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.

Hepatotoxicidad por tamsulosina / dutasterida: reporte de un caso probable

La tamsulosina y dutasterida son medicamentos ampliamente usados como tratamiento de la hipertrofia benigna de próstata. teniendo un buen perfil de seguridad. Existen escasos reportes de injuria hepática asociado al uso de tamsulosina; sin embargo, no hay reportes de toxicidad hepática por el uso de dutasterida y del uso combinado de tamsulosina/dutasterida. Se presenta el caso de un varón de 64 años quien desarrolla injuria hepática tras el uso combinado de tamsulosina/dutasterida, desarrollando un patrón de daño hepatocelular y clínica de hepatitis aguda. Se realizo descarte de patología hepática viral, autoinmune y enfermedades metabólicas de depósito, así como de patología biliar mediante ecografía abdominal y colangioresonancia. En la evaluación de causalidad, presentó CIOMS-RUCAM: 6 puntos (probable) y Naranjo: 4 puntos (posible). El paciente presentó respuesta clínica y laboratorial luego de suspender el medicamento.

Tamsulosin and dutasteride are drugs widely used to treat benign prostatic hypertrophy. having a good safety profile. There are few reports of liver injury associated with the use of tamsulosin; however, there are no reports of hepatic toxicity from the use of dutasteride and the combined use of tamsulosin/dutasteride. We present the case of a 64-year-old man who developed liver injury after the combined use of tamsulosin/dutasteride, developing a pattern of hepatocellular damage and acute hepatitis symptoms. Viral, autoimmune, and metabolic storage diseases of the liver were ruled out, as well as biliary pathology by means of abdominal ultrasound and resonance cholangiography. In the causality evaluation, CIOMS-RUCAM presented: 6 points (probable) and Naranjo: 4 points (possible). The patient presented a clinical and laboratory response after discontinuing the drug.

A prospective study to evaluate the efficacy and adverse effects of alpha-blockers in the management of benign prostatic hyperplasia

Background: Benign prostatic hyperplasia (BPH) is the most common cause for the lower urinary tract symptoms in men. The conservative management of BPH comprises of alpha blockers, especially selective alpha 1 adrenergic blockers for symptomatic relief. Aims and Objectives: We aimed to evaluate the efficacy and adverse effects of alpha blockers in managing BPH. Materials and Methods: After getting approval from the Institutional Human Ethics Committee and consent from subjects, this prospective, randomized, and controlled trial was conducted. In this study, patients under inclusion criteria were divided into two groups. Group I received silodosin 8 mg once daily for 8 weeks. Group II received tamsulosin 0.4 mg once daily for 8 weeks. Primary outcome measure was reduction in international prostate symptom score (IPSS). Adverse events during study period were recorded. Results: A total of 90 patients were enrolled in this study. Ten patients were excluded and remaining 80 patients were divided as 40 in Group I (Silodosin) and 40 in Group II (Tamsulosin), patients were followed up for 8 weeks. As primary outcome, the IPSS at 8th week was significantly <0 week, that is, baseline in both the groups. The comparison of IPSS within Group I and Group II at 0 week and 8th week was significant (P < 0.05). The quality of life comparison within Group I and Group II at 0 week and 8th week was significant (P < 0.05). Both the drugs were well tolerated. Retrograde ejaculation and diarrhea were noted with silodosin (Group I), dizziness and orthostatic hypotension were noted with Tamsulosin (Group II). Conclusion: The obtained results showed that both silodosin and tamsulosin produced significant improvement in IPSS and quality of Life in BPH patients. In silodosin group, retrograde ejaculation and diarrhea were notable adverse effects and in tamsulosin group, dizziness and orthostatic hypotension were noted.

