Comparative efficacy and safety of alpha-adrenoblockers in the treatment of LUTS due to BPH: a systematic review and meta-analysis

Loran O.B., Vorobev V.А., Kosova I.V., Gadzhieva Z.K., Kogan M.I., Su-Yanz K.M., Syrova A.I.

1) State Budgetary Healthcare Institution of the city of Moscow «Moscow Multidisciplinary Scientific and Clinical Center named after S.P. Botkin» of the Department of Health of the City of Moscow, Moscow, Russia; 2) Federal State Budgetary Educational Institution of Additional Professional Education «Russian Medical Academy of Сontinuing Professional Education» of the Ministry of Health of the Russian Federation, Moscow, Russia; 3) Bashkir State Medical University, Ufa, Russia; 4) Irkutsk State Medical University, Irkutsk, Russia; 5) FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia; 6) Rostov State Medical University, Rostov-on-Don, Russia

Introduction. Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are common and significantly impair quality of life. Alpha-1 adrenergic blockers (ABs) are the first-line pharmacotherapy; however, direct comparative data between individual agents remain limited.
Objective. To systematically compare the efficacy and safety of silodosin, tamsulosin, alfuzosin, terazosin, and doxazosin in men with LUTS/BPH.
Materials and Methods. A comprehensive search was performed in eLibrary, PubMed, Embase, and the Cochrane Library from July to September 2025. Randomized controlled trials (RCTs) evaluating AB monotherapy in men with LUTS/BPH were included. Primary outcomes were the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), quality of life (QoL), and incidence of adverse events (AEs). Study selection and data extraction were conducted in duplicate. Risk of bias was assessed using Cochrane RoB 2. Pairwise meta-analyses (random-effects model, RevMan) and a network meta-analysis with placebo as a common comparator were performed. Certainty of evidence was evaluated using the GRADE approach.
Results. Twenty-two RCTs (n=3,371; median follow-up = 12 weeks) were included; 20 were eligible for quantitative synthesis. Compared with placebo, all ABs significantly improved symptom and uroflow parameters: pooled mean difference for IPSS = –2.3 to –2.5 points; increase in Qmax = +2 mL/s; reduction in PVR = –10 to –20 mL; improvement in QoL = –0.4 points. Network analysis revealed no statistically significant efficacy differences among agents. Rank probability suggested slightly greater improvements in IPSS/Qmax/PVR with tamsulosin, and in QoL with doxazosin, though differences were clinically marginal. Safety profiles varied: dizziness and orthostatic hypotension were more frequent with doxazosin/terazosin, while ejaculatory dysfunction occurred more often with silodosin (≈ 20–25%) and, to a lesser extent, tamsulosin (8–10%). The rate of discontinuation due to AEs was comparable to placebo; serious AEs were rare.
Conclusion. Alpha-1 adrenergic blockers as a class effectively reduce LUTS and improve urinary flow parameters in men with BPH. No clinically meaningful superiority of any single agent has been demonstrated. Treatment choice should be individualized according to comorbidities and tolerability profile. Large-scale head-to-head trials are warranted to confirm potential subtle differences.

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About the Authors

Corresponding author: V.A. Vorobev – Doctor of Medical Sciences, M.D.; Professor of the Department of Faculty Surgery and Urology at the Federal State Budgetary Educational Institution of Higher Education «Irkutsk State Medical University» of the Ministry of Health of the Russian Federation, Irkutsk, Russia; Associate Professor of the Department of Urology and Oncology of the Federal State Budgetary Educational Institution of Higher Education «Bashkir State Medical University» of the Ministry of Health of the Russian Federation, Ufa, Russia; e-mail: denecer@yandex.ru

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