Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysis

ABSTRACT Purpose: Medical expulsive therapy (MET) is recommended for distal ureteral stones from 5 to 10 mm. The best drug for MET is still uncertain. In this review, we aim to compare the effectiveness of tadalafil and tamsulosin for distal ureteral stones from 5 to 10 mm in terms of stone expulsion rate (SER), stone expulsion time (SET) and the side effect profile. Materials and methods: A comprehensive literature search was conducted on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science, from inception until April 2023. Only randomized controlled trials were included in the analysis. Results: Eleven publications with 1,330 patients were included. We observed that tadalafil has a higher SER (OR 0.55, CI 95% 0.38;0.80, p=0.02, I2=52%) and the same efficacy in SET (MD 1.07, CI 95% -0.25; 2.39, p=0.11, I2=84%). No differences were found when comparing side effects as headache, backache, dizziness, and orthostatic hypotension. Conclusion: Tadalafil has a higher stone expulsion rate than tamsulosin as a medical expulsive therapy for patients with distal stones from 5 to 10 mm without differences in side effects.

Analysis of factors related to the efficacy of Tamsulosin monotherapy for overactive bladder symptoms in benign prostatic hyperplasia patients with the prostate volume <40 ml / 中华老年医学杂志

Objective:To assess the efficacy of Tamsulosin monotherapy for overactive bladder(OAB)symptoms in benign prostatic hyperplasia(BPH)patients with the prostate volume(PV)<40 ml, and to analyze related factors affecting the efficacy.Methods:300 BPH patients with OAB were enrolled, with an average age of(66.9±7.7)years and the PV<40 ml.Smoking, drinking and other living habits were investigated.Data on the Overactive Bladder Symptom Score(OABSS), International Prostate Symptom Score(IPSS)and Quality of Life Scale(QOLS)were collected before and after 4 weeks of treatment with Tamsulosin 0.2 mg QN.The maximum urine flow rate(Qmax)and bladder residual urine volume(PVR)were measured before and after treatment.OBASS was used as the main assessment parameter to analyze the correlation of efficacy with age, lifestyle, pre-treatment symptom scores, PV, Qmax and PVR.Results:257 patients completed the study, and 169 patients were treated effectively, with an overall effectiveness rate of 65.8%.The effectiveness rates of the mild, moderate and severe OAB groups were 83.6%, 62.4% and 38.5%, respectively, with statistical significance( χ2=13.037, P=0.001).3 patients showed adverse drug reactions, including 2 patients with mild dizziness and 1 patient with nausea.The baseline OABSS score, the proportion of smoking patients and the proportion of drinking patients in the effectively treated OAB group were significantly lower than those in the ineffectively treated group.Multivariate analysis showed that baseline OABSS score( OR=0.735, P<0.001)and smoking( OR=2.111, P=0.029)were correlated with tamsulosin's efficacy in treating BPH patients with OAB with PV<40 ml. Conclusions:The effectiveness rate of Tamsulosin for the treatment of BPH patients with mild OAB with PV<40 ml is high.The baseline OABSS score and smoking are factors affecting the efficacy of Tamsulosin on OAB symptoms in these patients.

Therapeutic effects of B ultrasound-guided extracorporeal shock wave lithotripsy combined with tamsulosin hydrochloride medication on ureteral calculi / 中国基层医药

