Alpha-1 Adrenergic Receptor Blockers for the Treatment of Lower Urinary Tract Symptoms in Women: A Systematic Review and Meta-Analysis

Abstract

Purpose: To assess the effectiveness of alpha-1 adrenergic receptor blockers (α1-blockers) in the treatment of female lower urinary tract symptoms (LUTS).

Methods: A literature search was conducted using the PubMed/MEDLINE, Embase, and Cochrane Library databases. Fourteen studies with 1,319 patients were ultimately included. The study comprised 2 analyses: a comparison of urinary symptom scores, maximal flow rate (Qmax), and postvoid residual (PVR) urine volume before and after α1-blocker administration in 8 prospective, open-label studies and 5 randomized clinical trials (RCTs); and an evaluation of the same variables in α1-blocker and placebo groups in 4 RCTs.

Results: The first meta-analysis showed that, following treatment, patients exhibited statistically significant symptom relief (mean difference [MD], -5.85; 95% confidence interval [CI], -7.71 to -3.99; P<0.00001), increased Qmax (MD, 3.67 mL/sec; 95% CI, 2.76-4.59 mL/sec; P<0.00001), and decreased PVR volume (MD, -28.46 mL; 95% CI, -34.99 to -21.93 mL; P<0.00001). In the second meta-analysis, α1-blockers demonstrated significant symptom relief relative to placebo (MD, -1.60; 95% CI, -2.68 to -0.51; P=0.004). However, no significant differences were observed in Qmax (MD, 0.05 mL/sec; 95% CI, -0.74 to 0.83 mL/sec, P=0.91) and PVR (MD, -8.10 mL; 95% CI, -32.32 to 16.12 mL, P=0.51) between the α1-blocker and placebo groups.

Conclusion: These analyses suggest that α1-blockers are effective in the treatment of female LUTS patients. However, the effect of α1-blockers on female LUTS should be assessed according to the underlying cause, and the role of α1-blockers in combination therapy with other drugs should also be investigated.

Keywords: Alpha-adrenergic antagonists; Lower urinary tract symptoms; Meta-analysis; Voiding dysfunction; Women.

Fig. 1.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) flowchart. Chart presenting the flow of information through the different phases of the systematic review, together with the utilized exclusion criteria.

Fig. 2.

Forest plots comparing pre-post study outcomes (subgroup-analysis by study design). The evaluated outcomes included urinary symptom score (A), maximal flow rate (B), and postvoid residual urine volume (C). P, prazosin; T, terazosin; SD, standard deviation; CI, confidence interval; df, degrees of freedom.

Fig. 3.

Forest plots comparing outcomes between α1-blocker and placebo groups. Evaluated outcomes included urinary symptom score (A), maximal flow rate (B), residual urine volume (C), and adverse events (D). SD, standard deviation; CI, confidence interval; df, degrees of freedom.

Fig. 4.

Publication bias analysis. Funnel plots for maximal flow rate (A) and postvoid residual urine volume (B).

Fig. 5.

Risk of bias assessment graph. Risk of bias was assessed using the Cochrane Risk of Bias Tool.

Fig. 6.

Study-specific bias risk. Risk of bias was assessed using the Cochrane Risk of Bias Tool. A green plus sign indicates a low risk of bias, a yellow question mark indicates an unclear risk of bias, and a red minus sign indicates a high risk of bias.