Evaluation of the effect of Alfuprost® MR on detrusor thickness and bladder mass in patients with detrusor hypertrophy caused by benign prostatic hyperplasia

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction. Benign prostatic hyperplasia (BPH) can lead to the detrusor hypertrophy and deterioration of the bladder function with a decrease in its contractile activity. A number of publications are presented in the literature, the results of which indicate the possibility of reducing bladder hypertrophy with alpha-blockers.

Aim. To carry out the retrospective analysis to study the effect of Alfuprost® MR on urodynamic parameters, as well as the influence of the therapy on detrusor thickness and bladder mass in patients with detrusor hypertrophy and bladder outlet obstruction caused by BPH.

Materials and methods. Outpatient records of 30 patients with lower urinary tract symptoms (LUTS) caused by BPH who received Alfuprost® MR as monotherapy for 24 weeks were reviewed. Based on the diaries, the following parameters were assessed: total IPSS score, IPSS voiding (questions No. 1, 3, 5 and 6) and storage subscale scores (questions No. 2, 4 and 7), maximum flow rate (Qmax) according to uroflowmetry, the volume of the prostate and the postvoid residual (assessed by ultrasound), satisfaction with treatment on the quality-of-life score (QoL), as well as the changes in detrusor thickness and bladder mass index.

Results. An improvement in LUTS severity, starting from the 4th week of treatment, followed by a positive trend that persists until the 24th week of therapy with Alfuprost® MR, was found. The overall average IPSS score improved by 39.0% by the 24th week of therapy. At the same time, voiding symptoms improved by 46.8%, and storage symptoms improved by 30.9% by 24 weeks of therapy. The average Qmax increased significantly (p<0.05) by 22.1% after 24 weeks of therapy. The average detrusor thickness decreased by 40,2%. Bladder mass index decreased significantly by an average of 34,3% (p<0.05). QoL score improved significantly (p<0.05) by 2.2 points after 24 weeks of therapy.

Conclusion. During the 24-week treatment of patients with BPH, Alfuprost® MR demonstrated clinical efficacy not only in reducing voiding symptoms and in improving the QoL, but also a positive effect on detrusor hypertrophy, as evidenced by changes in detrusor thickness and bladder mass index. The absence of any adverse events, including decrease in blood pressure and heart rate, allows us to recommend Alfuprost® MR as an effective treatment for LUTS associated with BPH, which reduces detrusor hypertrophy and has a high safety profile and minimal vasodilating effects.

Full Text

Restricted Access

About the authors

A. V. Kuzmenko

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: kuzmenkoav09@yandex.ru
ORCID iD: 0000-0002-7927-7015

Ph.D., MD, professor, professor at the Department of Specialized Surgical disciplines, Department of Urology 

Russian Federation, Voronezh

V. V. Kuzmenko

Voronezh State Medical University named after N.N. Burdenko

Email: kuzmenkovv2003@mail.ru

Ph.D., MD, professor, professor at the Department of Specialized Surgical disciplines