Objective:To investigate the therapeutic effects of B ultrasound-guided extracorporeal shock wave lithotripsy combined with tamsulosin hydrochloride medication on ureteral calculi.Methods:The clinical data of 130 patients with ureteral calculi who received treatment in Ninghai First Hospital from March 2019 to June 2020 were retrospectively analyzed. These patients were divided into an observation group and a control group ( n = 65/group) according to the different treatment methods. Patients in the control group received B ultrasound-guided extracorporeal shock wave lithotripsy, and those in the observation group received B ultrasound-guided extracorporeal shock wave lithotripsy combined with tamsulosin hydrochloride medication. Total response rate, stone-free rate after the first treatment, time taken to get rid of stone, treatment times, and Visual Analogue Scale (VAS) score 14 days after the first treatment were compared between the two groups. Renal function indexes (serum creatinine, blood urea nitrogen), mean arterial pressure, VAS score, blood loss, and immunoglobulin G, immunoglobulin M, malondialdehyde, superoxide dismutase levels were determined in the two groups. Results:The total response rate in the control group was significantly lower than that in the observation group [89.23% (58/65) vs. 98.46% (64/65), χ2 = 4.80, P < 0.05]. After 14 days of treatment, the VAS score in the observation group was significantly lower than that in the control group [(3.97 ± 0.36) points vs. (5.59 ± 0.87) points, t = 13.87, P < 0.05). After treatment, the stone-free rate after the first treatment in the control group was significantly lower than that in the observation group [61.54% (40/65) vs. 78.46% (51/65), χ2 = 4.43, P < 0.05). The time taken to get rid of stone and treatment times in the control group were (18.98 ± 3.52) days and (2.53 ± 0.50) times, respectively, which were significantly higher than (12.27 ± 2.77) days and (1.64 ± 0.55) times in the observation group ( t = 12.08, 9.66, both P < 0.05). Urine Kim-1 in the observation group was significantly higher than that in the control group [(89.46 ± 42.46) mmol/L vs. (72.75 ± 17.65) mmol/L, t = 2.93, P < 0.05]. Serum creatinine and blood urea nitrogen levels in the observation group were (101.75 ± 24.53) μmol/L and (348.76 ± 29.84) μmol/L, respectively, which were significantly lower than (139.53 ± 30.56) μmol/L and (397.65 ± 35.64) μmol/L in the control group ( t = 5.82, 8.48, both P < 0.05). After 20-minutes of anesthesia induction, the mean arterial pressure in the observation group was significantly higher than that in the control group [(83.45 ± 12.65) mmHg (1 mmHg=0.133 kPa) vs . (61.68 ± 9.75) mmHg, t = -10.99, P < 0.05]. Intraoperative blood loss in the observation group was significantly lower than that in the control group [(112.65 ± 30.74) mL vs. (170.68 ± 35.67) mL, t = 9.94, P < 0.05]. Serum immunoglobulin G and malondialdehyde levels in the observation group were (8.56 ± 1.74) g/L and (7.74 ± 0.74) mol/L, respectively, which were significantly higher than (7.75 ± 1.68) g/L and (5.21 ± 0.65) mol/L in the control group ( t = 2.70, 20.71, both P < 0.05). Serum immunoglobulin M and superoxide dismutase levels in the observation group were (1.23 ± 0.32) g/L and (71.75 ± 8.57) U/L, which were significantly lower than (1.55 ± 0.45) g/L and (90.64 ± 9.73) U/mL in the control group ( t = -4.67, -11.75, both P < 0.05). Conclusion:B ultrasound-guided extracorporeal shock wave lithotripsy combined with tamsulosin hydrochloride medication is more effective on ureteral calculi than B ultrasound-guided extracorporeal shock wave lithotripsy alone. The combined therapy can effectively reduce pain, increases the treatment efficacy, and is worthy of reference and promotion in clinical practice.

Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis

ABSTRACT Introduction: The efficacy of alpha-blockers as medical expulsive therapy (MET) is well established. However, it is not known which of the three most commonly used alpha-blockers (tamsulosin, alfuzosin and silodosin) is the most efficacious. With this study we aimed to assess the efficacy of the three commonly used alpha-blockers as MET for distal ureter stones. Materials and Methods: For this review, we searched multiple databases such as PubMed/Medline, Scopus, Embase, OviD SP, CINAHL, and web of science to identify all the relevant randomized studies comparing the efficacy of tamsulosin, alfuzosin, and silodosin. Preferred reporting items for systematic reviews for network meta-analysis (PRISMA-NMA) were followed while conducting this review and the study protocol was registered with PROSPERO (CRD42020175706). Results: In this review, 31 studies with 7077 patients were included. Compared to placebo all the treatment groups were more effective for both stone expulsion rate (SER) and stone expulsion time (SET). For both SER and SET, silodosin had the highest SUCRA (94.8 and 90.4) values followed by alfuzosin (58.8 and 64.9) and tamsulosin (46.2 and 44.5). The incidence of postural hypotension was similar with all the drugs, whereas, the incidence of retrograde ejaculation was significantly higher for silodosin. Overall confidence for each comparison group in this review ranged from "very low" to "moderate" according to the CINeMA approach. Conclusion: Among the three commonly used alpha-blockers silodosin is the most efficacious drug as MET for lower ureter stones followed by alfuzosin and tamsulosin.

