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Prostatic urethral angle could predict response to α-blockers in patients with lower urinary tract symptoms

With an estimated prevalence of 11–43.9% in people aged 20–40 years, and 68.9–93% in people aged >70 years, the lower urinary tract symptom nocturia is a common cause of adult sleep disorder.1Nocturia is frequently associated with benign prostatic hyperplasia and can be treated with α-adrenergic receptor antagonists (α-blockers).1However, clinical improvement can be marginal or unsustained, resulting in impairment to a patient’s sense of well-being.1

Researchers from Daegu, South Korea, investigated whether structural differences in the prostate were associated with a differential response to α-blocker monotherapy for treatment for nocturia.1

The study included 108 men with nocturia, defined as ≥2 awakenings at night to void, who received α-blocker monotherapy for >3 months.1

Age and prostatic urethral angle were significantly associated with nocturia (p=0.001 and p=0.010, respectively).1

After treatment with α-blockers, 25% of patients showed improvement of nocturia.
The researchers then compared patients with improvement (<2 episodes of nocturia) to those without (≥2 episodes). 1

They found that patients with improved nocturia: 1

  • Were younger (59.6 versus 68.0 years; p≤0.001)
  • Had lower International Prostate Symptom Scores (13.4 versus 17.9; p=0.008)
  • Had lower storage system scores (4.5 versus 7.4; p≤0.001)
  • Had an improved quality of life index (3.0 versus 3.7; p=0.03)
  • Had higher maximum flow rates (Qmax 16.9 mL/s versus 11.9 mL/s; p=0.002
  • Had a lower prostatic urethral angle (31.8° versus 39.4°; p=0.009).

Patients with a lower (<33.5°) prostatic urethral angle showed significantly more improvements in nocturia compared with higher (≥33.5°) prostatic urethral angle (36.6% versus 17.9%; p=0.030).1

Patients with a lower prostatic urethral angle (<33.5°) had:1

  • Lower total International Prostate Symptom Scores (14.2 versus 18.3; p=0.005)
  • Lower voiding symptom scores (8.6 versus 11.0; p=0.025)
  • Lower storage scores (5.6 versus 7.3; p=0.025)
  • Improved quality of life index (3.1 versus 3.8; p=0.021).

In conclusion, the researchers suggested that ultrasonography could be used to characterise patient’s prostate structure and enable individualised nocturia treatment.1

Reference list

  1. Kim BH, Kim KH, Ko YH, Song PH, Kim T-H, Kim BS. The prostatic urethral angle can predict the response to alpha adrenoceptor antagonist monotherapy for treating nocturia in men with lower urinary tract symptom: a multicenter study. Prostate Int 2016; 4(1): 30–35.