α1-Blockers Improve Benign Prostatic Obstruction in Men with Lower Urinary Tract Symptoms: A Systematic Review and Meta-analysis of Urodynamic Studies

Context:The urodynamic outcomes fora1-blockers (ABs) treatment in patients withlower urinary tract symptoms related to benign prostatic enlargement (LUTS/BPE) is amatter of debate.Objective:To perform a systematic review and meta-analysis of studies evaluating theABs urodynamic outcomes in patients with LUTS/BPE. The primary endpoint wasvariation in bladder outlet obstruction index (BOOI). Secondary endpoints were themaximum urinary flow rate (Qmax) and detrusor pressure atQmax(PdetQmax). A meta-analysis of placebo-controlled randomized clinical trials (RCTs) was performed tocompare ABs with placebo.Evidence acquisition:A systematic review of PubMed/Medline, ISI Web of Knowledge,and Scopus databases was performed in May 2015. Seventeen studies were selected forinclusion.Evidence synthesis:The overall pooled data showed a mean BOOI change of –14.19(p<0.0001), a meanPdetQmaxchange of –11. 39 cm H2O(p<0.0001), and a meanQmaximprovement of 2.27 ml/s (p<0.0001). Subgroup analysis showed a mean BOOI changeof –14.88 (p= 0.01) for alfuzosin, –19.41 (p= 0.01) for doxazosin, –16.47 (p<0.0001) fornaftopidil, –30.45 (p<0.0001) for silodosin, –14.27 (p= 0.002) for tamsulosin, and –6.69(p= 0.005) for terazosin. Subanalysis of RCTs containing a placebo arm showed asignificant improvement in BOOI in patients undergoing ABs treatment. Meta-regressionrevealed a significant positive association between the percentage of patients withobstruction at baseline and the improvement in BOOI after treatment with ABs.Conclusion:ABs improve BOOI in patients with LUTS/BPE mainly by reducingPdetQmax,and this effect is higher in patients presenting with urodynamic obstruction at baseline.The freeQmaxvariation underestimates the real effect of ABs on benign prostaticobstruction.Patient summary:Results of this meta-analysis suggest thata1-blockers objectivelyimprove urinary voiding function in patients with benign prostatic obstruction.