A Prospective, Multicenter, Open-Label Study of Dose Escalation Therapy in Male Patients With Nocturia Refractory to 0.2-mg Tamsulosin Monotherapy / 대한배뇨장애요실금학회지

PURPOSE: To investigate the efficacy and safety of 0.4 mg of tamsulosin in patients with nocturia not responding to 0.2 mg.METHODS: Patients with intractable nocturia after treatment with 0.2 mg of tamsulosin for>1 month were included in a multicenter, prospective, observational, single-arm study. Patients were prescribed 0.4 mg of tamsulosin and followed up for 2 months to assess nocturnal voiding and nocturia-related bother. Changes in the mean number of nocturnal voids, the proportion of 50% responders, 3-day frequency-volume chart parameters, and questionnaire scores were assessed.RESULTS: Sixty-two patients were prescribed 0.2 mg of tamsulosin, of whom 56 were prescribed 0.4 mg of tamsulosin. Ten patients dropped out. A single case of orthostatic hypotension was reported. The mean age was 68 years. After 1 and 2 months of taking 0.4 mg of tamsulosin, 23.9% and 22.7% of patients demonstrated a>50% reduction of nocturia, and 16.1% and 19.4% of patients rated the treatment as “very effective,” respectively. Dose escalation to 0.4 mg of tamsulosin, compared to 0.2 mg, did not show an additional effect on reducing nocturnal urine volume. Multivariate logistic regression analysis showed that lower serum sodium levels (odds ratio [OR], 0.41, P=0.037) and the presence of urge incontinence (OR, 7.08, P=0.036) were predictors of a significant improvement of nocturia in response to 0.4 mg of tamsulosin.CONCLUSIONS: Dose escalation may yield a significant improvement of nocturia in>20% of patients, and may be especially helpful in patients with lower sodium levels and urge incontinence.

Efficacy of an Alpha-Blocker for the Treatment of Nonneurogenic Voiding Dysfunction in Women: An 8-Week, Randomized, Double-Blind, Placebo-Controlled Trial / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the efficacy of an alpha-1 adrenergic receptor (α1-AR) blocker for the treatment of female voiding dysfunction (FVD) through a pressure-flow study. METHODS: This was a randomized, double-blind, placebo-controlled trial. Women aged ≥18 years with voiding symptoms, as defined by an American Urological Association symptom score (AUA-SS) ≥15 and a maximum flow rate (Qmax) 100 mL and/or a postvoid residual (PVR) volume >150 mL, were randomly allocated to either the alfuzosin or placebo group. After 8 weeks of treatment, changes in the AUA-SS, Bristol female lower urinary tract symptoms (BFLUTS) questionnaire, Qmax/PVR, and voiding diary were compared between groups. Patients’ satisfaction with the treatment was compared. Patients were categorized into 3 groups according to the Blaivas-Groutz bladder outlet obstruction (BOO) nomogram: none, mild, and moderate to severe. Subgroup comparisons were also made. RESULTS: Of a total of 187 women, 154 (79 alfuzosin, 75 placebo) were included in the analysis. After 8 weeks of treatment, the AUA-SS decreased by 7.0 in the alfuzosin group and by 8.0 in the placebo group. Changes in AUA-SS subscores, BFLUTS (except the I-sum), the voiding diary, and Qmax/PVR were not significantly different between groups. Approximately 54% of the alfuzosin group and 62% of the placebo group were satisfied with the treatment. No significant difference was observed between groups according to the presence or grade of BOO. CONCLUSIONS: Alfuzosin might not be more effective than placebo for treating FVD. The presence or the grade of BOO did not affect the results. A further study with sufficient power is needed to determine the efficacy of α1-AR blockers for the treatment of FVD.

Seasonal Changes in Lower Urinary Tract Symptoms in Japanese Men With Benign Prostatic Hyperplasia Treated With α₁-Blockers / 대한배뇨장애요실금학회지