Effect of moxibustion on ureteral stent-related symptoms after ureteroscopic lithotripsy / 中国针灸

OBJECTIVES@#To observe the clinical efficacy of moxibustion combined with western medication on ureteral stent-related symptoms after ureteroscopic lithotripsy (URL).@*METHODS@#One hundred and fifty patients with upper urinary tract calculus implanted with ureteral stents after URL were randomly divided into a moxibustion group (50 cases, 1 case dropped out), a placebo moxibustion group (50 cases, 3 cases dropped out) and a blank control group (50 cases). No intervention was performed in the blank control group. On the basis of oral administration with tamsulosin hydrochloride sustained release capsule (starting from the first day after surgery, once a day, 0.2 mg each time, continuously for 4 weeks), in the moxibustion group, moxibustion was operated at Guanyuan (CV 4) and bilateral Shenshu (BL 23); the sham-moxibustion was delivered at the same acupoints in the placebo moxibustion group, once daily, 6 times a week, for 15 min in each treatment. The duration of treatment was 4 weeks. Before treatment, and after 1, 2 and 4 weeks of treatment, the scores of lower urinary tract symptoms, body pain, general health, work performance and satisfaction of sexual matters were compared among the 3 groups. The tract calculus clearance rate, urinary infection and the oral administration of painkillers were compared after 4 weeks of treatment in the 3 groups.@*RESULTS@#The scores of lower urinary tract symptoms, body pain and general health after 1 week of treatment, and the scores of lower urinary tract symptoms, body pain, general health and work performance after 2 and 4 weeks of treatment were lower than those before treatment in the 3 groups (P<0.01). The scores of lower urinary tract symptoms and body pain in the moxibustion group after 1, 2 and 4 weeks of treatment were lower than those in the blank control group and the placebo moxibustion group (P<0.01, P<0.05) respectively. The score of general health in the moxibustion group was lower than that in the blank control group after 1 week of treatment (P<0.01), and lower than those of the blank control group and the placebo moxibustion group after 2 and 4 weeks of treatment (P<0.01, P<0.05). Regarding the score of work performance, it was lower in the moxibustion group after 1 and 2 weeks of treatment compared with those in the blank control group (P<0.05, P<0.01), and lower than those of the blank control group and the placebo moxibustion group after 4 weeks of treatment (P<0.01, P<0.05). The tract calculus clearance rate in the moxibustion group was 95.9% (47/49), higher than that in the blank control group (80.0%, 40/50, P<0.05). The proportion of oral administration of painkillers in the moxibustion group (28.6%, 14/49) and the placebo moxibustion group (40.4%, 19/47) was lower than that in the blank control group (76.0%, 38/50, P<0.01) respectively.@*CONCLUSIONS@#Moxibustion combined with western medication relieves lower urinary tract symptoms and body pain, and accelerate the recovery of general health and work performance in the patients after URL.

Comparative evaluation of cost-effectiveness of alpha blockers prescribed in patients with non-neurogenic lower urinary tract symptoms due to benign prostatic hyperplasia

Background: Lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) is a common problem among aging men. Several classes of drugs are efficacious and safe, but the first-line treatment is with alpha-1 adrenergic blockers. They provide symptomatic relief and have to be taken for a longer duration to sustain the effect. The preferred alpha-blockers among the stockpile should be efficacious, tolerable, and also cost-effective. Aim and Objective: This study focuses to compare the cost-effectiveness of various alpha blockers prescribed in patients with LUTS-BPH. Materials and Methods: An observational study of 78 patients who were newly diagnosed with LUTS-BPH from April 2014 to May 2015 was conducted. Patients were followed up at 4 weeks and at 12 weeks after the drugs had been prescribed. Efficacy assessment was done on basis of change in International Prostate Symptom Score (IPSS) score over 12 weeks. Average cost-effectiveness ratio of different alpha-blockers prescribed was evaluated and compared with Mann-Whitney U test in order to find the most cost-effective alpha-blocker in the study. Results: All patients were prescribed alpha-blockers either alone or in combination with other drugs. Tamsulosin was prescribed to n = 46, Silodosin to n = 16 and Alfuzosin to n = 16. The efficacy in terms of Mean change in IPSS after 12 weeks of study was 11.34 ± 5.23 for Tamsulosin, 11.70 ± 5.9 for Silodosin and 10.87 ± 4.77 for Alfuzosin and average cost-effectiveness ratio was 108.74, 183.07 and 127.50 for Tamsulosin, Silodosin, and Alfuzosin, respectively. Conclusion: Tamsulosin was the most cost-effective drug among the prescribed alpha-blockers. Since all the prescribed alpha-blockers had comparable efficacy so we concluded that the most cost-effective drug should be preferred for long-duration treatment.

