Comparative evaluation of naftopidil and tamsulosin in the treatment of patients with lower urinary tract symptoms with benign prostatic hyperplasia

Naftopidil, approved initially in Japan, is an alpha1d-adrenergic receptor antagonist [alpha1-blocker] used to treat lower urinary tract symptoms [LUTS] due to benign prostatic hyperplasia [BPH]. It is different from tamsulosin hydrochloride and silodosin, in that it has a higher affinity for the alpha1D-adrenergic receptor subtype than for the alpha1A subtype and has a superior efficacy to a placebo and comparable efficacy to other alpha1-blockers such as tamsulosin. The incidences of ejaculatory disorders and intraoperative floppy iris syndrome induced by naftopidil may also be lower than that for tamsulosin and silodosin, which have a high affinity for the alpha1A-adrenergic receptor subtype. However, it remains unknown if the efficacy and safety of naftopidil in Japanese men is applicable to Indian men having LUTS/BPH. Two groups of 60 patients each, having LUTS due to BPH, were treated with tamsulosin 0.4 mg and Naftopidil 75 mg for three months. Ultrasonography [for prostate size, post-void residual volume], uroflowmetry, and the International Prostate Symptom Score [IPSS] and Quality of Life [QOL] score were recorded at the beginning of the study, and then at one and three months. The prostate size, post-void residual volume, all the uroflowmetry variables, and the IPSS QOL scores showed a statistically significant improvement [P < 0.001] in both the groups. The improvement in the average flow rate and the QOL index was better in the naftopidil group on the intergroup comparison and was statistically significant [P < 0.001]. Although the QOL life index was significantly better in the naftopidil group, overall both naftopidil and tamsulosin were found to be equally effective in the treatment of LUTS due to BPH

Is periprostatic nerve block a gold standard in case of transrectal ultrasound-guided prostate biopsy?

Controversy exists over the pain during prostate biopsy. Periprostatic nerve block [PNB] is a gold standard anesthetic technique during transrectal ultrasound [TRUS]-guided prostate biopsy. Recent studies showed that PNB alone is insufficient as analgesic. We compared the efficacy of tramadol and intraprostatic nerve block [INB] in addition to PNB. We conducted a prospective double blinded placebo controlled study at our institute in 150 consecutive patients. Patients were randomized into three groups. Group A received PNB with INB with 1% lignocaine. Group B received oral tramadol with PNB. Group C patients were administered PNB only with 1% lignocaine. Patients were asked to grade the pain level using 11 point linear visual analog scale [VAS] at the time of ultrasound probe insertion, at time of anesthesia, during biopsy, and 30 min after biopsy. The study groups were comparable in demographic profile, prostate-specific antigen [PSA] levels, and prostate size. Group A recorded the minimum mean pain score of 2.66 during prostate biopsy which was significantly lower than group 3 [P < 0.001]. Group B recorded significantly lower pain score at time of probe insertion and at anesthetic needle insertion than other two groups. PNB provides better pain control in TRUS-guided prostate biopsy but still there is need of additional analgesic in the form of tramadol or INB. Tramadol has advantage of oral intake and analgesic effect at time of probe insertion and at nerve block. Both tramadol and INB may be used in combination along with PNB.

Comparative Evaluation of Periprostatic Nerve Block with and without Intraprostatic Nerve Block in Transrectal Ultrasound-Guided Prostatic Needle Biopsy

PURPOSE: Controversy exists over the pain during prostate biopsy. Periprostatic nerve block is a commonly used anaesthetic technique during transrectal ultrasound (TRUS)-guided prostate biopsy. The recent trend toward increasing the number of cores has become popular. This practice further increases the need for a proper anaesthetic application. We compared the efficacy of periprostatic nerve block with or without intraprostatic nerve block. MATERIALS AND METHODS: We conducted a prospective double-blinded placebo-controlled study at our institute with 142 consecutive patients. Patients were randomly assigned into 3 groups. Group 1 received periprostatic nerve block with intraprostatic nerve block with 1% lignocaine. Group 2 patients were administered periprostatic nerve block only with 1% lignocaine. Group 3 received no anaesthesia. Patients were asked to grade their level of pain by using an 11-point linear analogue scale at the time of ultrasound probe insertion, at the time of anaesthesia, during biopsy, and 30 minutes after biopsy. RESULTS: The study groups were comparable in demographic profile, prostate-specific antigen (PSA) level, and prostate size. The mean pain scores at the time of biopsy in groups 1, 2, and 3 were 2.70, 3.39, and 4.16, respectively. Group 1 recorded the minimum mean pain score of 2.70 during prostate biopsy, which was significantly lower than the scores of groups 2 and 3 (p0.05). CONCLUSIONS: Periprostatic nerve block with intraprostatic nerve block provides better pain control than does periprostatic nerve block alone in TRUS-guided prostate biopsy.