PURPOSE: To investigate whether seasonal changes occurred in lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). METHODS: Patients aged 50 years and older with BPH treated with α1-blockers were enrolled. The International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum and average flow rate, voided volume, and postvoid residual volume were measured in summer and winter. RESULTS: A total of 164 patients were enrolled. The total IPSS and QoL index did not show a significant difference between the 2 seasons. When the IPSS was divided into storage symptoms and voiding symptoms, storage symptoms in winter were substantially but nonsignificantly higher than those in summer (P=0.056). Of the 7 individual symptoms in the IPSS, a significant seasonal difference was observed only for nocturia, with a higher score in winter. Moreover, none of the uroflowmetric parameters showed a seasonal change. Voided volume had significant correlations with each symptom (urgency and nocturia) and overall subjective scores (storage, total IPSS, and QoL) exclusively in summer, while this correlation remained only for nocturia in winter. CONCLUSIONS: As it has generally been assumed that LUTS deteriorate in winter, the present study corroborated that the severity of storage symptoms was higher in winter than in summer, even in patients treated with α₁-blockers. In contrast, a seasonal difference was not observed in the uroflowmetric parameters, which may be partly due to the loss of the correlation between subjective and objective measurements of storage symptoms in winter.

Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia

ABSTRACT Purpose Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia. Materials and Methods A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded. Results There were 60 patients in each Group. Their mean age was 35.95±15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697). Conclusion This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.

Clinical efficacy of combination therapy of Tamsulosin plus Tolterodine sustained-release capsules on benign prostatic hyperplasia with overactive bladder in elderly men / 中华老年医学杂志

Objective To evaluate the efficacy of combination therapy of cholinergic receptor blocker Tolterodine and Alpha-adrenergic receptor blocker Tamsulosin sustained-release capsules on benign prostatic hyperplasia(BPH)with overactive bladder(OAB) in elderly men.Methods A total of 97 male BPH patients aged 80 years and over(80～98 years old,mean 87.7 years old)were enrolled in this study,who met the diagnosis and treatment guidelines of OAB formulated by Chinese Urological Association and were admitted to our hospital from Jan.2015 to July.2015.Patients were randomly divided into Tamsulosin group(n＝ 51,treated with Tamsulosin) and combination group(n＝ 46,treated with Tamsulosin and Tolterodine).Results In Tamsulosin group after treatment,the international prostate symptom score(IPSS) was reduced from (18.3 ± 2.7) to (13.3 ± 3.1) (t ＝ 14.94,P ＜ 0.05),OAB symptom score(OABSS) from (9.3 ± 2.7) to (6.8 ± 1.9) (t ＝ 3.92,P ＜ 0.05),and post void residual volume(PVRV)from(36.5±32.3)ml to(16.2±12.1)ml(t＝14.98,P＜0.01).And the daily frequency of urgency,urgency incontinence and nocturia were improved in Tamsulosin group after treatment.IPSS,OABSS and PVRV were improved more significantly in combination group after treatment than in Tamsulosin group,and the daily frequency of urgency,urgency incontinence and nocturia were reduced more significantly in combination group than in tamsulosin group(t＝-5.23,-3.98,9.01,11.5,14.8,P＜0.01).While there was no significant difference in prostate volume (PV)and PVRV between the two groups after 8 weeks of treatment(t＝ 1.22,-0.94,P＞0.05).The total incidences of adverse events (mainly mouth dryness)had no significant differences between the Tamsulosingroup and the combination group(8.7％ vs.5.9％,x2 ＝99.47,P＞0.05).No acute urinary retention was found in the two groups.Conclusions The combination therapy of Tamsulosin and Tolterodine has better efficacy and safety than single Tamsulosin application in the treatment of BPH with OAB in elderly men.

Efficacy ofα1-blockers on expulsion urinary calculi post extracorporeal shock wave lithotripsy:a Meta-analysis / 天津医药

Objective To review the efficacy of α1-blocker in the treatment of urinary calculi post extracorporeal shock wave lithotripsy (ESWL). Methods Key words include Urinary calculi, Alpha-blocker, Randomized clinical trail, Ex?tracorporeal shockwave lithotripsy, et al were searched against databases include Pubmed, Embase, Cochrane Library data?bases and CNKI. All studies that reported effect ofα-blockers post ESWL were eligible for the analysis. Data was extracted through quality assessment and data filtering, then were analysed using RevMan 5.0. Results Fourteen randomized clinical trails with a total of 1 464 patients met the inclusion criteria. Pooled analysis showed a better stone clearance and shorter in?terval between stone fragment discharges (RR=1.21, 95%CI:1.10-1.33, P<0.05) and (SMD=-1.23, 95%CI:-2.09--0.36, P<0.05) respectively afterα1-blocker administration. However, evidence is still not convincible that it can reduced the fre?quency of colic episodes (RR=0.54,95%CI:0.28-1.02, P=0.06). Conclusion α1-blockers facilitates the expulsion of uri?nary calculi shown by a higher expulsion rate, a shorter expulsion interval during treatment. Adjunctive therapy with α1-blockers after ESWL is effective in the treatment of urinary calculi.

