Androgens and bladder outlet obstruction: a correlation with pressure-flow variables in a preliminary study.

Abstract

To determine the relationship between androgens, lower urinary tract symptoms (LUTS) and urodynamic variables of bladder outlet obstruction (BOO) in patients with LUTS/benign prostatic hyperplasia (BPH), as androgens are important in the pathogenesis of LUTS. Twenty-five men with symptomatic BPH were enrolled in the study and had a complete urodynamic investigation, establishing BOO. Age, prostate-specific antigen level, prostate volume and postvoid residual volume were recorded and the International Prostate Symptom Score (IPSS) was estimated. Detrusor pressure at maximum flow (P(det)Q(max)), at urethral closure (P(det)Cl, the pressure at the end of urinary flow) and maximum detrusor pressure (P(detmax)) was recorded, while detrusor overactivity (DO) was noted when present. Blood samples were collected to measure total testosterone (T), and free T (FT) was calculated. Patients were grouped according to FT levels as low (<72 pg/mL) and normal (FT > or =72 pg/mL). Ten patients had a low FT level, with a mean (sd) of 54.3 (16.5) pg/mL, and 15 a normal level of FT, of 90.5 (11) pg/mL. FT was negatively correlated with P(det)Cl, and P(det)Q(max); the mean P(det)Cl and P(det)Q(max) differed significantly between patients with low and normal FT levels. Fourteen patients had DO and they had significantly lower levels of FT than those with no DO. All patients with a FT level of <60 pg/mL had DO, and the presence of instability differed significantly from the rest of the group. Low T levels in clinical BOO correlated negatively with P(det)Cl and P(det)Q(max), while promoting DO. Androgen seems to have an ameliorating role in lower urinary tract function.