Impacto en el índice de síntomas y calidad de vida con un bloqueador alfa adrenérgico en el tratamiento de la hiperplasia benigna de la próstata / Impact on the rate and quality of life symptoms with alpha-adrenergic blocker in the treatment of benign prostatic hyperplasia

Determinar el impacto en la calidad de vida de los pacientes con STUI dados por HBP en el Hospital Nacional PNP Luis N. Sáenz, que reciben tratamiento con un bloqueador alfa adrenérgico y definir cuál es la relación de dicho impacto con la severidad de los síntomas antes y después del tratamiento. Métodos: Se incluyeron 60 pacientes con síntomas de tracto urinario inferior dados por crecimiento prostático que fueron tratados con un bloqueador alfa adrenérgico. Se realizó medición de síntomas urinarios según el IPSS y medición de calidad de vida según el cuestionario; antes del tratamiento y 3 meses luego de la misma. Resultados: Se realizó análisis de correlación entre los síntomas del IPSS y el índice de Calidad de vida antes del tratamiento y 3 meses después de la misma, encontrándose una correlación significativa entre las dos escalas en ambos momentos. El promedio del índice de síntomas Prostáticos antes del tratamiento de 16,57 en el control inicial, mostró reducción hasta un rango de 6.0 en el último control (p<0.0000) y el promedio en índice de Escala de Vida mejoró desde 4,02 hasta 2,15 (p=0.000). Solo 2.7 por ciento de pacientes presentaron eventos adversos. Conclusiones: Existe una correlación entre la escala IPSS y el índice de calidad de vida en los pacientes con hiperplasia benigna de la próstata que reciben tratamiento médico con un bloqueador alfa adrenérgico. Se infiere que el tratamiento con un bloqueador alfa adrenérgico ofrece la seguridad y eficiencia que se evidencia en la literatura...

To determine the impact on quality of life of patients with LUTS secondary to BPH, given in the PNP National Hospital "Luis N. Saenz" receiving treatment with an alpha-adrenergic blocker and define what the relationship of this impact with the severity of symptoms before and after treatment. Methods: 60 patients were recruited, all with lower urinary tract symptoms given by prostatic growth were treated with alpha-adrenergic blocker. Measurement of urinary symptoms was performed according to the IPSS and measurement of quality of life according to the questionnaire; before treatment and 3 months after the same. Results: Analysis of correlation between symptoms of IPSS and Quality of life index before treatment and 3 months after it was made, found a significant correlation between the two scales at both times. The average rate of Prostate symptoms before treatment to 16.57 in the initial control, showed reduced to a range of 6.0 in the last control (p<0.0000) and the average rate of Life Scale improved from 4.02 to 2.15 (p=0.000). Only 2.7 per cent of patients experienced adverse events. Conclusions: There is a correlation between the IPSS scale and quality of life index in patients with benign prostatic hyperplasia receiving medical treatment with an alpha-adrenergic blocker. It is inferred that treatment with alpha-adrenergic blocker provides safety and efficiency that is evidence in the literature...

Análise de eficácia, eventos adversos e desfechos cardiovasculares em estudos relacionados às combinações de nifedipino GITS ou anlodipino com medicamentos que atuam no sistema renina angiotensina aldosterona / Efficacy analysis, adverse events and cardiovascular outcomes in studies related to combinations of nifedipine GITS or amlodipine with drugs acting on the renin angiotensin aldosterone system

Revisamos 17 estudos com o objetivo de avaliar a eficácia anti-hipertensiva da combinação de antagonistas de cálcio com bloqueadores dos receptores de angiotensina na redução da pressão arterial, de desfechos cardiovasculares e na incidência de efeitos adversos. A terapia combinada de bloqueador de canais de cálcio anlodipino ou nifedipino GITS, mais o bloqueador de receptor de angiotensina II valsartana, mostrou-se, na maioria dos estudos, mais eficaz que a monoterapia para redução de pressão arterial, além de mais benéfica quanto à diminuição de eventos cardiovasculares. O perfil de segurança e tolerabilidade das combinações também se revelou bastante aceitável, com o manejo de efeitos adversos favorecido pela maior possibilidade de ajustes de doses de substâncias com diferentes mecanismos de ação, sem comprometimento da eficácia anti-hipertensiva.

We reviewed 17 studies in order to evaluate the antihypertensive efficacy on the combination of calcium antagonists and angiotensin receptor blockers in lowering the blood pressure, cardiovascular outcomes and incidence of side effects. The combination therapy of amlodipine or nifedipine GITS calcium channel blockers, and angiotensin II receptor blocker valsartan showed, in most studies, more effective than monotherapy to lower blood pressure, as well as more beneficial to decrease cardiovascular events. The safety profile and tolerability of the combinations also proved quite acceptable, with side effects management benefited by higher possibility of adjustments on doses of substances with different mechanisms of actions, without affecting the antihypertensive efficacy.