The Effectiveness of Silodosin for Nocturnal Polyuria in Elderly Men With Benign Prostatic Hyperplasia: A Multicenter Study / 대한배뇨장애요실금학회지

PURPOSE: To investigate improvement in nocturia and nocturnal polyuria in nocturnal polyuria patients after silodosin administration by using a 3-day frequency volume chart. METHODS: This was a prospective multicenter study. We enrolled nocturnal polyuria patients (nocturnal polyuria index [NPi]>0.33), aged > or =60 years, diagnosed with the 3-day frequency volume charts of patients with benign prostatic hyperplasia taking alpha-blockers. Of the 54 patients, 30 (55.6%) completed the study according to the study protocol (per-protocol group), and 24 dropped out (dropout group). RESULTS: Of the 24 patients in the dropout group, 5 withdrew consent due to side effects or lack of efficacy, 7 were lost to follow-up at 4 weeks, 8 were lost to follow-up at 12 weeks, and 4 dropped out due to failure to complete 3-day frequency volume charts at 12 weeks. In the per-protocol group, there was significant improvement in the International Prostate Symptom Score (IPSS), especially question numbers 1, 3, 4, 5, 6, 7, and the quality of life question (P=0.001, P=0.007, P0.33. Considering the high dropout rate of our study due to no implementation of 3-day frequency volume charts, prospective and large-scale studies are needed to confirm our results.

Effects of prostatic inflammation on LUTS and alpha blocker treatment outcomes

Purpose To evaluate the association between prostatic inflammation and lower urinary tract symptoms (LUTS), and to identify the effects of prostatic inflammation on the treatment with an alpha blocker. Materials and Methods 111 Participants who were aged ≥ 50 years, the presence of LUTS (maximal flow rate < 20 m/s, IPSS ≥ 11), and an elevated PSA level (3-20ng/mL) were treated with tamsulosin 0.2mg once daily for 3 months after prostate biopsies. Prostatic inflammation was scored as none (0), mild (I), moderate (II), or marked (III). LUTS parameters including urine flow rates, IPSS, PSA, and prostate volume were evaluated. Results Inflammation grading resulted in 25, 60, and 26 patients that were grade 0, I, and II, respectively. Lower grade inflammation was related to higher urine flow rate at baseline. Patients with higher inflammation grades had larger prostate volumes, larger total and transitional zone volumes, and higher PSA levels. Overall, urine flow rates and residual urine volume were improved after 3 months of alpha blocker therapy. Eighty percent of patients with grade 0 inflammation, 73% of patients with grade I inflammation, and 92.3% of patients with grade II inflammation showed improvement of LUTS after treatment. Longer duration of treatment was related to a decreased chance of improvement of LUTS. Patients with increased IPSS voiding subscales could be predictive of improvement of LUTS. Conclusions Patients with high grade inflammation had lower flow rates and higher prostatic volumes than patients with low grade inflammation. Inflammation grade did not affect the outcomes of alpha blocker treatment. .

ADALIMUMAB FOR MAINTENANCE THERAPY FOR ONE YEAR IN CROHN?S DISEASE: results of a Latin American single-center observational study / Adalimumabe na terapia de manutenção por um ano na doença de Crohn: resultados de um estudo observacional unicêntrico Latinoamericano

Context Adalimumab is a fully-human antibody that inhibits TNF alpha, with a significant efficacy for long-term maintenance of remission. Studies with this agent in Latin American Crohn’s disease patients are scarce. Objectives The objective of this study was to outline clinical remission rates after 12 months of adalimumab therapy for Crohn’s disease patients. Methods Retrospective, single-center, observational study of a Brazilian case series of Crohn’s disease patients under adalimumab therapy. Variables analyzed: demographic data, Montreal classification, concomitant medication, remission rates after 1, 4, 6 and 12 months. Remission was defined as Harvey-Bradshaw Index ≤4, and non-responder-imputation and last-observation-carried-forward analysis were used. The influence of infliximab on remission rates was analyzed by Fischer and Chi-square tests (P<0.05). Results Fifty patients, with median age of 35 years at therapy initiation, were included. Remission rates after 12 months of therapy were 54% under non-responder-imputation and 88% under last-observation-carried-forward analysis. After 12 months, remission on patients with previous infliximab occurred in 69.23% as compared to 94.59% in infliximab-naïve patients (P = 0.033). Conclusions Adalimumab was effective in maintaining clinical remission after 12 months of therapy, with an adequate safety profile, and was also more effective in infliximab naïve patients. .

Contexto O adalimumabe é um anticorpo monoclonal totalmente humano que inibe o TNF alfa, com eficácia documentada na manutenção da remissão clínica na doença de Crohn. Estudos com pacientes latinoamericanos são escassos nesse cenário. Objetivos O objetivo deste estudo foi analisar as taxas de remissão clínica após 12 meses de terapia com adalimumabe em portadores de doença de Crohn. Métodos Estudo retrospectivo unicêntrico observacional de uma série de casos de pacientes brasileiros portadores de doença de Crohn tratados com adalimumabe. Variáveis analisadas: dados demográficos, classificação de Montreal, medicações concomitants, taxas de remissão após 1, 4, 6 e 12 meses. Remissão foi definida como índice de Harvey-Bradshaw ≤4 e foram utilizadas as análises de imputação de não-resposta e última observação considerada. A influência do infliximab prévio foi analisada pelo teste de Fischer e qui-quadrado (P<0.05). Resultados Cinquenta pacientes, com media de idade de 35 anos no início da terapia foram incluídos. As taxas de remissão após um ano foram de 54% (análise imputação de não-resposta) e 88% (análise de última observação considerada. A remissão clínica ocorreu em 69.23% dos pacientes com infliximab prévio e 94.59% nos virgens de infliximab (P = 0.033). Conclusão O adalimumabe foi efetivo na manutenção da remissão clínica após 1 ano, com adequado perfil de segurança com eficácia maior nos pacientes virgens de infliximab. .

Clinical Outcome in Male Patients With Detrusor Overactivity With Impaired Contractility / 대한배뇨장애요실금학회지

PURPOSE: To review the clinical outcomes of patients with voiding dysfunction who have detrusor overactivity with impaired contractility (DOIC) diagnosed with urodynamic studies. METHODS: Urodynamic reports from 2005 to 2009 were reviewed, and 54 male patients had findings consistent with DOIC. Patients with acontractile or neuropathic bladders were excluded. Clinical outcomes were obtained from patient records. RESULTS: Of 54 men, 8 presented with voiding symptoms, 17 had storage symptoms, and 29 had mixed symptoms. Twenty-two had a previous transurethral resection of the prostate. The median follow-up was 12 months. Four patients received no intervention. Two patients were taught intermittent self-catheterization. Five patients underwent surgery to reduce outlet resistance and all reported improvement. Forty-three patients were started on pharmacotherapy; symptomatic improvement was reported by 9 of 16 patients commenced on anticholinergics alone, 6 of 16 on alpha-blockers alone, and 4 of 5 treated with a combination of alpha-blockers and anticholinergics. Eleven patients experienced no difference on pharmacotherapy and 2 reported deterioration. One patient developed acute urinary retention (18 months after commencing treatment with alpha-blockers). No patient had urosepsis. CONCLUSIONS: Anticholinergics and alpha-blockers appear to be safe in patients with DOIC. The risk of urinary retention and sepsis is low. The majority of patients report symptomatic benefit from either drugs or surgical treatment.

The Effect of alpha-Blocker Treatment for Nocturia with Benign Prostatic Hyperplasia