Potent Anti⁃bacteria Activity of Tamsulosin Hydrochloride and Ningmitai Capsule in Combination by Regulating the Gene Expression Related to β⁃Lactamase, Hemolysis, and Virulence / 中国生物化学与分子生物学报

Tamsulosin hydrochloride (TSH) is a selective α

Efficacy of tamsulosin versus tadalafil as medical expulsive therapy on stone expulsion in patients with distal ureteral stones: A randomized double-blind clinical trial

ABSTRACT Purpose: To compare the effects of tadalafil, tamsulosin, and placebo as a medical expulsive therapy (MET) for distal ureteral calculi. Materials and Methods: This prospective randomized double-blind clinical trial was conducted on 132 renal colic patients with distal ureteric stones (≤10mm) over a period of 12 months. Patients were randomly divided into three groups. Patients in group A received tamsulosin 0.4mg, in group B received tadalafil 10mg, and in group C received placebo. Therapy was given for a maximum of 4 weeks. The rate of stone expulsion, duration of stone expulsion, the dose and the duration of nonsteroidal anti-inflammatory drugs (NSAIDs), analgesic use, and adverse effects of drugs were recorded. Results: Demographic profiles were comparable between the 3 groups. Although the stone expulsion rate in group A (72.7%) was higher in comparison to group B(63.6%) and group C(56.8%), it was not considered statistically significant (P=0.294). Shorter mean time to stone expulsion was significantly observed in group A (17.75±75), than group B(21.13±1.17) and group C(22.25±1.18) (P=0.47). The mean number of analgesic use was 9.8±5.09 days in group A, 14.6±7.9 days in group B, and 12.6±22.25 days in group C, this difference was significant (P=0.004). The analgesic requirement (doses of NSAIDs and pethidine) in group A was significantly lower than other groups (P<0.05). Also, patients in group A reported fewer headaches compared to other groups (P=0.011). Conclusion: Tamsulosin as medical expulsive therapy is more effective for distal ureteric stones with less need for analgesics and less stone expulsion time than tadalafil.

Adjunctive medical expulsive therapy with tamsulosin for repeated extracorporeal shock wave lithotripsy: a systematic review and meta-analysis

ABSTRACT Purpose: To evaluate the efficacy of adjunctive medical expulsive therapy (MET) with tamsulosin for the promotion of stone fragments clearance for repeated extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: This meta-analysis was conducted by systematic search for randomized controlled trial (RCT) studies in PubMed/Medline, Scopus, Cochrane Library, Web of Science databases in January 2020, which compared tamsulosin with either placebo or non-placebo control for repeated ESWL. The primary endpoint was stone-free rate (SFR), the second endpoints were stone clearance time and complications. The quality assessment of included studies was performed by using the Cochrane System and Jadad score. Results: 7 RCTs were included in this meta-analysis. Tamsulosin provided higher SFR (for stones larger than 1cm, OR: 5.56, p=0.0003), except for patients with stones less than 1cm. For patients with renal stones (OR: 2.97, p=0.0005) or upper ureteral stones (OR: 3.10, p=0.004), tamsulosin can also provide a higher SFR. In addition, tamsulosin provided a shorter stone clearance time (WMD: −9.40, p=0.03) and lower pain intensity (WMD=-17.01, p <0.0001) and incidences of steinstrasse (OR: 0.37, p=0.0002). Conclusion: Adjunctive MET with tamsulosin is effective in patients with specific stone size or location that received repeated ESWL. However, no well-designed RCT that used computed tomography for the detection and assessment of residual stone fragments was found. More studies with high quality and the comparison between tamsulosin and secondary ESWL are needed in the future.

