Role of anticholinergic drugs in patients with benign prostatic hyperplasia symptoms

We determined the efficacy and safety of combination therapy of a-blockers and anticholenergic drugs in patients with benign prostatic hyperplasia complain mainly of storage symptoms. Study has been design to assess the efficacy and safety of combined treatment with oxybutynin plus tamsulosin in patients with lower urinary tract symptoms [LUTS] and benign prostatic hyperplasia [BPH]. Prospective randomized controlled study of patients with moderate to severe lower urinary tract symptoms. Eligible patients were men 40 years and older with a total IPSS of 12 or higher; An IPSS quality-of-life [QOL] item score of 3 or higher. Additional inclusion criteria were micturition frequency [>8 micturitions per 24 hours] and urgency [micturitions with urgency rating>3 per 24 hours] for 3 or more months. Men with clinically significant bladder outlet obstruction, or serum prostate-specific antigen of more than 4 ng/mL with risk of prostate cancer were excluded. A total of 24[80%] patients receiving oxybutynin plus tamsulosin [Group3] reported treatment benefit by week 12 compared with 13[46.4%] patients receiving placebo [Groupl] [P=0.02], 16 [53.4%] patients receiving tamsulosin[Group2] [P=0.45 vs. placebo], there is statistically significant difference between group 3 and group 2 with the p value 0.04. Patients receiving oxybutynin plus tamsulosin compared with placebo experienced significant reductions in urgency urinary incontinence, Urgency episodes, micturitions per 24 hours, and micturitions per night. Group3 Patients demonstrated significant improvements on the total International Prostate Symptom Score [-7.22 vs. -3.46 in Gl, P=.003] and QOL item [-2.21 vs -1.17, In Gl P=.003]. The incidence of acute urinary retention requiring catheterization was low in group3, the incidence was only 1 patient 3.3%; 3 patients[10.3%] in groupl, while in tamsulosin group there was no patient complain of acute urinary retention 0% .These results suggest that treatment with oxybutynin plus tamsulosin provides benefit for men with moderate to severe LUTS and BPH

Effectiveness of immediate Mitomycin C instillation in patients with low risk non-muscle invasive bladder cancer

We determined if immediate instillation chemotherapy after transurethral resection [TUR] decrease the risk of recurrence and/or progression in patient with stage Ta T1 bladder cancer. This study has been designed to analyze the impact of a single immediate mitomycin C instillation after transurethral resection of bladder cancer on recurrence and progression rates in patients with low risk superficial bladder cancer. A total of 50 patients with low risk superficial bladder cancer were included in a prospective randomized controlled trial. All patients had a 3 cm. or less single, papillary bladder tumor. The tumor was completely resected before patients were randomized into 2 arms of no further treatment [control group] and a single immediate instillation [usually within 6 hours] of 40 mg. mitomycin C [mitomycin c group]. Median follow up was 24 months .The events studied were the recurrence free rate, the recurrence rate/year, and the number of new tumors developing /year. At 24-month follow-up the recurrence-free rate was significantly increased [84.7% VS 54.2%]. Recurrence [15.3% VS 45.8%], and recurrence per year rate [7% VS 20%] and tumor per year rate [11% VS 33%] were significantly decreased in the mitomycin C compared to the control group. This study confirms the positive effect of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer. Thus, this approach is an alternative to observation. This study also suggests cell implantation as a mechanism of early recurrence can be controlled with a single immediate mitomycin C instillation

value of second look transurethral resection in the evaluation and management of patients with bladder tumors

The role of a routine second transurethral resection in evaluating and management of patients with bladder tumor is defined. From January 2004 to October 2006, 100 patients with new or recurrent bladder tumors underwent repeat transurethral resection within 4-6 weeks after the initial resection, and the results, including the presence of residual tumor and tumor stage, were compared. Of 100 cases, 28 [28%] had no tumor and 72[72%] had residual tumor on repeat TUR. Out of 64 cases with superficial [Ta, Tis, T1] bladder tumors, 20[31%] had residual non-invasive tumor and 13 [20%] were upstaged to muscle invasive tumor. Among 36 patients with a muscle invasive tumor, 10[28%] had no residual tumor on re-TURBT. Results of second resection had changed treatment option in 39 patients [39%] from the initial treatment recommendation which was given after the first TUR. Many patients with bladder tumor have residual tumor present after an initial TUR. Routine repeat resection is advised to control noninvasive tumors and to detect residual tumor invasion