OBJECTIVE: Nocturia is one of the most bothersome complaints in men with benign prostatic hyperplasia. It might be valuable to determine if alpha-blocker treatment for benigh prostatic hyperplasia can improve nocturia and the quality of life (QoL). The purpose of this study was to determine the efficacy of alpha blocker therapy in benigh prostatic hyperplasia patients with nocturia. METHODS: From January 2004 to June 2006, 68 men (> or =45 years) with lower urinary tract symptoms (LUTS: International Prostatic Symptom Score (IPSS)> or =12) and benign prostatic hyperplasia by transrectal ultrasonography (> or =25 mL) and a maximal urine flow rate (Qmax< or =12) were selected for this study. The efficacy of alpha blocker treatment was assessed by analyzing IPSS, QoL, Qmax, and postvoid residual urine (PVR). The data for these parameters was acquired at baseline and after short-term (range, 4-6 weeks) and long-term (range, 12-14 weeks) treatment. We analyzed the relationships between nocturia and other parameters, including age, prostate volume, Qmax, and PVR after alpha-blocker treatment. RESULTS: Overall, 47 of the 68 patients (69.1%) completed the study. IPSS, QoL, Qmax, and PVR showed significantly improvement after alpha blocker treatment. The nocturia score improved 23.8% after long-term alpha blocker treatment. However, nocturia improvement was lowest among the seven individual symptom scores. Other clinical parameters, including patient age, prostate volume, Qmax, and PVR, were not significantly associated with nocturia; only the LUTS severity was associated with nocturia. CONCLUSION: Treatment with alpha-blocker can reduce nocturia in benigh prostatic hyperplasia patients and can improve QoL.

Effects of Terazosin and Tolterodine on Ureteral Stent Related Symptoms: A Double-Blind Placebo-Controlled Randomized Clinical Trial

Objective To evaluate the effects of terazosin and tolterodine on ureteral stent discomfort. Materials and Methods Of 163 patients assessed for eligibility, 104 patients were randomly assigned to receive placebo, 2 mg of terazosin twice daily, 2 mg of tolterodine daily, or both terazosin plus tolterodine during the stenting period. Prior to stenting and at stent removal, the International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) subscore and the Visual Analog Scale for Pain were determined. The patients also reported their analgesic use during the stenting period. Results Ninety-four patients completed the study. We noted significant decreases in the total IPSS scores (p = 0.002), irritative subscore (p = 0.039), QoL (p = 0.001), flank pain (p = 0.013), voiding pain (p = 0.01) and amount of analgesics used (p = 0.02) in the groups. However, neither the obstructive subscore nor the suprapubic pain improved significantly (p = 0.251 and p = 0.522, respectively). The patients receiving terazosin plus tolterodine experienced significant reductions in the total IPSS, irritative symptoms, QoL, flank pain, voiding pain and decreased analgesics use compared with those patients receiving placebo. However, compared with placebo, terazosin monotherapy did not affect pain levels, and tolterodine monotherapy did not improve QoL, flank pain or analgesics use. Conclusions Terazosin plus tolterodine improves ureteral stent-related complications, including irritative symptoms, the amount of analgesics used, QoL, flank pain and voiding pain but does not decrease obstructive symptoms or suprapubic pain. This trial was registered at www.clinicaltrials.gov as NCT01530243. .

The efficacy of α1-adrenergic receptor blocker, 5α-reductase inhibitor or combination therapy in benign prostatic hyperplasia / 中华老年医学杂志

Objective To compare the efficacy of α1 adrenergic receptor blocker,5α-reductase inhibitor or combination therapy in benign prostatic hyperplasia (BPH),and to explore the application of multi-level statistical model in assessment of BPH treatments.Methods Pragmatic clinical trials (PCT) design was used.BPH patients received drug therapy including α-adrenergic receptor blocker,5α reductase inhibitor,and combination therapy were followed up for 4 years.Multilevel statistical model was used to compare the scores of international prostate symtom score(IPSS) and BPH qality of life scale(QLS) among the 3 therapeutic regimens.Results The intra class correlation coefficients of I-PSS and BPH-QLS were 0.6136 and 0.6946 respectively,which indicated that both data were hierarchical structured.During the follow-up period,scores of IPSS and BPH-QLS were improved along with the drug therapy in 3 regimens.There was curve relationship between treatment time and IPSS and BPH-QLS scores in 3 regimens (all P＜0.05),and there was no significant differences in the trend of curves between the 3 regimens (P＞0.05).Conclusions For BPH patients with moderate symptoms bothering the quality of life,α-adrenergic receptor blocker,5α-reductase inhibitor,or combination therapy are significantly effective in reducing symptoms and improving quality of life.There are no efficacy differences among the 3 drug therapy during the 4-years follow-up.Compared with traditional analysis,multilevel statistical model is a more suitable and precise method for assessment of BPH treatments.