Russian Federation, Voronezh

T. A. Gyaurgiev

Voronezh State Medical University named after N.N. Burdenko

Email: gta001100@yandex.ru

Ph.D., associate professor at the Department of Specialized Surgical disciplines

Russian Federation, Voronezh

References

  1. Benign prostatic hyperplasia. Clinical guidelines (2020). https://cr.minzdrav.gov.ru/clin_recomend. Russian (Доброкачественная гиперплазия предстательной железы. Клинические рекомендации (2020). https://cr.minzdrav.gov.ru/clin_recomend).
  2. EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam 2022. ISBN 978-94-92671-16-5.
  3. Kudryavtsev Yu.V., Sivkov A.V. Morphological changes in prostate tissue in benign hyperplasia. Experimental and clinical urology. 2010;1:18–22.
  4. Roehrborn C., McConnell J. Etiology, pathophysiology, epidemiology and natural history of benign prostatic hyperplasia. In: Walsh P, retik A, Vaughan E, Wein A (eds). Campbells Urology, 8th ed. Saunders: Philadelphia, 2002:1297–1336.
  5. Alyaev Yu.G., Gadzhieva Z.K., Rapoport L.M., Kazilov Yu.B. Medical treatment of lower urinary tract symptoms in men. The role of uroselectivity in drug selection. Andrology and genital surgery. 2014;1:6–14. Russian (Аляев Ю.Г., Гаджиева З.К., Рапопорт Л.М., Казилов Ю.Б. Медикаментозное лечение симптомов нижних мочевых путей у мужчин. Роль уроселективности в выборе препарата. Андрология и генитальная хирургия. 2014;1:6–14.)
  6. Gadzhieva Z.K., Kazilov Yu. B. New possibilities of treatment of combined symptoms of the lower urinary tract in patients with benign prostatic hyperplasia - prerequisites and advantages. Urologiia. 2017;1:95–102. Russian (Гаджиева З.К., Казилов Ю.Б. Новые возможности лечения комбинированных симптомов нижних мочевыводящих путей у пациентов с доброкачественной гиперплазией предстательной железы - предпосылки и преимущества. Урология. 2017;1:95–102).
  7. Eckhardt M.D., van Venrooji G.E., Boon T.A. Symptoms, prostate volume and urodynamic findings in elderly male volunteers without and with LUTS and in patients with LUTS suggestive of benign prostatic hyperplasia. Urology. 2001;58:966–971.
  8. Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A. Combined drug therapy of patients with BPH. Urologiia. 2018;1:101–105. Russian (Кузьменко А.В., Кузьменко В.В., Гяургиев Т.А. Комбинированная медикаментозная терапия больных ДГПЖ. Урология. 2018;1:101–105).
  9. Kuzmenko A.V., Kuzmenko V.V., Guriev T.A. Modern possibilities of therapy for a urological patient with concomitant diseases of the cardiovascular system. Urologiia. 2021;6:78–84. Russian (Кузьменко А.В., Кузьменко В.В., Гяургиев Т.А. Современные возможности терапии урологического пациента с сопутствующими заболеваниями сердечно-сосудистой системы. Урология. 2021;6:78–84.)
  10. Kirpatovskiy V.I., Sivkov A.V., Fedyakov R.P., Khromov R.A., Bablumyan A.Yu., Nadtochy O.N. The role of circulatory disorders and tissue hypoxia in the development of bladder dysfunction with infravesical obstruction caused by prostate adenoma. Urologiia. 2013;(2):123–128. Russian (Кирпатовский В.И., Сивков А.В., Федяков Р.П., Хромов Р.А., Баблумян А.Ю., Надточий О.Н. Роль нарушения кровоснабжения и тканевой гипоксии в развитии дисфункции мочевого пузыря при инфравезикальной обструкции, вызванной аденомой предстательной железы. Урология. 2013;(2):123–128).
  11. Chughtail B., Simma-Chiang V., Kaplan S.A. Evaluation and management of post-transurethral resection of prostate lower urinary tract symptoms. Curr Urol Rep. 2014;15(9):434.
  12. Han H.H., Ko W.J., Yoo T.K., Oh T.H., Kim D.Y., Kwon D.D., et al. Factors associated with continuing medical therapy after transurethral resection of prostate. Urology. 2014;84(3):675–680. doi: 10.1016/j.urology.2014.04.027.
  13. Sahakyan M.R., Bablumyan A.Yu., Avoyan A.E., Zograbyan A.Yu., Ayvazyan L.G., Srapyan A.S. The effectiveness of surgical treatment with a combination of overactive bladder and infravesical obstruction in patients with benign prostatic hyperplasia. Meditsinskiy vestnik Erebuni = Medical Journal Erebouni 2012;3(51):69–74. Russian (Саакян М.Р., Баблумян А.Ю., Авоян А.Э., Зограбян А.Ю., Айвазян Л.Г., Срапян А.С. Эффективность оперативного лечения при сочетании гиперактивного мочевого пузыря и инфравезикальной обструкции у больных с доброкачественной гиперплазией простаты. Медицинский вестник Эребуни 2012; 3(51):69–74).
  14. Bright E., Oelke M., Tubaro A., Abrams P. Ultrasound estimated bladder weight and measurement of bladder wall thickness – useful noninvasive methods for assessing the lower urinary tract? J Urol. 2010;184(5):1847–1854. doi: 10.1016/j.juro.2010.06.006.
  15. Park J.S., Lee H.W., Lee S.W., Moon H.S., Park H.Y., Kim Y.T. Bladder wall thickness is associated with responsiveness of storage symptoms to alpha blockers in men with lower urinary tract symptoms. Korean J Urol. 2012;53(7):487–491. doi: 10.4111/kju.2012.53.7.487.
