Uroselective Alpha-1A Blockade Versus Surgical De-Obstruction: Differential Associations with Heart Rate Variability...

Benign prostatic hyperplasia (BPH) can be associated with lower urinary tract symptoms (LUTS) and potential avlterations in autonomic nervous system function, as reflected by heart rate variability (HRV). This observational study was designed to generate hypotheses regarding the differential impacts of surgical de-obstruction versus uroselective pharmacological blockade on autonomic nervous system equilibrium, HRV restoration, and symptomatic outcomes in men with BPH and bladder outlet obstruction.

Data from a prospective cohort of 242 men undergoing TURP and 210 men receiving tamsulosin were analyzed. HRV parameters (standard deviation of normal-to-normal intervals [SDNN], low-frequency/high-frequency [LF/HF] ratio, total power [TP], very low frequency [VLF]) and International Prostate Symptom Score (IPSS) was assessed at baseline and 12 weeks. Propensity score matching (PSM) was used to address baseline differences in age, prostate volume, IPSS, and baseline SDNN. Inter-group comparisons used ANCOVA with baseline as a covariate.

After TURP, SDNN increased by 14.70 ms (40%; 36.97 ± 22.80 to 51.67 ± 27.59 ms; p = 0.032; paired Cohen's d = 0.58), LF/HF decreased by 0.90 (55%; 1.63 ± 1.60 to 0.73 ± 0.52; p = 0.028; d = -0.76), TP increased by 1303 ms² (95%; 1367 ± 820 to 2670 ± 1420 ms²; p = 0.025; d = 1.12), and VLF increased by 810 ms² (85%; 950 ± 560 to 1760 ± 980 ms²; p = 0.030; d = 1.01). For tamsulosin, SDNN increased by 6.73 ms (18%; 38.12 ± 12.50 to 44.85 ± 11.20 ms; p = 0.004; d = 0.57), LF/HF decreased by 0.16 (8%; 1.95 ± 0.65 to 1.79 ± 0.55; p = 0.012; d = -0.27), TP increased by 559 ms² (39%; 1453 ± 620 to 2012 ± 580 ms²; p = 0.006; d = 0.93), and VLF increased by 355 ms² (35%; 1020 ± 450 to 1375 ± 420 ms²; p = 0.010; d = 0.82). Secondary p-values (LF/HF, TP, VLF) were adjusted via the Benjamini-Hochberg method; adjusted p > 0.05 was used for some. Inter-group differences in changes were significant (ANCOVA p < 0.01; partial η² = 0.12-0.22 for group factor). TURP was associated with greater IPSS reduction (-10.2 points; 18.5 ± 6.2 to 8.3 ± 4.1; p < 0.001) compared to tamsulosin (-5.3 points; 15.8 ± 5.6 to 10.5 ± 4.8; p < 0.001; d = -1.02; inter-group p < 0.001). PSM confirmed these associations with p < 0.01 for HRV changes. Change in SDNN was associated with IPSS improvement in multivariate regression (standardized β = -0.42, p < 0.01).

In this observational study, TURP was associated with greater changes in HRV parameters and symptomatic improvement compared to tamsulosin. These findings are hypothesis-generating and require confirmation in long-term randomized trials.