Impact of Tamsulosin on Ureter Stone Expulsion in Korean Patients: A Meta-Analysis of Randomized Controlled Studies

PURPOSE: Using meta-analysis, the study's aim was to evaluate the efficacy of tamsulosin, an alpha-blocker, in the treatment of ureteral stones with or without shockwave lithotripsy (SWL) in Korean patients. MATERIALS AND METHODS: Relevant randomized controlled studies published through June 2011 were identified in a search of MEDLINE, KoreaMed, and the Korean Medical Database. No language restriction was applied. Only randomized controlled trials conducted with Korean patients were eligible for the analysis. The primary outcome assessed was the stone clearance rate. Two reviewers independently assessed the quality of the study and extracted the data. Meta-analysis was conducted by using R, version 2.13.0. RESULTS: A total of 6 articles were selected as being suitable for evaluation. Pooling of the trials demonstrated a 43% higher expulsion rate for tamsulosin treatment compared to a control group (risk ratio [RR], 1.43; 95% confidence interval [CI]: 1.24 to 1.65). Similar results were obtained in all subgroup analyses according to stone location (upper: RR, 1.31; 95% CI, 1.02 to 1.68, lower: RR, 1.50; 95% CI, 1.20 to 1.88) or concomitant SWL (yes: RR, 1.38; 95% CI, 1.14 to 1.68, no: RR, 1.48; 95% CI, 1.21 to 1.83). CONCLUSIONS: This meta-analysis of randomized controlled studies provides a high level of evidence supporting the suggestion that treatment with tamsulosin augments the stone expulsion rate for ureter stones with or without SWL in a Korean population. However, a high-quality, large-scale, multicenter, randomized controlled trial is warranted to fully support this hypothesis.

An exclusively dopamine secreting paraganglioma in the retroperitoneum: a first clinical case in Korea / 대한외과학회지

Exclusively dopamine producing retroperitoneal paragangliomas are extremely rare. We have experienced the first Korean case managed successfully based on the proper evaluation. A 26-year-old female patient came to our attention after the accidental detection of an adrenal mass. She had no symptoms and denied any family history. Laboratory evaluations were normal but serum dopamine (425 ng/L) and 24-hour urine dopamine levels (1,565.3 microg/day) were elevated. She underwent laparoscopic right adrenalectomy. Histopathological diagnosis was a paraganglioma. After operation, dopamine levels in serum and 24-hour urine dropped to 0.09 ng/L and 388.4 microg/day. Dopamine producing paraganglioma elicit no clinical symptoms. Only the dopamine level is elevated in serum and 24-hour urine samples. Surgical resection without using preoperative alpha blockage is the treatment of choice. The prognosis for patients with this tumor tends to be poor because the diagnosis is usually delayed due to lack of symptoms.

Bladder Wall Thickness is Associated with Responsiveness of Storage Symptoms to Alpha-Blockers in Men with Lower Urinary Tract Symptoms

PURPOSE: Bladder wall thickness (BWT) is reported to be related to detrusor overactivity and bladder outlet obstruction. We investigated the relationship between BWT and the responsiveness of storage symptoms to alpha-blockers in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: A total of 74 patients with LUTS were enrolled. International Prostate Symptom Score, uroflowmetry with post-void residual urine volume, and transrectal ultrasonography (TRUS) were investigated. BWT was measured by performing TRUS at the midsagittal plane view, and the average value of BWT at the anterior, dome, and trigone areas was used. After 4 weeks of alpha-blocker medication, patients were reevaluated and divided into two groups. The responder group consisted of patients who reported improvement in the storage symptom subscore of 2 points or more; the non-responder group consisted of patients who reported improvement of less than 2 points. Clinical parameters including BWT were compared between the two groups. RESULTS: A total of 52 patients were followed. BWT was positively correlated with intravesical prostate protrusion (IPP) (9.26+/-4.99, standardized beta=0.393, p=0.002) and storage symptom subscore (0.35+/-0.43, standardized beta=0.458, p=0.002). Compared with that in the responder group, BWT was thicker in the non-responder group, and improvement in the storage symptom score was correlated with BWT (0.58+/-0.09 cm vs. 0.65+/-0.11 cm, p=0.018) and prostate volume (27.08+/-16.26 ml vs. 36.44+/-10.1 ml, p=0.018). CONCLUSIONS: BWT was correlated with IPP, the storage symptom subscore, and the responsiveness of storage symptoms to alpha-blockers in LUTS/benign prostatic hyperplasia (BPH) patients. As BWT increased, the responsiveness of storage symptoms to alpha-blocker decreased in LUTS/BPH patients.