  16. Milicevic S. Tamsulosin efficiency in treatment of benign prostatic hyperplasia evaluated by determining bladder weight. Med Arch. 2012;66(6):391–395.
  17. Eghbali K., Shayegan M.R., Kianoush S. Investigating the effect of tamsulosin on the measurement of bladder wall thickness and International Prostate Symptom Score in benign prostatic hyperplasia. Can Urol Assoc J. 2013;7(5-6):E317–321. doi: 10.5489/cuaj.11262.
  18. Kirpatovskiy V.I., Mudrya I.S., Golovanov S.A., Drozhzheva V.V., Adamyan N.K., Ivanov V.P., Frolova E.V. Protective action of the anti-ischemic therapy with alpha-adrenoblockers on experimental infravesicalthe bladder obstruction. Eksperimental’naya i klinicheskaya urologiya=Experimental and clinical urology. 2015;(4):16–21. Russian (Кирпатовский В.И., Мудрая И.С., Голованов С.А., Дрожжева В.В., Адамян Н.К., Иванов В.П., Фролова Е.В. Протективное действие противоишемической терапии и α-адреноблокаторов на состояние мочевого пузыря при экспериментально вызванной инфравезикальной обструкции. Экспериментальная и клиническая урология 2015;(4):16–21).
  19. Kojima M., Inui E., Ochiai A., Naya Y., Ukimura O., Watanabe H. Ultrasonic estimation of bladder weight as a measure of bladder hypertrophy in men with infravesical obstruction. Urology. 1996;47:942.
  20. Bright E., Pearcy R., Abrams P. Ultrasound estimated bladder weight in men attending the uroflowmetry clinic. Neurourol Urodyn. 2011;30(4):583–586. doi: 10.1002/nau.21049.
  21. Ho C.C., Ngoo K.S., Hamzaini A.H., Rizal A.M., Zulkifli M.Z. Urinary bladder characteristics via ultrasound as predictors of acute urinary retention in men with benign prostatic hyperplasia. Clin Ter. 2014;165(2):75–81. doi: 10.7471/CT.2014.1680.
  22. Almeida F.G., Freitas D.G., Bruschini H. Is the ultrasound-estimated bladder weight a reliable method for evaluating bladder outlet obstruction? BJU Int. 2011;108(6):864–867. doi: 10.1111/j.1464-410X.2010.09881.x.
  23. Hakenberg O.W., Linne C., Manseck A., Wirth M.P. Bladder wall thickness in normal adults and men with mild lower urinary tract symptoms and benign prostatic enlargement. Neurourol Urodyn. 2000;19:585–593.
  24. Manieri C., Carter S.S.C., Romano G., trucchi A., Valentini M., Tubaro A. The diagnosis of bladder outlet obstruction in men by ultrasound measurement of bladder wall thickness. J Urol. 1998;159:761–765.
  25. Oelke M., Hofner K., Wiese B., Grunewald V., Jonas U. Increase in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men. World J Urol. 2002;443–452.
  26. Keong T.F. Decision making in the management of benign prostatic enlargement and the role of transabdominal ultrasound. IJU. 2010; 7:974–979.
  27. Kirpatovsky V.I., Ivanov A.P., Kudryavtseva L.V., Frolova E.V. The effect of therapy with alpha-blockers and a complex of anti-ischemic drugs on the reversibility of detrusor hypertrophy and its dysfunction after the elimination of infravesical obstruction. Experimental and Clinical Urology. 2020;(2):34–41. Russian (Кирпатовский В.И., Иванов А.П., Кудрявцева Л.В., Фролова Е.В. Влияние терапии α-адреноблокаторами и комплексом противоишемических препаратов на обратимость гипертрофии детрузора и его дисфункции после ликвидации инфравезикальной обструкции. Экспериментальная и клиническая урология 2020;(2):34–41).
  28. Esilevsky Yu.M. Assessment of the effect of M-choline and α1-blockers on blood supply to the vesicourethral segment (VUS) in men with lower urinary tract symptoms (LUTS). Mat. X Congress «Men’s Health.» Minsk, 2014:244–246. Russian (Есилевский Ю.М. Оценка влияния М-холино- и α1-адреноблокаторов на кровоснабжение пузырно-уретрального сегмента (ПУС) у мужчин с симптомами нижних мочевых путей (СНМП). Мат. Х конгресса «Мужское здоровье». Минск, 2014:244–246).
  29. Martov A.G., Dukhanin A.S., Bernikov A.N. Topical issues of therapy with alpha-1 blockers: integration of the pharmacological approach and clinical experience. Urology. 2022;3:166–175. Doi: https://dx.doi.org/10.18565/urology.2022.3.166-175. Russian (Мартов А.Г., Духанин А.С., Берников А.Н. Актуальные вопросы терапии альфа1-адреноблокаторами: интеграция фармакологического подхода и клинического опыта. Урология. 2022;3:166–175. Doi: https://dx.doi.org/10.18565/urology.2022.3.166-175).
  30. Wilde M.I., Fitton A., McTavish D. Alfuzosin. Drugs. 1993;45(3):410–429. doi: 10.2165/00003495-199345030-00008.
  31. Wilde M.I., McTavish D. Tamsulosin. Drugs. 1996;52(6):883–898. doi: 10.2165/00003495-199652060-00012.
  32. Curran M.P. Silodosin. Drugs. 2011;71(7):897–907. doi: 10.2165/11204780-000000000-00000.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1

Download (127KB)
Indexing metadata
3. Fig. 2.

Download (98KB)
Indexing metadata
4. Fig. 3.

Download (60KB)
Indexing metadata
5. Fig. 4.

Download (58KB)
Indexing metadata
6. Fig. 5.

Download (85KB)
Indexing metadata
7. Fig. 6.

Download (81KB)
Indexing metadata
8. Fig. 7.

Download (98KB)
Indexing metadata

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies