatment, Benign prostatic hyperplasia, Urgency urinary incontinence, Post-void residual urine volume
1.
Yamaguchi O, Nishizawa O, Takeda M, Yokoyama O, Homma Y, Kakizaki H, et al. Clinical guidelines for overactive bladder.
Int J Urol
. 2009;16(2):126–42.
2.
Eapen RS, Radomski SB. Review of the epidemiology of overactive bladder.
Res Rep Urol
. 2016;8:71–6.
3.
Agarwal A, Eryuzlu LN, Cartwright R, Thorlund K, Tammela TL, Guyatt GH, et al. What is the most bothersome lower urinary tract symptom? Individual- and population-level perspectives for both men and women.
Eur Urol
. 2014;65(6):1211–7.
4.
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(6):1306–14.
5.
Homma Y, Gotoh M, Kawauchi A, Kojima Y, Masumori N, Nagai A, et al. Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia.
Int J Urol
. 2017;24(10):716–29.
6.
Gormley EA, Lightner DJ, Faraday M, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment.
J Urol
. 2015;193(5):1572–80.
7.
Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction.
Eur Urol
. 2015;67(6):1099–109.
8.
Fusco F, Palmieri A, Ficarra V, Giannarini G, Novara G, Longo N, et al. α1-Blockers Improve Benign Prostatic Obstruction in Men with Lower Urinary Tract Symptoms: A Systematic Review and Meta-analysis of Urodynamic Studies.
Eur Urol
. 2016;69(6):1091–101.
9.
Matsukawa Y, Takai S, Funahashi Y, Kato M, Yamamoto T, Gotoh M. Long-term efficacy of a combination therapy with an anticholinergic agent and an α1-blocker for patients with benign prostatic enlargement complaining both voiding and overactive bladder symptoms: A randomized, prospective, comparative trial using a urodynamic study.
Neurourol Urodyn
. 2017;36(3):748–54.
10.
Yun JH, Kim JH, Kim JH, Lee SW, Yang HJ, Doo SW, et al. Can we decide the optimal initial treatment for male lower urinary tract symptoms patients with overactive bladder by the most bothersome symptom? A randomized, prospective, open-label study.
Urol Int
. 2014;93(3):338–43.
11.
Oelke M, Murgas S, Baumann I, Schnabel F, Michel MC. Efficacy of propiverine ER with or without α-blockers related to maximum urinary flow rate in adult men with OAB: results of a 12-week, multicenter, non-interventional study.
World J Urol
. 2011;29(2):217–23.
12.
Lee JY, Kim HW, Lee SJ, Koh JS, Suh HJ, Chancellor MB. Comparison of doxazosin with or without tolterodine in men with symptomatic bladder outlet obstruction and an overactive bladder.
BJU Int
. 2004;94(6):817–20.
13.
Matsukawa Y, Funahashi Y, Takai S, Majima T, Ogawa T, Narita H, et al. Comparison of Silodosin and Naftopidil for Efficacy in the Treatment of Benign Prostatic Enlargement Complicated by Overactive Bladder: A Randomized, Prospective Study (SNIPER Study).
J Urol
. 2017;197(2):452–8.
14.
Homma Y, Yoshida M, Seki N, Yokoyama O, Kakizaki H, Gotoh M, et al. Symptom assessment tool for overactive bladder syndrome–overactive bladder symptom score.
Urology
. 2006;68(2):318–23.
15.
Mochtar CA, Kiemeney LA, Laguna MP, van Riemsdijk MM, Barnett GS, Debruyne FM, et al. Prognostic role of prostate-specific antigen and prostate volume for the risk of invasive therapy in patients with benign prostatic hyperplasia initially managed with alpha1-blockers and watchful waiting.
Urology
. 2005;65(2):300–5.
16.
Masumori N, Hashimoto J, Itoh N, Tsukamoto T; The Sapporo Medical University Naft. Short-term efficacy and long-term compliance/treatment failure of the alpha1 blocker naftopidil for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.
Scand J Urol Nephrol
. 2007;41(5):422–9.
17.
Matsukawa Y, Ishida S, Majima T, Funahashi Y, Sassa N, Kato M, et al. Intravesical prostatic protrusion can predict therapeutic response to silodosin in male patients with lower urinary tract symptoms.
Int J Urol
. 2017;24(6):454–9.
18.
Engström G, Henningsohn L, Walker-Engström ML, Leppert J. Impact on quality of life of different lower urinary tract symptoms in men measured by means of the SF 36 questionnaire.
Scand J Urol Nephrol
. 2006;40(6):485–94.
19.
Matsukawa Y, Hattori R, Sassa N, Yamamoto T, Gotoh M. What are the factors contributing to failure in improvement of subjective symptoms following silodosin administration in patients with benign prostatic hyperplasia? Investigation using a pressure-flow study.
Neurourol Urodyn
. 2013;32(3):266–70.
20.
Saito M, Shimizu S, Ohmasa F, Oikawa R, Tsounapi P, Dimitriadis F, et al. Characterization of silodosin and naftopidil in the treatment of bladder dysfunction in the spontaneously hypertensive rat.
Neurourol Urodyn
. 2013;32(4):393–8.
21.
Abarbanel J, Marcus EL. Impaired detrusor contractility in community-dwelling elderly presenting with lower urinary tract symptoms.
Urology
. 2007;69(3):436–40.
22.
Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V, et al. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis.
Eur Urol
. 2014;65(2):389–98.
23.
Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients.
JAMA
. 1987;257(22):3076–81.
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2019
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