NEUROUROLOGY & FEMALE UROLOGY

The Effect of Terazosin on Functional Bladder Outlet Obstruction in Women: A Pilot Study
Kessler TM, Studer UE, Burkhard FC
Department of Urology, University of Bern, Bern, Switzerland
J Urol. 2006; 176: 1487-92

• Purpose: We assessed the effect of terazosin (Hytrin®) on functional bladder outlet obstruction in women.
• Materials and methods: Functional bladder outlet obstruction was defined as a maximum flow rate of less than 12 ml per second combined with a detrusor pressure at maximum flow rate of more than 20 cm H2O in pressure flow studies in the absence of neurological disorders or mechanical causes. In a prospective pilot study 15 women with functional bladder outlet obstruction were treated with terazosin. Terazosin was initiated at 1 mg daily and gradually increased to the maintenance dose of 5 mg daily during 2 weeks. Symptoms and urodynamic parameters were assessed before and 3 to 4 weeks after the initiation of alpha-blocker therapy.
• Results: While on terazosin, voiding symptoms subjectively improved greater than 50% in 10 of the 15 women (p = 0.002). Median maximum urethral closure pressure at rest decreased significantly from 98 to 70 cm H2O (p = 0.001), median maximum detrusor pressure decreased from 45 to 35 cm H2O (p = 0.008), median detrusor pressure at maximum flow decreased from 34 to 27 ml per second and median post-void residual urine decreased from 120 to 40 ml (p = 0.006 and 0.002, respectively). There was a significant increase in the median maximum flow rate from 9 to 20 ml per second and in median voided volume from 300 to 340 ml (p = 0.0005 and 0.021, respectively). Storage symptoms, functional urethral length and maximum cystometric capacity did not change significantly with alpha-blocker therapy (p > 0.05). Overall terazosin resulted in a significant improvement in symptoms and urodynamic parameters in 10 of the 15 women (67%).
• Conclusions: Terazosin had a significant symptomatic and urodynamic effect in two-thirds of our patients. These results suggest that terazosin may be an effective treatment option in women with voiding dysfunction due to functional bladder outlet obstruction.
  
  
• Editorial Comment
  The authors review the efficacy of terazosin on functional bladder outlet obstruction in women. In this prospective study 15 women diagnosed with functional bladder outlet obstruction (as opposed to mechanical outlet obstruction) were treated with terazosin beginning at a dose of 1 mg with gradual increase to a maximum dose of 5 mg over a two week period. Patient’s symptoms and urodynamic studies were assessed at the onset of the study and approximately one month after the initiation of the terazosin therapy. The authors found that two-thirds of the women had improvement in their voiding symptoms as well as an improvement in the urodynamic studies examined. Simply stated, the investigators found that terazosin had both a subjective and objective improvement in two-thirds of the study patients.
  With this paper, the authors delve into the complex world of non-neurogenic female voiding dysfunction. The difficulty of diagnosis and the relative lack of understanding of this malady has been discussed in the literature (1). That only two-thirds of the patients experienced symptomatic improvement may be secondary to the potential cause of voiding dysfunction being secondary to the failure of relaxation of the striated urethral sphincter(2). The discussion section of this paper is excellent and provides a great deal of information upon which many may expand their understanding of functional bladder outlet obstruction in women.

References
1. Groutz A, Blaivas JG: Non-neurogenic female voiding dysfunction. Curr Opin Urol. 2002; 12: 311-6.
2. FitzGerald MP, Brubaker L: The etiology of urinary retention after surgery for genuine stress incontinence. Neurourol Urodyn. 2001; 20: 13-21.

Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA