Uroselective Alpha-1A Blockade Versus Surgical De-Obstruction: Differential Associations with Heart Rate Variability Restoration and Symptom Relief in Benign Prostatic Hyperplasia with Bladder Outlet Obstruction
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Assessments
2.3. Statistical Analysis
3. Results
3.1. Autonomic Nervous System Modulation
3.2. Symptomatic Efficacy
3.3. Propensity Score Matched Analysis
3.4. Safety Outcomes
4. Discussion
4.1. The BPH-ANS Association
4.2. Mechanical Relief Versus Pharmacological Blockade
4.3. Disparity in HRV Improvements: SDNN and LF/HF
4.4. Theoretical Safety of Selective Blockade and Cardiovascular Implications
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
| BPH | Benign Prostatic Hyperplasia |
| LUTS | Lower Urinary Tract Symptoms |
| ANS | Autonomic Nervous System |
| HRV | Heart Rate Variability |
| TURP | Transurethral Resection of Prostate |
| SDNN | Standard Deviation of Normal-to-Normal Intervals |
| IPSS | International Prostate Symptom Score |
| BOO | Bladder Outlet Obstruction |
| QoL | Quality of Life |
| MACE | Major Adverse Cardiovascular Events |
Appendix A
| Parameter Group | Baseline (Mean ± SD) | 12 Weeks (Mean ± SD) | Delta (Mean) | p-Value (Paired t-Test) | Adjusted p-Value (Benjamini–Hochberg) | Cohen’s d |
|---|---|---|---|---|---|---|
| VLF (ms2) TURP | 950 ± 560 | 1760 ± 980 | +810 | 0.030 | 0.042 | 1.01 |
| VLF (ms2) Tamsulosin | 1020 ± 450 | 1375 ± 420 | +355 | 0.010 | 0.018 | 0.82 |
| Parameter Group | Baseline (Mean ± SD) | 12 Weeks (Mean ± SD) | Delta (Mean) | p-Value (Paired t-Test) | Adjusted p-Value (Benjamini–Hochberg) | Cohen’s d |
|---|---|---|---|---|---|---|
| VLF (ms2) TURP | 960 ± 550 | 1730 ± 950 | +770 | 0.028 | 0.042 | 0.95 |
| VLF (ms2) Tamsulosin | 1015 ± 445 | 1370 ± 415 | +355 | 0.012 | 0.018 | 0.81 |
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| Characteristic | TURP Cohort (n = 242) | Tamsulosin Cohort (n = 210) | p-Value |
|---|---|---|---|
| Age (years, mean ± SD) | 67.4 ± 6.8 | 69.8 ± 7.5 | 0.002 |
| Prostate Volume (mL, mean ± SD) | 58.2 ± 20.1 | 52.4 ± 18.6 | 0.010 |
| Baseline IPSS (mean ± SD) | 18.5 ± 6.2 | 15.8 ± 5.6 | <0.001 |
| Baseline Qmax (mL/s, mean ± SD) | 9.8 ± 3.4 | 11.2 ± 3.1 | 0.004 |
| Treated Hypertension (%) | 45 | 48 | 0.620 |
| Diabetes (%) | 22 | 25 | 0.480 |
| BMI (kg/m2, mean ± SD) | 24.5 ± 3.2 | 24.8 ± 3.4 | 0.410 |
| Smoking History (%) | 30 | 28 | 0.710 |
| Baseline SDNN (ms, mean ± SD) | 36.97 ± 22.80 | 38.12 ± 12.50 | 0.520 |
| Baseline LF/HF (mean ± SD) | 1.63 ± 1.60 | 1.95 ± 0.65 | 0.030 |
| Baseline TP (ms2, mean ± SD) | 1367 ± 820 | 1453 ± 620 | 0.042 |
| Baseline VLF (ms2, mean ± SD) | 950 ± 560 | 1020 ± 450 | 0.030 |
| Parameter | Baseline (Mean ± SD) | 12 Weeks (Mean ± SD) | Delta (Mean) | p-Value (Paired t-Test) | Adjusted p-Value (Benjamini–Hochberg) |
|---|---|---|---|---|---|
| SDNN (ms) | 36.97 ± 22.80 | 51.67 ± 27.59 | +14.70 | 0.032 | N/A (Primary) |
| LF/HF | 1.63 ± 1.60 | 0.73 ± 0.52 | −0.90 | 0.028 | 0.042 |
| TP (ms2) | 1367 ± 820 | 2670 ± 1420 | +1303 | 0.025 | 0.042 |
| VLF (ms2) | 950 ± 560 | 1760 ± 980 | +810 | 0.030 | 0.042 |
