International Neurourology Journal 2015 19 107 112 AlphaBlocker

International Neurourology Journal 2015; 19: 107 -112 Alpha-Blocker Treatment Response in Men With Lower Urinary Tract Symptoms Based on Symptomatic Activity: Prospective, Multicenter, Open-Labeled, Observational Study Sung Gon Park 1, Byung Ha Chung 2, Sung Won Lee 3, Jong Kwan Park 4, Kwangsung Park 5, Jun Cheon 6, Kyung Seop Lee 7, Hyung-Jee Kim 8, Do-Hwan Seong 9, Seung-June Oh 10, Sae Woong Kim 11, Ji Youl Lee 11, Seol Ho Choo 1, Jong Bo Choi 1 1 Department of Urology, Ajou University School of Medicine, Suwon, Korea of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea 3 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 4 Department of Urology, Chonbuk National University Medical School, Jeonju, Korea 5 Department of Urology, Chonnam National University Medical School, Gwangju, Korea 6 Department of Urology, Korea University Anam Hospital, Seoul, Korea 7 Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea 8 Department of Urology, Dankook University College of Medicine, Cheonan, Korea 9 Department of Urology, Inha University College of Medicine, Incheon, Korea 10 Department of Urology, Seoul National University Hospital, Seoul, Korea 11 Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea 2 Department This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http: //creativecommons. org/licenses/by-nc/3. 0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

International Neurourology Journal 2015; 19: 107 -112 PURPOSE • The present study compared the treatment outcomes for an α-blocker between men with high sympathetic activity (HSA) and another with low sympathetic activity (LSA) or normal sympathetic activity.

International Neurourology Journal 2015; 19: 107 -112 MATERIALS AND METHODS • A total of 159 men (≥ 50 years of age) with lower urinary tract symptoms resulting from benign prostatic hyperplasia were assigned to groups according to their sympathetic activity, which was evaluated by heart rate variability measurements. • HSA was defined as a low frequency/high frequency ratio greater than 1. 6. • All patients received 10 mg of alfuzosin once a day for 12 weeks. • The primary end point was a change in the total International Prostate Symptom Score (IPSS) at 12 weeks from baseline.

International Neurourology Journal 2015; 19: 107 -112 RESULTS • The mean total IPSS change was not different between the HSA and LSA groups. • Both groups were not significantly different with respect to the changes in maximal flow rate, IPSS voiding or storage symptom subscores, quality of life, and rates of adverse drug events. • The HSA group showed a similar willingness to continue treatment compared to the LSA group, although their treatment satisfaction rating was lower.

International Neurourology Journal 2015; 19: 107 -112 CONCLUSIONS • The therapeutic effects of alfuzosin did not differ in regards to the differences in sympathetic activity. • However, treatment satisfaction ratings were lower in the HSA group.

International Neurourology Journal 2015; 19: 107 -112 Fig. 1. Patient disposition. HRV, heart rate variability.

International Neurourology Journal 2015; 19: 107 -112 Table 1. Baseline characteristics Characteristic HSA group (n=67) LSA group (n=92) P-value Age (yr) 60. 0± 5. 8 62. 5± 7. 9 0. 061 Body mass index (kg/m 2) 23. 7± 2. 5 23. 3± 2. 6 0. 476 LF/HF ratio 3. 97± 4. 52 0. 91± 0. 4 <0. 001 IPSS total 16. 8± 6. 2 16. 6± 6. 5 0. 741  Voiding subscore 10. 4± 4. 3 10. 2± 4. 9 0. 665  Storage subscore 6. 4± 3. 1 6. 5± 3. 1 0. 718 Quality of life 4. 0± 0. 8 3. 6± 1. 1 0. 045 Qmax (m. L/sec) 9. 2± 3. 6 11. 3± 4. 5 0. 001 22. 0± 25. 1 36. 6± 36. 7 0. 007 Postvoid residual (m. L) Values are presented as mean±standard deviation. HSA, high sympathetic activity; LSA, low sympathetic activity; LF/HF, low frequency/high frequency; IPSS, International Prostate Symptom Score; Qmax, maximum urinary flow rate.

International Neurourology Journal 2015; 19: 107 -112 Table 2. Changes of clinical characteristics from baseline after 12 weeks of treatment Variable HSA group (n=67) LSA group (n=92) P-value IPSS total  Baseline  Change from baseline Voiding subscore  Baseline  Change from baseline Storage subscore  Baseline  Change from baseline Quality of life  Baseline  Change from baseline Qmax (m. L/sec)  Baseline  Change from baseline Ratio of PVR (%)  Baseline  Change from baseline PVR (m. L)  Baseline  Change from baseline IIEF-5  Baseline  Change from baseline OAB-SS  Baseline  Change from baseline STAI - state anxiety  Baseline  Change from baseline STAI - trait anxiety  Baseline  Change from baseline 　 16. 8± 6. 2 – 3. 67± 5. 61 　 10. 4± 4. 3 – 2. 52± 4. 23 　 6. 4± 3. 1 – 1. 15± 2. 08 　 4. 0± 0. 8 – 0. 45± 0. 97 　 9. 2± 3. 6 3. 31± 6. 42 　 11. 6± 11. 7 – 1. 81± 8. 84 　 22. 0± 25. 1 – 0. 03± 25. 24 　 12. 9± 6. 6 1. 14± 5. 34 　 3. 9± 2. 4 – 0. 40± 1. 29 　 40. 8± 10. 0 – 1. 42± 5. 28 　 41. 1± 9. 7 – 0. 46± 5. 67 　 16. 6± 6. 5 – 3. 88± 6. 04 　 10. 2± 4. 9 – 2. 48± 4. 51 　 6. 5± 3. 1 – 1. 40± 2. 33 　 3. 6± 1. 1 – 0. 51± 1. 29 　 11. 3± 4. 5 2. 63± 6. 39 　 15. 0± 15. 1 – 2. 95± 12. 18 　 36. 6± 36. 7 – 9. 86± 29. 81 　 14. 1± 7. 6 – 0. 71± 5. 04 　 3. 5± 2. 1 – 0. 17± 1. 51 　 39. 5± 10. 8 – 1. 76± 6. 64 　 41. 3± 11. 1 – 1. 73± 5. 69 　 0. 741 0. 817 　 0. 665 0. 964 　 0. 718 0. 694 　 0. 045 0. 204 　 0. 001 0. 880 　 0. 174 0. 912 　 0. 007 0. 530 　 0. 219 0. 049 　 0. 310 0. 549 　 0. 447 0. 837 　 0. 903 0. 284 Values are presented as mean±standard deviation. HSA, high sympathetic activity; LSA, low sympathetic activity; LF/HF, low frequency/high frequency; IPSS, International Prostate Symptom Score; Qmax, maximum urinary flow rate; PVR, postvoid residual; IIEF-5, International Index of Erectile Function; OAB-SS, overactive bladder symptom score; STAI, state-trait anxiety inventory.