Effects of pharmaceutical medications on male fertility

The number of couples seeking consultation for infertility problems has steadily increased over the past decade, affecting 10%-15% of the sexually active population. Abnormal semen production, a male factor infertility [MFI], is thought to be the cause of up to 50% of all infertilities in developed countries. There are potentially many different causes of male infertility, including hormonal, anatomical, and secondary to exposure to exogenous substances. In many cases of MFI, a definitive cause for abnormalities is never identified. Recently, the research community has given greater attention to identifying causes of MFI ranging from genetic Y chromosome microdeletions to mechanisms of environmental damage on sperm production. Still evolving, is a clear understanding of how many pharmaceutical medications may cause MFI, which is often treatable and reversible. In this review we will out-line the data regarding various pharmaceutical medications that have been investigated as possible causes of MFI

Efficacy and Safety of Tamsulosin for the Treatment of Non-neurogenic Voiding Dysfunction in Females: A 8-Week Prospective Study

We evaluated the therapeutic effects of tamsulosin for women with non-neurogenic voiding dysfunction. Women who had voiding dysfunctions for at least 3 months were included. Inclusion criteria were age > or =18 yr, International Prostate Symptom Score (IPSS) of > or =15, and maximum flow rate (Q(max)) of > or =12 mL/sec and/or postvoid residuals (PVR) of > or =150 mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram as having no or mild obstruction (group A) or moderate or severe obstruction (group B). After 8 weeks of treatment, treatment outcomes and adverse effects were evaluated. One hundred and six patients were evaluable (70 in group A, 36 in group B). After treatments, mean IPSS, bother scores, Q(max), PVR, diurnal and nocturnal micturition frequencies and scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS-SF) were changed significantly. Eighty-nine patients (84%) reported that the treatment was beneficial. The proportion of patients reported that their bladder symptoms caused "moderate to many severe problems" were significantly decreased. No significant difference were observed between the groups in terms of IPSS, bother score, Q(max), PVR, micturition frequency, and BFLUTS-SF changes. Adverse effects related to medication were dizziness (n=3), de novo stress urinary incontinence (SUI) (n=3), aggravation of underlying SUI (n=1), fatigue (n=1). Tamsulosin was found to be effective in female patients with voiding dysfunction regardless of obstruction grade.

High-Dose Terazosin Therapy (5mg) in Korean Patients with Lower Urinary Tract Symptoms with or without Concomitant Hypertension: A Prospective, Open-Label Study

PURPOSE: We determined the efficacy and safety of a relatively high dose of terazosin (5mg) in Korean patients with lower urinary tract symptoms (LUTS), with or without concomitant hypertension. MATERIALS AND METHODS: From July to December 2006, 200 men who consecutively presented with LUTS were prospectively studied. Eight weeks after treatment, blood pressure (BP), uroflowmetry, and International Prostate Symptom Score (I-PSS) were assessed. For analysis purposes, patients were stratified according to concomitant hypertension. Of the 200 patients, 173 completed the scheduled eight-week treatment period. RESULTS: At baseline, no differences were evident in the two groups in terms of I-PSS, Qmax, PVR and BP. After eight weeks of treatment-although I-PSS and uroflowmetry parameters were not significantly different in the two groups-systolic and diastolic BP in the non-hypertensive control group were higher than in the hypertensive group (p= 0.001 and p=0.0100, respectively). Changes in I-PSS, uroflowmetry parameters, and BPs measured at week eight post- treatment commencement did not significantly differ between the two groups. Moreover, the addition of 5mg of terazosin to antihypertensives did not cause a significant reduction in either systolic or diastolic BP in either group. CONCLUSION: Adding terazosin to existing antihypertensive regimens did not seem to increase the incidence of adverse events. Our findings suggest that 5mg terazosin is effective and that it has an acceptable safety profile as an add-on therapy for patients with LUTS and concomitant hypertension.

Alfuzosin-induced Acute Liver Injury / 대한간학회지

We describe a 56-year-old man who developed an acute liver injury after taking alfuzosin for 1 month to control his newly diagnosed benign prostatic hypertrophy (BPH). There was no history of alcohol consumption or the taking herbal or traditional remedies. Viral causes, autoimmune hepatitis, and biliary tree obstruction were excluded. Other rare causes of hepatitis such as hemochromatosis, primary biliary cirrhosis and Wilson's disease were also absent in this patient. His liver test results began to improve after discontinuing the alfuzosin. Two weeks later, alfuzosin was administered again because the patient complained of dysuria. After 10 days of alfuzosin reuse, his liver test results worsened. Five months later after the complete discontinuation of the drug, his liver test results had returned to normal. This clinical sequence suggests that alfuzosin caused his acute liver injury.

