alpha-blocker monotherapy in the treatment of nocturia in men with lower urinary tract symptoms: a prospective study of response prediction

Abstract

OBJECTIVE: To determine the efficacy of an alpha-adrenoceptor antagonist, terazosin, in reducing nocturia in men with lower urinary tract symptoms (LUTS), and to identify the factors predicting treatment outcome. PATIENTS AND METHODS: In all, 100 patients were treated with 2 mg of terazosin once daily for the first 7 days, and continued to receive 4 mg of terazosin once daily for the following 3 weeks. The men were assessed at baseline and at the end of treatment using uroflowmetry, the International Prostate Symptom Score (IPSS), and the degree of nocturia estimated from a frequency-volume chart (FVC) and objectively. RESULTS: On the FVC, 27 patients reported that the terazosin treatment reduced their nocturia by more than half, and 14 reported a reduction of 25-49%. On the IPSS, 31 patients reported that the treatment reduced their nocturia by more than half and 27 reported a reduction of 25-49%. On multivariate regression analysis, only the actual number of nightly voids on the FVC was associated with a 2.1-fold chance of an improvement of >25% in objective nocturia (P = 0.016). Using a comparable model, a greater nocturia score on the IPSS was associated with a higher likelihood of improvement in subjective nocturia (odds ratio, 1.653; 95% confidence interval, 1.079-2.533; P = 0.021). CONCLUSION: Treatment with terazosin can reduce patients' episodes of nocturia both subjectively and objectively in some men with LUTS. Our results suggest that both subjective and objective numbers of nocturia episodes are associated with improvements in subjective and objective nocturnal frequencies, respectively.