Tizanidine as an Adjunct to Alpha-Blockers in Adults With Dysfunctional Voiding/Poor Relaxation of the External Sphincter: A Retrospective Review

IF 1.8 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms Pub Date : 2026-06-22 DOI:10.1111/luts.70077

Mayank Mohan Agarwal, Ved Bhaskar, Shailendra Kumar Gupta, Saumya Singh, Shakti Kumar Chowdhary, Vikrant Mishra, Rahul Agnihotri, Devendra Kumar Rathore

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引用次数: 0

Abstract

Background

Skeletal muscle relaxants (SMR), particularly baclofen, have been used in patients with dysfunctional voiding (DV) and poor relaxation of the external sphincter (PRES) with variable efficacy and notable side effects. Tizanidine, a centrally acting α2-adrenergic agonist, may offer comparable benefits with a more favorable tolerability profile. However, data regarding its use in DV remain limited.

Methods

This retrospective analysis included adults diagnosed with DV/PRES between July 2017 and January 2025. Data comprised demographics, lower urinary tract symptoms (LUTS), urodynamic parameters, pre, and posttreatment uroflowmetry values, and subjective response to alpha-blockers with pelvic floor relaxation exercises, and subsequent addition of tizanidine. Uroflowmetry indices included Qmax, Qave, and volume-normalized flow indices (VQImax, VQIave). Clinical outcomes were assessed via patient-reported symptom improvement.

Results

Of 114 patients, 62.2% showed no response to alpha-blockers alone. Following addition of tizanidine (median dose 6 mg/day), 69.3% reported symptomatic improvement (45% ≥ 50% improvement, 24.6% < 50% improvement; p < 0.00001). VQImax improved by ≥ 50% in 52% of patients, and clinical improvement significantly correlated with changes in VQImax (p = 0.004) and VQIave (p = 0.009). Women demonstrated greater improvement in flow parameters than men (p < 0.05), although symptom relief was similar across sexes. Tizanidine was generally well tolerated, with sedation being the most common dose-limiting side effect (25%). Median follow up duration was 12 months (IQR 9–22).

Conclusions

Addition of tizanidine to alpha-blocker and pelvic relaxation is associated with clinically significant improvement in LUTS and uroflometry parameters in adults with pelvic floor dysfunction. We acknowledge that causal inference is limited by the study design and randomized placebo-controlled studies are required for deriving stronger conclusions.

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替扎尼定辅助α受体阻滞剂治疗成人排尿功能障碍/外括约肌松弛不良：回顾性回顾

背景：骨骼肌松弛剂（SMR），特别是巴氯芬，已被用于排尿功能障碍（DV）和外括约肌松弛不良（PRES）的患者，疗效不一，副作用明显。Tizanidine是一种中枢作用的α2-肾上腺素能激动剂，可能具有更有利的耐受性。然而，关于其在家庭暴力中的使用的数据仍然有限。方法：回顾性分析2017年7月至2025年1月期间诊断为DV/PRES的成年人。数据包括人口统计学、下尿路症状（LUTS）、尿动力学参数、治疗前和治疗后尿流测量值、对-受体阻滞剂伴盆底放松运动的主观反应以及随后加用替扎尼定。尿流测量指标包括Qmax、Qave和体积归一化流量指标（VQImax、VQIave）。通过患者报告的症状改善来评估临床结果。结果：114例患者中，62.2%的患者对α -受体阻滞剂没有反应。在添加替扎尼定（中位剂量6mg /天）后，69.3%的患者报告症状改善（45%≥50%改善，24.6%改善）。结论：在α受体阻滞剂和盆腔松弛剂中添加替扎尼定可显著改善成人盆底功能障碍患者的LUTS和尿流速参数。我们承认，因果推理受到研究设计的限制，需要随机安慰剂对照研究来得出更有力的结论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

LUTS: Lower Urinary Tract Symptoms UROLOGY & NEPHROLOGY-

CiteScore

3.00

自引率

7.70%

发文量

审稿时长

>12 weeks

期刊介绍： LUTS is designed for the timely communication of peer-reviewed studies which provides new clinical and basic science information to physicians and researchers in the field of neurourology, urodynamics and urogynecology. Contributions are reviewed and selected by a group of distinguished referees from around the world, some of whom constitute the journal''s Editorial Board. The journal covers both basic and clinical research on lower urinary tract dysfunctions (LUTD), such as overactive bladder (OAB), detrusor underactivity, benign prostatic hyperplasia (BPH), bladder outlet obstruction (BOO), urinary incontinence, pelvic organ prolapse (POP), painful bladder syndrome (PBS), as well as on other relevant conditions. Case reports are published only if new findings are provided. LUTS is an official journal of the Japanese Continence Society, the Korean Continence Society, and the Taiwanese Continence Society. Submission of papers from all countries are welcome. LUTS has been accepted into Science Citation Index Expanded (SCIE) with a 2011 Impact Factor.