Predictors of outcome in patients with benign prostatic hyperplasia maintained on alpha-blockers

Aim: To determine factors that could predict failure of medical treatment or the need for surgical intervention in patients with benign prostatic hyperplasia (BPH) who were maintained on alpha‐blockers. Methods: 124 eligible patients aged 51–82 years (mean 66.8) with lower urinary tract symptoms attributable to BPH treated with alpha‐blockers were included in the study. Initial assessments included a complete medical history, physical examination, blood biochemistry, serum prostate‐specific antigen and urinalysis. Baseline symptoms were assessed by International Prostate Symptoms Score (IPSS) questionnaire, peak urine flow rate (Qmax) and post‐void residual urine volume (PVR). Transrectal ultrasound (TRUS), prostate biopsy, cystoscopy and urodynamic study were carried out when indicated. Mean follow‐up was 47.7 months. Baseline parameters were compared between the cohort of patients requiring surgical intervention and the remaining cohort who were still maintained on alpha‐blockers. Results: Forty‐four patients (35.5%) demanded surgical intervention despite treatment with alpha‐blockers. Patients requiring surgical intervention had significantly worse baseline IPSS, quality‐of‐life score, Qmax and PVR when compared with those not requiring surgery. Risk analysis using binary logistic regression model showed that IPSS (odds ratio: 1.096; P = 0.001) and PVR (odds ratio: 1.006; P = 0.008) were independent predictors for surgical intervention. Receiver–operating characteristics curves further demonstrated that IPSS was slightly better than PVR as a single predictor. Kaplan–Meier cumulative risk analyses showed that patients with baseline IPSS ≥ 14 or PVR ≥ 100 mL were more likely to require subsequent surgical intervention than their counterparts. Conclusions: In patients with BPH who were maintained on alpha‐blockers, baseline IPSS and PVR were two useful independent predictors for failure of medical treatment and the need for surgical intervention.