Intraoperative Floppy Iris Syndrome in patients on alpha 1 blocker tamsulosin: incidence and predictability

Background: Intraoperative Floppy Iris Syndrome (IFIS) was first described by Chang and Campbell in year 2005 in male patients undergoing phacoemulsification surgery who were on Tamsulosin, an alpha 1 blocker drug for their urinary symptoms for enlarged prostate. This condition was characterized by excessive floppiness of iris, prolapse of iris tissue through phaco and sideport incisions and progressive intraoperative miosis, resulting in increased surgical time and various major surgical complications compromising visual outcome.Methods: This study of 78 patients was undertaken to know the incidence and severity of IFIS as well as to predict its occurrence by observing maximum pupil dilation achieved preoperatively.Results: It was observed that majority of patients on tamsulosin dilated poorly and severe IFIS occurred in those with pupil dilation of 5 mm or less after putting mydriatic eye drops preoperatively.Conclusions: It was concluded that if IFIS was predicted and necessary precautions taken, postoperative complications can be reduced significantly with improved visual outcome.

Prescription pattern of alpha blockers in the treatment of benign prostatic hyperplasia in India: a paper based survey

Background: Benign prostatic hyperplasia (BPH) is the most common urological condition. The treatment of BPH depends on the severity of symptoms which aims to improve symptoms, lower the risk of progression and improve quality of life. The aim of this survey was to understand the prescription pattern of alpha blockers in the treatment of BPH among clinicians of India.Methods: A cross-sectional questionnaire-based survey was conducted between September to December 2018. Data regarding the management of BPH using ?-blockers were filled by clinicians and collated for data analysis using appropriate statistical test.Results: Total of 1764 clinicians’ responses was collected and the result was analysed. According to the survey, 47.68% of clinicians felt that severity of the BPH symptoms is most common deciding factor for medical management of BPH. For the pharmacological management of BPH patients, around 58% of clinicians opted for ? blockers monotherapy as a preferred option. Among ? blockers, 65.14% of clinicians preferred tamsulosin as first line therapy for management of BPH patients. In this survey, 81.75% of clinicians believed that tamsulosin offers highest persistence rate among commonly prescribed ? blockers. Looking at the switching to a second ?-blocker, 75.45% of clinicians felt that tamsulosin shows the highest return rate following initiation of a second ?-blocker. More than 90% of clinicians felt that favourable efficacy or tolerability of tamsulosin is due to its highest persistence and highest return rates.Conclusions: Tamsulosin is the most commonly preferred and prescribed ?-blocker by Indian clinicians due to its favourable efficacy or tolerability.

Evaluation of efficacy and safety profile of tamsulosin in benign prostatic hyperplasia

Background: To evaluate the efficacy and safety profile of alpha-1A receptor subtype specific antagonist-tamsulosin in benign prostatic hyperplasia.Methods: An open label, non-randomised, prospective, single centred study who were visiting urology department with confirmed diagnosis of benign prostatic hyperplasia (BPH) were included in the study. Thirty patients with BPH were prescribed tamsulosin and were followed up to three months. The initial or baseline data collected were identification of the patients such as international prostate symptom score (IPSS), prostate specific antigen, urine analysis, and ultrasonography of prostate including post void residual urine. The patients were followed up to 3 months to measure clinical and laboratory outcomes (IPSS score, post void residual urine, uroflow rates etc.).Results: In our study, patients receiving tamsulosin 0.4 mg once daily showed a significant improvement in post-void residual urine (PVRU), uroflow rates and IPSS score. The improvements in the above parameters were found to be statistically insignificant at first and third month of follow-up.Conclusions: In our study, tamsulosin an alpha-1A receptor subtype specific antagonist showed significant improvement in BPH symptoms and the drug was well tolerated.

