Alpha-Blockade im Wandel: Wirksamkeit und Sicherheit von Urapidil vs. Phenoxybenzamin bei Phäochromozytom-Operationen
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Pheochromocytoma is a catecholamine-producing tumor requiring careful preoperative pharmacological preparation because surgical resection may be associated with pronounced perioperative blood pressure fluctuations. Phenoxybenzamine is an established nonselective, irreversible α-adrenergic receptor blocker, whereas urapidil, through selective and reversible α1-adrenergic blockade, may offer a more readily controllable alternative. This study compared both agents with respect to perioperative safety, hemodynamic stability, tolerability, and clinical course.
This retrospective single-center observational study included all patients with pheochromocytoma who underwent surgery at University Hospital Marburg between 2010 and June 2023. Of 49 patients, 26 received phenoxybenzamine and 23 received urapidil; among the latter, 15 were treated with a sustained-release oral formulation and eight with intravenous urapidil. The primary endpoint was the occurrence of serious adverse events. Secondary endpoints included adverse drug reactions, length of hospital stay, intraoperative blood pressure parameters, the Haemodynamic Instability Score (HIS), and its modified version, HIS2. Potential confounding was addressed using statistical methods including propensity score matching, inverse probability of treatment weighting, and entropy balancing.
No deaths, strokes, or myocardial infarctions occurred in either treatment group. Urapidil was associated with significantly fewer adverse drug reactions (p=0.02) and a median hospital stay that was five days shorter (p<0.001). No significant differences were observed in HIS, HIS2, or lowest mean arterial pressure. In contrast, maximum systolic blood pressure values were approximately 20 mmHg lower with phenoxybenzamine (p=0.005). No significant differences in the investigated hemodynamic or clinical endpoints were observed between intravenous and sustained-release oral urapidil administration.
Overall, this cohort showed no evidence of relevant differences in intraoperative hemodynamic stability between urapidil and phenoxybenzamine. Urapidil was associated with better tolerability and a shorter hospital stay, whereas phenoxybenzamine more effectively limited systolic blood pressure peaks. Given the retrospective single-center design and limited sample size, these findings do not permit definitive conclusions regarding non-inferiority with respect to rare serious complications. Nevertheless, urapidil appears to represent a clinically plausible alternative for the preoperative treatment of patients with pheochromocytoma.
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