{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:56:01Z","timestamp":1785412561351,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T00:00:00Z","timestamp":1775260800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004699","name":"Chung Shan Medical University Hospital","doi-asserted-by":"publisher","award":["CSH-2026-A-008"],"award-info":[{"award-number":["CSH-2026-A-008"]}],"id":[{"id":"10.13039\/501100004699","id-type":"DOI","asserted-by":"publisher"}]},{"award":["CSH-2026-A-008"],"award-info":[{"award-number":["CSH-2026-A-008"]}],"id":[{"id":"https:\/\/ror.org\/01abtsn51","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Benign prostatic hyperplasia (BPH) can be associated with lower urinary tract symptoms (LUTS) and potential avlterations in autonomic nervous system function, as reflected by heart rate variability (HRV). This observational study was designed to generate hypotheses regarding the differential impacts of surgical de-obstruction versus uroselective pharmacological blockade on autonomic nervous system equilibrium, HRV restoration, and symptomatic outcomes in men with BPH and bladder outlet obstruction. Methods: Data from a prospective cohort of 242 men undergoing TURP and 210 men receiving tamsulosin were analyzed. HRV parameters (standard deviation of normal-to-normal intervals [SDNN], low-frequency\/high-frequency [LF\/HF] ratio, total power [TP], very low frequency [VLF]) and International Prostate Symptom Score (IPSS) was assessed at baseline and 12 weeks. Propensity score matching (PSM) was used to address baseline differences in age, prostate volume, IPSS, and baseline SDNN. Inter-group comparisons used ANCOVA with baseline as a covariate. Results: After TURP, SDNN increased by 14.70 ms (40%; 36.97 \u00b1 22.80 to 51.67 \u00b1 27.59 ms; p = 0.032; paired Cohen\u2019s d = 0.58), LF\/HF decreased by 0.90 (55%; 1.63 \u00b1 1.60 to 0.73 \u00b1 0.52; p = 0.028; d = \u22120.76), TP increased by 1303 ms2 (95%; 1367 \u00b1 820 to 2670 \u00b1 1420 ms2; p = 0.025; d = 1.12), and VLF increased by 810 ms2 (85%; 950 \u00b1 560 to 1760 \u00b1 980 ms2; p = 0.030; d = 1.01). For tamsulosin, SDNN increased by 6.73 ms (18%; 38.12 \u00b1 12.50 to 44.85 \u00b1 11.20 ms; p = 0.004; d = 0.57), LF\/HF decreased by 0.16 (8%; 1.95 \u00b1 0.65 to 1.79 \u00b1 0.55; p = 0.012; d = \u22120.27), TP increased by 559 ms2 (39%; 1453 \u00b1 620 to 2012 \u00b1 580 ms2; p = 0.006; d = 0.93), and VLF increased by 355 ms2 (35%; 1020 \u00b1 450 to 1375 \u00b1 420 ms2; p = 0.010; d = 0.82). Secondary p-values (LF\/HF, TP, VLF) were adjusted via the Benjamini\u2013Hochberg method; adjusted p &gt; 0.05 was used for some. Inter-group differences in changes were significant (ANCOVA p &lt; 0.01; partial \u03b72 = 0.12\u20130.22 for group factor). TURP was associated with greater IPSS reduction (\u221210.2 points; 18.5 \u00b1 6.2 to 8.3 \u00b1 4.1; p &lt; 0.001) compared to tamsulosin (\u22125.3 points; 15.8 \u00b1 5.6 to 10.5 \u00b1 4.8; p &lt; 0.001; d = \u22121.02; inter-group p &lt; 0.001). PSM confirmed these associations with p &lt; 0.01 for HRV changes. Change in SDNN was associated with IPSS improvement in multivariate regression (standardized \u03b2 = \u22120.42, p &lt; 0.01). Conclusions: In this observational study, TURP was associated with greater changes in HRV parameters and symptomatic improvement compared to tamsulosin. These findings are hypothesis-generating and require confirmation in long-term randomized trials.<\/jats:p>","DOI":"10.3390\/life16040600","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T04:10:27Z","timestamp":1775448627000},"page":"600","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6638-9897","authenticated-orcid":false,"given":"Kuan-Yu","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Urology, Chung Shan Medical University Hospital, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Hui","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"},{"name":"Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Sheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua 500, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Hsin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Urology, Chung Shan Medical University Hospital, Taichung 402, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3496-3371","authenticated-orcid":false,"given":"Kai-Siang","family":"Chen","sequence":"additional","affiliation":[{"name":"The Center of Humanities and Society, Chia Nan University of Pharmacy & Science, Tainan 717, Taiwan"},{"name":"Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei 242, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chieh-Jui","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6275-7680","authenticated-orcid":false,"given":"Cheng-Ju","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Urology, Chung Shan Medical University Hospital, Taichung 402, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2728-6996","authenticated-orcid":false,"given":"Chih-Kai","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Urology, Chung Shan Medical University Hospital, Taichung 402, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2648-4691","authenticated-orcid":false,"given":"Sung-Lang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology, Chung Shan Medical University Hospital, Taichung 402, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.ucl.2009.07.003","article-title":"Etiology, epidemiology, and natural history","volume":"36","author":"Bushman","year":"2009","journal-title":"Urol. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1016\/j.eururo.2006.09.019","article-title":"Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: Results of the EPIC study","volume":"50","author":"Irwin","year":"2006","journal-title":"Eur. Urol."},{"key":"ref_3","first-page":"S122","article-title":"BPH: Epidemiology and comorbidities","volume":"12","author":"McVary","year":"2006","journal-title":"Am. J. Manag. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1111\/bju.12745","article-title":"Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH)\u2013focus on the UK","volume":"115","author":"Speakman","year":"2015","journal-title":"BJU Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1001\/jama.2025.7045","article-title":"Lower urinary tract symptoms in men: A review","volume":"334","author":"Wei","year":"2025","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"764","DOI":"10.21037\/tau-2025-12","article-title":"Tracking and analysis of benign prostatic hyperplasia and prostate cancer burden globally: 1990\u20132021 epidemiological trends","volume":"14","author":"Mo","year":"2025","journal-title":"Transl. Androl. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"102883","DOI":"10.1016\/j.fjurol.2025.102883","article-title":"Autonomic nervous system and overactive bladder: A systematic review","volume":"35","author":"Biardeau","year":"2025","journal-title":"Fr. J. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Chen, K.-Y., Chen, Y.-S., Yang, M.-H., Huang, Y.-H., and Chen, S.-L. (2025). Autonomic Modulation and Symptomatic Efficacy of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia. Life, 15.","DOI":"10.3390\/life15101520"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Roy, H.A., and Green, A.L. (2019). The central autonomic network and regulation of bladder function. Front. Neurosci., 13.","DOI":"10.3389\/fnins.2019.00535"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Huang, Y.-H., Chang, H.-Y., Tsai, S.-W., Chou, L.-W., Chen, S.-L., and Lin, Y.-H. (2016). Comparison of autonomic reactions during urodynamic examination in patients with spinal cord injuries and able-bodied subjects. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0161976"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1097\/01.ju.0000173072.73702.64","article-title":"Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia","volume":"174","author":"Mcvary","year":"2005","journal-title":"J. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1007\/s11255-022-03213-5","article-title":"Heart rate variability in men with lower urinary tract symptoms: A case-control study","volume":"54","author":"Brum","year":"2022","journal-title":"Int. Urol. Nephrol."},{"key":"ref_13","first-page":"1069","article-title":"Effects of urination process on heart rate variability","volume":"57","year":"2025","journal-title":"Int. Urol. Nephrol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"44","DOI":"10.2174\/1874303X00801010044","article-title":"Autonomic nervous system activity in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia estimated by heart rate variability","volume":"1","author":"Juszczak","year":"2008","journal-title":"Open Urol. Nephrol. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"49","DOI":"10.4111\/icu.2018.59.1.49","article-title":"Changes in autonomic nervous system activity after treatment with alpha-blocker in men with lower urinary tract symptoms","volume":"59","author":"Shim","year":"2018","journal-title":"Investig. Clin. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/S0302-2838(02)00273-7","article-title":"Study of the association between ischemic heart disease and use of alpha-blockers and finasteride indicated for the treatment of benign prostatic hyperplasia","volume":"42","author":"Souverein","year":"2002","journal-title":"Eur. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1097\/JU.0000000000001561","article-title":"Cardiac failure associated with medical therapy of benign prostatic hyperplasia: A population based study","volume":"205","author":"Lusty","year":"2021","journal-title":"J. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e2343299","DOI":"10.1001\/jamanetworkopen.2023.43299","article-title":"Cardiovascular outcomes of \u03b1-blockers vs. 5-\u03b1 reductase inhibitors for benign prostatic hyperplasia","volume":"6","author":"Zhang","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1016\/j.juro.2007.09.084","article-title":"The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study","volume":"179","author":"Roehrborn","year":"2008","journal-title":"J. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S0735-1097(22)01256-6","article-title":"Uroselective Alpha-1 Blockers in Males with Heart Failure: Nested Case-Control Study","volume":"79","author":"Turgeon","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Shaffer, F., and Ginsberg, J.P. (2017). An overview of heart rate variability metrics and norms. Front. Public Health, 5.","DOI":"10.3389\/fpubh.2017.00258"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1016\/S0022-5347(17)36966-5","article-title":"The American Urological Association symptom index for benign prostatic hyperplasia","volume":"148","author":"Barry","year":"1992","journal-title":"J. Urol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Bonanni, M., Rehak, L., Massaro, G., Benedetto, D., Matteucci, A., Russo, G., Esperto, F., Federici, M., Mauriello, A., and Sangiorgi, G.M. (2022). Autologous Immune Cell-Based Regenerative Therapies to Treat Vasculogenic Erectile Dysfunction: Is the Immuno-Centric Revolution Ready for the Prime Time?. Biomedicines, 10.","DOI":"10.3390\/biomedicines10051091"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1161\/01.CIR.98.15.1510","article-title":"Prospective study of heart rate variability and mortality in chronic heart failure: Results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart)","volume":"98","author":"Nolan","year":"1998","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"235","DOI":"10.30773\/pi.2017.08.17","article-title":"Stress and heart rate variability: A meta-analysis and review of the literature","volume":"15","author":"Kim","year":"2018","journal-title":"Psychiatry Investig."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"de Groat, W.C., and Yoshimura, N. (2009). Afferent nerve regulation of bladder function in health and disease. Sensory Nerves, Springer.","DOI":"10.1007\/978-3-540-79090-7_4"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1016\/j.juro.2011.01.074","article-title":"Update on AUA guideline on the management of benign prostatic hyperplasia","volume":"185","author":"McVary","year":"2011","journal-title":"J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.eursup.2004.10.010","article-title":"Tamsulosin Oral Controlled Absorption System (OCAS) in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia (LUTS\/BPH): Efficacy and Tolerability in a Placebo and Active Comparator Controlled Phase 3a Study","volume":"4","author":"Chapple","year":"2005","journal-title":"Eur. Urol. Suppl."},{"key":"ref_29","first-page":"1","article-title":"Heart rate variability: Highlights from hidden signals","volume":"4","year":"2018","journal-title":"J. Integr. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1055\/s-0036-1586142","article-title":"Medical and surgical treatment modalities for lower urinary tract symptoms in the male patient secondary to benign prostatic hyperplasia: A review","volume":"33","author":"Macey","year":"2016","journal-title":"Semin. Interv. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s11884-017-0426-3","article-title":"Impact of autonomic dysfunction on lower urinary tract symptoms","volume":"12","author":"Kowalik","year":"2017","journal-title":"Curr. Bladder Dysfunct. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Viti, A., Amore, M., Garfagnini, S., Minciacchi, D., and Bravi, R. (2025). PAPIMI Short Effect on Pain Perception and Heart Rate Variability in Chronic Musculoskeletal Pain: A Pilot Study. Healthcare, 13.","DOI":"10.3390\/healthcare13162006"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3015","DOI":"10.1007\/s00345-022-04179-w","article-title":"Transurethral resection of the prostate in 85+\u2009patients: A retrospective, multicentre study","volume":"40","author":"Seklehner","year":"2022","journal-title":"World J. Urol."},{"key":"ref_34","first-page":"1314","article-title":"Comparative Study of Uroflowmetric Parameters Pre and Post-TURP in Benign Prostatic Hy-perplasia","volume":"8","author":"Bansal","year":"2023","journal-title":"J. Urol. Ren. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Cahill, E.M., Lindenbaum, M.M., Estright, A., Ljubetic, B.M., Aslot, V., Nero, N., De, S., Bajic, P., and Bole, R. (2026). The Impact of Minimally Invasive Surgical Therapy for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-Analysis. Prostate Cancer Prostatic Dis.","DOI":"10.1038\/s41391-026-01091-x"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"g3253","DOI":"10.1136\/bmj.g3253","article-title":"Use of placebo controls in the evaluation of surgery: Systematic review","volume":"348","author":"Wartolowska","year":"2014","journal-title":"BMJ Br. Med. J."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/4\/600\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T09:58:41Z","timestamp":1775555921000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/4\/600"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,4]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["life16040600"],"URL":"https:\/\/doi.org\/10.3390\/life16040600","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,4]]}}}