Alpha1 blockers may not improve Lower urinary tract symptoms in females
The European Urological Association guidelines suggest that, relative to placebo, alpha-1 adrenergic receptor blockers (α1- blockers) reduce urinary symptoms and increase maximal flow rate (Qmax) in men with lower urinary tract symptoms (LUTS). However, according to prize-winning abstract presented at the International Continence Society, 2020 virtual annual meeting, the use of α1-blockers on female LUTS should be based on the subjective cause as it has little effects on urologic symptom scores, quality of life, and overall adverse events compared to placebo.
The overall prevalence of female voiding dysfunction is estimated to be between 3% and 39%. However, considering the present lack of standardized diagnostic criteria and clinical guidelines, female LUTS is likely overlooked and underestimated. Moreover, the pathophysiological mechanism of female LUTS remains unclear. The current use of α1-blockers for female LUTS is based on their remarkable effects in the treatment of male LUTS. Published clinical trials evaluating the use of α1-blockers for female LUTS have remained limited in prevalence and participation and have produced contradictory results. For this purpose, researchers of South Korea, conducted a study to assess the effectiveness of alpha-1 adrenergic receptor blockers (α1-blockers) in the treatment of female lower urinary tract symptoms (LUTS).
It was a systematic review and meta-analysis on published a-prior protocols. They analyzed multiple data sources for published and unpublished randomized controlled trials in any language. The major outcome assessed were urologic symptom scores, quality of life and overall adverse events. They performed meta-analysis using RevMan 5.3 and rated the certainty of evidence (CoE) using GRADE.
Key findings of the study were:
♦ Among 1406 studies, researchers included 12 studies (alpha-blockers vs placebo: 5 studies, combination with alpha-blockers and other treatments vs other treatments: 7 studies).
♦ Four studies examined the use of alpha-blockers vs placebo in 456 patients. Researchers noted an "uncertain" results upon analysis.[ IPSS (mean difference (MD): -1.13), quality of life (MD: -0.48), and overall adverse events (risk ratio (RR): 1.09)].
♦ Seven studies examined alpha-blockers combined with anticholinergics vs anticholinergics alone in 144 patients, from that they found a consistently yielded "uncertain" results IPSS (MD: 0.30) and quality of life (MD: 0.00).
♦ One study compared combination therapy with an alpha-blocker and cholinergic and cholinergic alone, comprising 81 randomized participants, They again found uncertain evidence about the effects of alpha-blocker on urologic symptom scores based on IPSS (MD: -3.06). However, they didn't report any adverse events overall.
♦ Besides, the studies were judged of low to moderate quality according to GRADE criteria.
The authors concluded, "Alpha-blockers treatment depending on subjective LUTS might have little effects on urologic symptom scores, quality of life, and overall adverse events compared to placebo and other treatments in women".
For further information:
Kim H, Kim K, Yoon H, Choi J, Kim J, Kim S. Effect of alpha blocker on lower urinary tract symptoms in women: systematic review and meta-analysis. Presented at: ICS 2020 Online, November 19-22, 2020. Presentation 146.