Evaluation of Short Term Clinical Effects and Presumptive Mechanism of Botulinum Toxin Type A as a Treatment Modality of Benign Prostatic Hyperplasia

The purpose of this study was to evaluate the effect and investigate the putative mechanism of botulinum toxin type A (BTA) applied to the treatment of benign prostatic hyperplasia (BPH). A total of 52 patients with symptomatic BPH were evaluated. Transperineal intraprostatic injection under transrectal ultrasonography was carried out. BTA dissolved in 4 to 9 mL of saline was used from 100 U to 300 U, according to prostate volume. Twenty-six patients received only BTA (BT group), and 26 received both BTA and one month of an alpha-adrenergic antagonist (BTalpha group). The therapeutic outcomes were evaluated by comparing parameters such as international prostate symptom score (IPSS), quality of life, prostate specific antigen, prostate volume, post-void residual urine, and peak urinary flow rate. At the one month follow- up, 18 patients in the BT group and 21 in the BTalpha group had subjective symptomatic relief (p = 0.337). Only IPSS5 (weak stream) was significantly different between the BT group and BTalpha groups (p = 0.034). At the three month follow-up, 39 patients had subjective symptomatic relief. The storage symptoms were improved more than the voiding symptoms. Additionally, about 50 percent of the patients whose voiding symptom improved expressed improved erectile function. BTA injection seems to be an alternative treatment for BPH. The differences after the one month evaluation between the BT and the BTalpha groups might suggest that the adrenergic influence could be relatively reinforced by the anticholinergic effect of BTA. Nitric oxide would thus be involved in a BTA action mechanism in BPH.

Bloqueo beta y alfa adrenérgico con carvedilol en el tratamiento de hipertensos esenciales no complicados: estudio multicéntrico abierto no comparativo / Beta and alfa adrenergic blockade with carvedilol in the treatment of essential hypertensive patients: open, multicenter, non comparative study

Antecedentes: Los beneficios de algunos antihipertensivos están limitados por sus efectos adversos y baja adhesividad a terapia. El Carvedilol es una beta y alfa-bloqueador, sin efectos metabólicos adversos y además, utilizable como monoterapia y muchas veces en monodosis, mejorando adherencia al tratamiento. Objetivos: Evaluar los efectos del Carvedilol, en hipertensos esenciales no complicados sobre presión arterial (PA), glicemia, lípidos, su tolerabilidad, posibilidad de ser usado en monodosis y adherencia a la terapia. Método: Estudio multicéntrico prospectivo, abierto, de 12 semanas. Los resultados fueron sometidos a análisis estadísticos. Se contemplaron normas éticas de investigación clínica. Resultados: 285 enfermos en 79 consultorios, 66 por ciento mujeres, 53,6 ± 12 años de edad. La PA basal mostró que el 28,8 por ciento tenían HT etapa 1; 49,8 por ciento etapa 2 y el 21,4 por ciento etapa 3, clasificación JNC VI, siendo el 90,6 por ciento de los pacientes HT sisto-diastólicos. En promedio la PAS bajó de 159,9 ± 14,8 a 131,3 ± 13.5 mmHg y la PAD de 98,5 ± 8,1 a 80,9 ± 8,6 mmHg. El 4,2 por ciento alcanzó normotensión. El colesterol total bajó de 219,2 a 202,4 mg/100ml (p<0,001). La glicemia no se modificó. El 90,2 por ciento de los pacientes usó 25 mg diarios en dosis única. Los efectos adversos fueron escasos, los más comunes mareos, cefalea, rubor facial, edema e hipotensión. La adhesividad al tratamiento fue de 85,5 por ciento. Como hallazgos secundarios, el 77 por ciento de los hipertensos tenían IMC > 25 kg/m². Conclusiones: Carvedilol mostró buena eficacia antihipertensiva, sin efectos metabólicos adversos y buena tolerabilidad.

Clinic outcome evaluation of tamsulosin therapy for benign prostatic hyperplasia

To evaluate the clinical outcome of the once daily oral dose of tamsulosin [0.4 mg] for managing clinical benign prostatic hyperplasia [BPH], a total of 157 out of 186 patients completed the 6-month follow up study protocol. All cases had a bothersome international prostate symptom score [IPSS] of more than 7 and peak flow rate [PFR] of less than 12 ml/second with no absolute surgical indications. The efficacy assessment variables included monitoring IPSS, peak flow rate [PFR] and post-voiding residual volume [PVR] for six months through five outpatients clinic visits [initial, two weeks, six weeks, three months and six months]. The clinical outcome was satisfactory in 124/157 patients with documented improved IPSS and/or PFR. An unsatisfactory outcome occurred in 33/157 patients; 19 showed no improved IPSS and/or PFR, 11 were unsatisfied and decided to undergo surgery and 3 developed acute urinary retention which was persistent and required to undergo surgery. Adverse effects occurred in 21/157 patients including dizziness in 6/157 patients, asthenia in 8/157, abnormal ejaculation in 11/157, rhinitis in 4/157 and severe adverse effects necessitating drug withdrawal in 3/157 patients

