Predictors of Response to Tamsulosin in Patients with Benign Prostatic Enlargement Presenting at a University Teaching Hospital in Nigeria

Abstract

Background: Benign prostatic hyperplasia is of global concern as it affects the quality of life of men. The responsibilities of physicians are gradually shifting from merely treating diseases to encompassing the quality of life of patients. Tamsulosin is an effective agent used in the treatment of symptomatic benign prostatic enlargement. Identifying the predictors of response to tamsulosin treatment will prevent unnecessary drug exposure and delays in surgical care. Aim: To determine if prostate volume, intravesical prostatic protrusion, and bladder wall thickness can be used to predict response to tamsulosin in patients with benign prostatic enlargement. Materials and Methods: This was a one-year prospective longitudinal cohort study involving adult males with uncomplicated diseases of BPH presenting at the University of Port Harcourt Teaching Hospital. Patients were evaluated using the International Prostate Symptom Score questionnaire, uroflowmetry, and transrectal ultrasonography, and were then treated with tamsulosin 0.4mg daily for six weeks. Response to treatment was defined as a reduction in post-treatment IPSS and an increase in post-treatment Qmax by ≥25%. Data were analyzed using SPSS version 2025. Multivariate regression analysis was used to determine the predictors of response to tamsulosin in patients with BPE. P-value = .05 was considered significant Results:  We recruited 178 patients in this study; 119(67%) were responders, while 59 (33%) were non-responders. The mean IPSS before and after treatment was 18.71±5.06 and 10.06±6.25, respectively, with a P-value of < .0001, while that of Qmax was 11.33±2.90 and 17.33±7.07, respectively, with a P-value of < .001. Multivariate linear regression analysis was done, and intravesical prostatic protrusion was the only independent variable that made a statistically significant negative impact on response to treatment, with a P-value of .0001, and a cutoff point of 0.88cm, which can be used to predict response to tamsulosin with a sensitivity of 90.8% and 69.5% specificity. Conclusion: Intravesical prostatic protrusion is a significant predictor of response to tamsulosin in patients presenting with benign prostatic enlargement.