| Parameter | Baseline (Mean ± SD) | 12 Weeks (Mean ± SD) | Delta (Mean) | p-Value (Paired t-Test) | Adjusted p-Value (Benjamini–Hochberg) |
|---|---|---|---|---|---|
| SDNN (ms) | 38.12 ± 12.50 | 44.85 ± 11.20 | +6.73 | 0.004 | N/A (Primary) |
| LF/HF | 1.95 ± 0.65 | 1.79 ± 0.55 | −0.16 | 0.012 | 0.018 |
| TP (ms2) | 1453 ± 620 | 2012 ± 580 | +559 | 0.006 | 0.018 |
| VLF (ms2) | 1020 ± 450 | 1375 ± 420 | +355 | 0.010 | 0.018 |
| Parameter | TURP Delta (Mean) | Tamsulosin Delta (Mean) | ANCOVA p-Value | Partial η2 (Group Factor) | Cohen’s d (Inter-Group) |
|---|---|---|---|---|---|
| SDNN (ms) | +14.70 | +6.73 | <0.001 | 0.15 | 0.62 |
| LF/HF | −0.90 | −0.16 | <0.001 | 0.12 | −0.85 |
| TP (ms2) | +1303 | +559 | <0.001 | 0.22 | 0.98 |
| VLF (ms2) | +810 | +355 | <0.001 | 0.18 | 0.92 |
| Total IPSS (points) | −10.2 | −5.3 | <0.001 | 0.25 | −1.15 |
| Voiding Sub-score | −7.1 | −3.8 | <0.001 | 0.20 | −1.02 |
| QoL Index | −2.5 | −1.4 | 0.002 | 0.14 | −0.78 |
| Correlation Pair | TURP Group (r, p-Value) | Tamsulosin Group (r, p-Value) |
|---|---|---|
| ΔIPSS vs. ΔSDNN | −0.55, p < 0.001 | −0.35, p = 0.028 |
| ΔIPSS vs. ΔLF/HF | 0.45, p = 0.002 | 0.28, p = 0.056 |
| ΔQoL vs. ΔSDNN | −0.52, p < 0.001 | −0.32, p = 0.032 |
| ΔQoL vs. ΔTP | 0.50, p = 0.001 | 0.30, p = 0.041 |
| Variable | TURP (Mean ± SD) | Tamsulosin (Mean ± SD) | SMD |
|---|---|---|---|
| Age (years) | 68.2 ± 7.1 | 68.5 ± 7.3 | 0.04 |
| Prostate Volume (mL) | 55.4 ± 18.2 | 54.8 ± 17.9 | 0.03 |
| Baseline IPSS | 16.2 ± 5.8 | 15.8 ± 5.6 | 0.07 |
| Baseline SDNN (ms) | 37.5 ± 20.1 | 37.8 ± 19.8 | 0.02 |
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Chen, K.-Y.; Huang, Y.-H.; Chen, Y.-S.; Yang, M.-H.; Chen, K.-S.; Chen, C.-J.; Ho, C.-J.; Peng, C.-K.; Chen, S.-L. Uroselective Alpha-1A Blockade Versus Surgical De-Obstruction: Differential Associations with Heart Rate Variability Restoration and Symptom Relief in Benign Prostatic Hyperplasia with Bladder Outlet Obstruction. Life 2026, 16, 600. https://doi.org/10.3390/life16040600
Chen K-Y, Huang Y-H, Chen Y-S, Yang M-H, Chen K-S, Chen C-J, Ho C-J, Peng C-K, Chen S-L. Uroselective Alpha-1A Blockade Versus Surgical De-Obstruction: Differential Associations with Heart Rate Variability Restoration and Symptom Relief in Benign Prostatic Hyperplasia with Bladder Outlet Obstruction. Life. 2026; 16(4):600. https://doi.org/10.3390/life16040600
Chicago/Turabian StyleChen, Kuan-Yu, Yu-Hui Huang, Yun-Sheng Chen, Min-Hsin Yang, Kai-Siang Chen, Chieh-Jui Chen, Cheng-Ju Ho, Chih-Kai Peng, and Sung-Lang Chen. 2026. "Uroselective Alpha-1A Blockade Versus Surgical De-Obstruction: Differential Associations with Heart Rate Variability Restoration and Symptom Relief in Benign Prostatic Hyperplasia with Bladder Outlet Obstruction" Life 16, no. 4: 600. https://doi.org/10.3390/life16040600
APA StyleChen, K.-Y., Huang, Y.-H., Chen, Y.-S., Yang, M.-H., Chen, K.-S., Chen, C.-J., Ho, C.-J., Peng, C.-K., & Chen, S.-L. (2026). Uroselective Alpha-1A Blockade Versus Surgical De-Obstruction: Differential Associations with Heart Rate Variability Restoration and Symptom Relief in Benign Prostatic Hyperplasia with Bladder Outlet Obstruction. Life, 16(4), 600. https://doi.org/10.3390/life16040600