To Compare the Efficacy of Tamsulosin and Deflazacort Combination with Tamsulosin Alone in Expulsion of Lower Ureteric Stones in a Medical College in South Haryana

Introduction: Men have been suffering from urinary stones since antiquity. Symptomatic ureteric stone is a very common emergency condition faced by general surgeons and urologists. There are many medical and interventional treatments for lower ureteric stones. Removal of stone with ureteroscopy is very effective but this is very costly also. Anesthetist is required; stent is placed in ureter which has to be removed afterward. Stones of size <4 mm will pass hopefully spontaneously. Stones more than 10 mm size will require surgery in general. The expulsion of stones of size 4–10 mm can be tried with the help of pharmacological agents. Materials and Methods: This prospective observational study was conducted in the Surgery Department at SGT Medical College located in South Haryana. A total of 150 patients of distal ureteric stones of sizes 4–10 mm were taken in this study, divided into two groups of 75 patients each. Group I patients were given tamsulosin 0.4 mg and deflazacort 30 mg once in a day and Group II patients were given tamsulosin 0.4 mg once in a day. Treatment was for 10 days. Results: In Group I, the stones were expelled in 24 (32%) patients. While in Group II, 11 (14.6%) patients passed stones. This is statistically significant with P = 0.023. The median time for stone expulsion was 192 h in Group I and 312 h in Group II with again a significant P = 0.039. Conclusion: We conclude that Group I (tamsulosin + deflazacort) showed a statistically significant advantage in stone expulsion rate than Group II (tamsulosin alone). Group I also showed a statistically significant advantage in stone expulsion time.

Efficacy of Tamsulosin Alone or Combined with Antimuscarinic Drugs in the Treatment of Ureteral Stent- related Symptoms ：A Meta-analysis / 中国药房

OBJECTIVE：To systematically review the efficacy of tamsul osin a lone or combined with antimuscarinic drugs in the treatment of ureteral stent-related symptom （SRSs），and to provide evidence-based reference for the clinical treatment. METHODS：Retrieved from PubMed ，Embase，Cochrane Library ，CJFD，CBM，VIP and Wanfang database ，from the inception to Oct. 2019，RCTs about tamsulosin alone （monotherapy group ）or combined with antimuscarinic drugs （combination group ） versus placebo or blank control （control group ）in the treatment of SRSs were collected. After data extraction of included clinical studies met inclusion criteria ，their quality was evaluated with Cochrane collaborative network system evaluation manual 5.1.0，and Meta-analysis was conducted by using Rev Man 5.3 statistical software. RESULTS ：A total of 9 RCTs were included ，involving 932 patients. Meta-analysis results showed that after stent placement ，the urinary symptoms score [MD ＝－4.23，95％CI（－5.96， －2.51），P＜0.000 01]，body pain score [MD ＝－4.20，95％CI（－5.30，－3.10），P＜0.000 01]，general health score [MD ＝ － 1.36， 95％ CI（ － 1.75， － 0.98）， P＜0.000 01] in monotherapy group were significantly lower than control group with statistical significance ； there was no significantly 2805097532@qq.com difference in the work performance score [MD ＝0.19，95％CI（－0.99，1.37），P＝0.76]，sexual matters score [MD ＝－0.31 95％CI（－0.68，0.05），P＝0.09] in 2 groups. 4 weeks after the stent was removed ，the body pain score [MD ＝－0.64，95％CI（－0.84，－0.43），P＜0.000 01]，general health score [MD ＝ －0.28，95％CI（－0.41，－0.15），P＜0.000 01] ，urinary symptoms score [MD ＝－0.64，95％CI（－0.84，－0.43），P＜0.000 01] in monotherapy group were significantly lower than control group after stent placement ，with statistical significance ；there was no significantly difference in the work performance score [MD ＝0.31，95％CI（－0.22，0.84），P＝0.25] or sexual matters score [MD ＝ －0.31，95％CI＝（－0.68，0.05），P＝0.09] in 2 groups. The urinary symptoms score [MD ＝5.93，95％CI（2.83，9.02），P＝0.000 2]， body pain score [MD ＝3.49，95％CI（1.39，5.60），P＝0.001] and general health score [MD ＝2.96，95％CI（1.44，4.49），P＝0.000 1] in the monotherapy group were higher than the combination group ；there was no significantly difference in the work performance score [MD ＝1.53，95％CI（－0.12，3.18），P＝0.07] or sexual matters score [MD ＝0.46，95％CI（－1.03，1.96），P＝0.54] in 2 groups. CONCLUSIONS：Tamsulosin has a good therapeutic effect on SRSs ；its combination with antimuscarinic drugs can achieve better therapeutic efficacty.

