Clinical and pressure-flow changes after long-term treatment with alfuzosin SR

The aim of our study was to evaluate the symptomatic and urodynamic changes after 1-5 years of treatment with alfuzosin in patients with benign prostatic hyperplasia.

Out of 255 patients with lower urinary tract symptoms observed from 1992 to 1997, who completed the International Prostatic Symptom Score (I-PSS) and underwent full urodynamic investigation, 161 were found to be obstructed (Schäfer classes 2-6). One hundred and two subsequently consented to a second clinical and urodynamic evaluation. Out of these, 46 underwent surgical treatment, 20 were elected for watchful waiting (WW) and 36 received a medical treatment. Twenty out of these, with a mean age of 65 years, a mean prostatic volume of 44 ml (20-70) a median Schäfer's obstruction class of 3 (range 2-5) were treated with slow release alfuzosin 5 mg twice a day. We re-evaluated these 20 patients with a second I-PSS and pressure-flow study after 1-5 years (mean: 2 years) of treatment. The patients in the WW group with comparable baseline characteristics were considered as controls. The Wilcoxon matched-pairs signed rank test and the Kruskal-Wallis test were used for statistical analysis.

In the group treated with alfuzosin, no differences were noted for I-PSS (14.9 +/- 6,8; 13.3 +/- 5); maximum flow (124 +/- 6; 14 +/- 6) and projected isometric pressure (105 +/- 36; 105 +/- 26). Statistically significant differences were noted for residual urine (103 +/- 100; 33 +/- 38, p = 0.02); detrusor pressure at maximum flow (64.4 +/- 23; 53 +/- 12, p = 0.04), minimum urethral opening pressure (36.5 +/- 9; 31 +/- 9, p = 0.02), Schäfer class (2.7 +/- 0.7; 2 +/- 0.8, p = 0.04); urethral resistance algorithm (34.7 +/- 11; 27 +/- 7, p = 0.02). Statistically significant differences between baseline and follow-up were noted for none of the clinical and urodynamic parameters in the WW group.

Patients with bladder outlet obstruction seem to remain clinically stable and to improve urodynamically when treated with alfuzosin for a long period of time.