A double-blind, randomized, placebo-controlled study, to assess the efficacy of alfuzosin in the treatment of patients with benign prostatic hyperplasia / Um estudo duplo cego, randomizado e controlado com placebo para avaliar a eficácia da alfuzosina no tratamento de pacientes com hiperplasia prostática benigna

Introduçäo: Os alfa-bloqueadores säo hoje as drogas de escolha no tratamento clínico de pacientes com hiperplasia prostática benigna (HPB). Os autores apresentam os resultados de um estudo prospectivo, randomizado, duplo-cego, e controlado por placebo da alfuzosina no tratamento de pacientes com HPB. Material e métodos: 31 pacientes foram randomizados em dois grupos: alfa-bloqueador seletivo alfuzosina na dose de 5 mg duas vezes ao dia (n=16) ou placebo (n=15) por 12 semanas. Os pacientes foram selecionados de acordo com critérios de inclusäo e exclusäo que, de forma geral, incluiram pacientes com 50 anos de idade ou mais, escore internacional de sintomas prostáticos (EISP) de 12 pontos, índice de qualidade de vida (IQV) de 3 pontos ou mais, e fluxo urinário máximo (Fmáx) entre 5 e 15 ml/s. Resultados: Näo houve diferença na taxa de melhora do EISP (37 por cento versus 29 por cento, p=0,446) e IQV (15 por cento versus 21 por cento, p=0,446) entre o grupo alfuzosina e o grupo placebo. No entanto, embora marginalmente significante, o Fmáx mostrou uma melhora marcante após a alfuzosina quando comparado ao placebo (50 por cento versus 5,5 por cento, p=0,06). A incidência de efeitos colaterais foi similar em ambos os grupos, alfuzosina e placebo (43,8 por cento versus 40 por cento, respectivamente). Conclusöes: O alfa-bloqueador alfuzosina näo é uma panacéia e, em alguns pacientes, a melhora clínica ocorre principalmente devido ao efeito placebo, que neste estudo resultou em aproximadamente 30 por cento de melhora do EISP (p=0,001), 21 por cento de melhora do IQV (p=0,017) e um aumento do Fmáx ò50 por cento em 26,5 por cento dos pacientes. Entretanto, o alfa-bloqueador alfuzosina tem um papel importante na abordagem clínica da HPB, já que seu mecanismo de açäo alivia o componente dinâmico da obstruçäo prostática, como demonstrado pela melhora do Fmáx.

Disfunçäo erétil / Erectile dysfunction

Na introduçäo, os autores apresentam dados epidemiológicos da disfunçäo erétil (DE) e, em seguida, o diagnóstico clínico da DE de origem orgânica e psicogênica, bem como o diagnóstico laboratorial. O tratamento é subdividido em informaçöes gerais, medicamentos por via oral (sildenafil e análogos, ioimbina e fentolamina, apomorfina, trazodone e L-arginina), medicamentos por via uretral (alprostadil), farmacoterapia intracavernosa, bombas de vácuo e próteses penianas. Os autores concluem que existiu uma grande evoluçäo da fisiopatologia e do tratamento da DE e que esta doença é bastante comum, existindo soluçöes para restabelecer o bem-estar do paciente.(au)

Tratamiento médico de la hiperplasia benigna de la próstata mediante terazocina / Medical treatment of the benign prostatic hyperplasia using terazosin

Para estudiar la eficacia y la seguridad de la terapia alfa bloqueadora en el tratamiento de la hiperplasia prostática benigna de la próstata en nuestra población, tratamos 70 pacientes con dosis ascendentes de Terazocina hasta alcanzar una dosis de 5 mg con lo cual se mantuvieron en tratamiento hasta completar un año. A lo largo de la evaluación se demostraron diferencias estadísticamente significativas en las evaluaciones del Score de síntomas de Madsen y en la uroflujometría no invasiva practicada en los pacientes. No se observaron evidencias objetivas o subjetivas de cambio de tamaño del adenoma. La frecuencia de efectos colaterales fue escasa y sólo un 2,8 por ciento de los pacientes debieron suspender el tratamiento por una marcada intolerancia. De este modo concluimos que el tratamiento médico con Terazocina es efectivo y útil en la hiperplasia benigna de la próstata, y por algún tiempo pospone su intervención o es útil en los pacientes añosos que sean portadores de un al riesgo quirúrgico que les impida ser sometido a una intervención prostática convencional