Comparison of Tamsulosin versus Tadalafil as an Effective Expulsive Treatment for Distal Ureteral Stones – A Prospective Comparative Study

Introduction: The increasing prevalence of ureteric stone is a matter of concern in this era and it may be linked to improvedquality of life. Medical expulsive therapy, including alpha-blockers, steroids, and calcium channel blockers, has been extensivelystudied for improving the rate of stone passage in patients who do not require immediate urologic intervention.Aim: The aim of this study is to compare the efficacy of tamsulosin and tadalafil in expulsive treatment for distal ureteralstones.Materials and Methods: This was a prospective comparative study included 120 adult patients (>18 years of age) presentingwith distal ureteric stones were randomized into 60 patients with tamsulosin 0.4 mg once daily (Group A) or 60 patients withtadalafil 10 mg once daily (Group B) treatment. Therapy was given for a maximum of 4 weeks.Results: About 85% of study patients had a size between 5 mm and 7 mm and 18 patients had size between 8 mm and 10 mm.There was no statistical difference noted in the pain duration and analgesic usage of both groups. In Group A, 67% of patientshad expulsion of stones; in Group B, 63% of patients had expulsion of stones. About 90% of patients in 40 cases of expelledstones are in <5 days in Group A and 89% of patients 38 cases of expelled stones are in <5 days in Group B. There was nostatistical difference noted between both groups.Conclusion: Tamsulosin and tadalafil have shown similar expulsion rate. Both of them simultaneously provides better paincontrol and significantly lower the needs for analgesia.

A comparative study of efficacy and safety of tamsulosin with nifedipine versus tamsulosin alone as medical expulsive therapy for lower ureteric stones

Background: Lower ureteric stones (LUS) comprises of 70% of ureteric stones. Spontaneous passage depends on stone size and location in ureter. Impacted calculi initiate smooth muscles contractions causing ureteric spasms. ?-1 blockers like tamsulosin and calcium channel blocker like nifedipine relaxes ureteric smooth muscle, facilitating spontaneous expulsion. Pain and discomfort associated with urolithiasis, hospitalization and surgical cost can be minimized by medical expulsive therapy. Many studies had compared efficacy of tamsulosin with nifedipine, only few have explored the combination. This study compared efficacy of nifedipine and tamsulosin versus tamsulosin alone.Methods: 64 patients with LUS (5-10 mm) were assigned into 2 groups. Group 1 received tamsulosin and nifedipine and group 2 only tamsulosin. Rate of expulsion, time to expulsion, analgesic frequency and pain VAS score were analyzed. Chi-square or Fisher’s exact test to analyze categorical data, Mann Whitney U test or unpaired t test for differences between groups and Wilcoxon matched-pairs signed rank test for within group. A p<0.05 was statistically significant.Results: Rate of expulsion was 87.5% in group 1 and 65.6% in group 2 (p<0.05). Mean expulsion time was 6.68±1.89 days for group 1 and 8.52±2.62 in group 2 (p<0.05). Analgesic requirement was similar. Adverse effects were headache, dizziness and postural hypotension.Conclusions: Combination therapy yielded better rate of expulsion and reduction in stone expulsion time than tamsulosin alone. Thus, combination therapy can be considered for effective treatment outcomes.

Efficacy and safety of tadalafil in ureteric stent related symptoms: a double blind, prospective, randomised study

Background: Is tadalafil effective and safe in ureteric stent related symptoms? The objective of this trial is to study the efficacy and safety of tadalafil and compare it with tamsulosin in relieving ureteric stent related symptoms by using ureteral stent symptom questionnaire.Methods: Total 144 patients with dj stent symptoms were randomized into two groups with 72 patients in each. Group A patients were given tadalafil 5mg and Group B, tamsulosin 0.4mg for 2 weeks. Ureteral stent symptom questionnaire was filled on 7th day and on 21st day after stent insertion. Statistically significant difference between groups was determined by the t-test, Mann-Whitney U-test, Pearson Chi-square test or Fisher's exact test. Comparison between quantitative time related variables was done by Wilcoxon Signed Rank test. All the statistical tests were two-sided and were performed at a significance level of α=.05.Results: Tamsulosin was found more effective then tadalafil in decreasing mean urinary index (p=0.004). Tadalafil caused significant decrease in body pain (p=0.006) and improvement in general health index score, work performance and sex score (P value= 0.041, <0.001 and <0.015 respectively) as compared to tamsulosin. Additional problems score improvement and analgesic use were found comparable in 2 groups (p value =0.193, 0.070 respectively). Adverse effect with both the drugs were minimal, mild to moderate and self-limiting.Conclusions: Tadalafil found more effective then Tamsulosin in relieving body pain, sexual symptoms and improving general health and work performance but less effective in improvement of urinary symptoms.

​Evaluation Of The Efficacy Of Tamsulosin And Deflazacort Versus Tamsulosin Alone In Expulsion Of Lower Ureteric Stones In A Tertiary Center

Introduction: Urolithiasis is a very common problem present. About 70% of all ureteric stones are found in the lower third ofureter. Many factors affect the modality of treatment such as setup available, type, size of stone and expertise of the surgeon.Extracorporeal shock wave lithotripsy and ureteroscopy and removal of stone are very effective, but they require the help ofanesthetist. Ureter is to be stented, and the stent has to be removed later on. They are very costly and not without complications.Many pharmacological agents have been used for the expulsion of ureteric stones, for example, diclofenac, alkalizers, ketorolac,nifedipine, deflazacort, prazosin, silodosin, and tamsulosin.Materials and Methods: This prospective observational study was conducted in the Surgery Department at SGT MedicalCollege. A total of 100 patients of distal ureteric stones of sizes 4–10 mm were taken in this study, divided into two groups of50 patients each. Group I patients were given tamsulosin 0.4 mg and deflazacort 30 mg once in a day, Group II patients weregiven tamsulosin 0.4 mg once in a day. Treatment was for 10 days.Results: In Group I, the stones were expelled in 38 (76%) patients, while in Group II, 26 (52%) patients passed stones. Thisis statistically significant with P = 0.038. The median time for stone expulsion was 3 days in Group I and 11 days in Group IIwith P = 0.032.Conclusion: We have evaluated that medical expulsive therapy using tamsulosin alone is also effective and can be used inpatients where steroids are contraindicated, but by adding deflazacort, it becomes very effective for management of distalureteral calculi.

Management of lower ureteral stones using Tamsulosin – A prospective study

Introduction: It has been scientifically established that α1-adrenergic antagonists cause inhibition of the basal tone, peristaltic frequency, and contractions in the lower ureter. Earlier studies have shown promising results with Tamsulosin (α1-adrenergic antagonist) helping in spontaneous passage of Ureteral stones. Hence this prospective randomized double-blind placebo-controlled study is taken up to establish the real impact of Tamsulosin a specific alpha blocker (α1-adrenergic receptors) in expelling distal ureteral stones. This study aimed to include 80 patients with ureteral stones of less than 5 mm and more than 5 mm in size located in the distal ureter. Materials and methods: In the Present study, informed consent was obtained from all 80 patients and the study was conducted after institutional ethical committee approval. Patients are randomized to two groups to receive Tamsulosin and placebo along with analgesics whenever required. Patients were followed up for a period of one month to study the stone expulsion rate, drug side effects and pain episodes. Results: All 80 patients complied with prescribed treatment schedules except 4 patients in placebo group and 2 in study group who were lost to follow up. At the end of 4 weeks, stone expulsion was seen in 30 out of 38 (79% patients in study group and 20 patients out of 36 (56%) in placebo group. The stone expulsion time was shorter in the study group (6.2±3.2 days) and in 9.67±5.4 days for placebo group. No significant impact on the expulsion rate was seen in relation with age, gender and ureteric stones present either in right side or left side. The frequency of pain episodes was almost same and mild in both groups. Conclusion: Tamsulosin is safe and effective drug to enhance spontaneous passage of smaller stones present in distal ureter.

Effect of scopolamine butylbromide injection combined with tamsulosin oral auxiliary extracorporeal shock wave lithotripsy in the treatment of urinary calculi and influence on serum inflammatory factors / 中国基层医药

Objective To study the effect of scopolamine butylbromide injection combined with tamsulosin oral auxiliary extracorporeal shock wave lithotripsy(ESWL) in the treatment of urinary calculi,and to investigate its effect on serum inflammatory factors.Methods From January 2016 to May 2017,96 patients with urinary calculi in the People's Hospital of Lanxi were selected and randomly divided into control group(n =42) and observation group(n =54).The control group received scopolamine butylbromide assisted ESWL treatment,the observation group treated with tamsulosin on the basis of the control group.The VAS score,clinical efficacy,adverse reactions and serum C reactive protein(CRP),tumor necrosis factor alpha(TNF-alpha) and other inflammatory factors were compared between the two groups.Results Before treatment,no statistically significant difference in VAS score was found between the two groups (t =0.274,P ＞ 0.05).After treatment,the VAS score of the observation group was (2.21 ± 0.28) points,which was significantly lower than that of the control group[(4.75 ± 0.63) points] (t =7.935,P ＜ 0.05).The stone clearance rate in the observation group was 96.30％ (52/54),which was significantly higher than that in the control group[71.43％ (30/42)] (x2 =6.712,P ＜ 0.05).The time of disappearance of pain in the observation group was (10.86 ± 1.54) d,which was significantly lower than that in the control group [(7.02 ± 1.25) d] (t =7.468,P ＜0.05).The lithecbole time of the observation group was (9.01 ± 1.53) h,which was significantly shorter than that of the control group[(13.25 ± 2.21) h] (t =8.035,P ＜ 0.05).Before treatment,there were no statistically significant differences in serum CRP and TNF-levels between the two groups (t =0.152,0.185,all P ＞0.05).After treatment,the serum level of CRP in the observation group was (11.64 ± 1.75) mg/L,which was significantly lower than that in the control group [(18.94 ± 2.03) mg/L] (t =7.008,P ＜ 0.05).After treatment,the serum TNF-level in the observation group was (13.95 ± 2.01)mg/L,which was significantly lower than that in the control group[(20.76 ±3.18) mg/L] (t =7.008,P ＜0.05).The incidence rate of adverse reactions of the observation group was 5.56％,which was significantly lower than 26.19％ of the control group (x2 =9.572,P ＜ 0.05).Conclusion Urinary calculi underwent intravenous infusion of scopolamine butylbromide combined with tamsulosin oral adjuvant ESWL therapy,can effectively reduce the pain of patients,reduce the serum levels of inflammatory cytokines,improve the stone clearance rate,and with less complications,it is worthy of clinical popularization and application.

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.