Does sildenafil enhance the effect of tamsulosin in relieving acute urinary retention?

Objective To compare the safety and efficacy of combined therapy using sildenafil and tamsulosin for management of acute urinary retention (AUR) with tamsulosin alone in patients with benign prostate hyperplasia (BPH). Materials and Methods 101 patients were enrolled in a randomized placebo-controlled study from June 2009 to April 2012. Patients presenting with an initial episode of spontaneous AUR underwent urethral catheterization and then prospectively randomized to receive tamsulosin 0.4mg plus sildenafil 50mg in group A and tamsulosin 0.4mg plus placebo in group B for three days. Urethral catheter was removed three days after medical treatment and patient’s ability to void assessed at the day after catheter removal and seven days later. Patients who voided successfully were followed at least for three months. Results Mean age of patients was 59.64 ± 3.84 years in group A and 60.56 ± 4.12 years in group B (p value = 0.92). Mean prostate volume and mean residual urine were comparable between both groups (p value = 0.74 and 0.42, respectively). Fifteen patients in group A (success rate: 70%) and nineteen patients in group B (success rate: 62.7%) had failed trial without catheter (TWOC) at 7th day following AUR (p value = 0.3). No significant difference was noted between both groups regarding the rate of repeated AUR at one month and three month follow-up period (p = 0.07 and p = 0.45, respectively). Conclusion It seems that combination therapy by using 5-phosphodiesterase inhibitor and tamsulosin has no significant advantages to improve urinary retention versus tamsulosin alone. .

Effectiveness of tamsulosin in prevention of post-operative urinary retention: a randomized double-blind placebo-controlled study

Purpose: Urinary retention is one of the most common complications contributing to surgical procedures. Recent studies have shown the benefits of alpha-adrenergic blockers in preventing post-operative urinary retention (POUR). The aim of this prospective study was to compare the prophylactic effect of tamsulosin with placebo on postoperative urinary retention. Materials and Methods: In this randomized placebo controlled, clinical trial, 232 male patients aged 18 to 50 years old admitted to Razi University Hospital for varicocelectomy, inguinal herniorrhaphy, and scrotal surgery were randomly assigned to receive either three doses of 0.4mg tamsulosin (n = 118) or placebo (n = 114), 14 and 2 hours before, and 10 hours after surgery. Patients were closely monitored for the development of urinary retention 24 hours after surgical intervention. The primary endpoint was to investigate the effect of tamsulosin in prevention of post-operative urinary retention during the first 24 hours after surgical intervention. Collected data were analyzed using SPSS software version 18 and the P < 0.05 was considered statistically significant. Results: One hundred and eighteen patients were included in tamsulosin arm and 114 in placebo arm. POUR in patients who received tamsulosin was significantly lower than placebo, as 5.9% of the patients treated with tamsulosin and 21.1% placebo group, reported urinary retention following surgery (P = 0.001). No serious adverse effects were seen in both groups. Conclusions: This study suggests that short perioperative treatment with tamsulosin can reduce the incidence of urinary retention and the need for catheterization after varicocelectomy, inguinal herniorrhaphy, and scrotal surgery. .

Management of men with a first episode of acute urinary retention due to benign prostatic enlargement.

OBJECTIVE: To determine the effect of the existing management protocol of patients presenting with acute urinary retention due to benign prostatic enlargement on clinical efficacy and surgical practice. DESIGN: Prospective study. SETTING: The Urology Unit at the Teaching Hospital, Karapitiya, Galle. PATIENTS: 100 consecutive patients with a first episode of acute urinary retention due to a clinically benign enlarged prostate. MEASUREMENTS: Success of voiding urine after one week of treatment with an alpha adrenoceptor blocker (prazosin). Incidence of subsequent urinary retention during the follow up period of 6 months despite continuing treatment with the drug. RESULTS: Of the 94 patients who completed the follow up period of 6 months, 56 voided successfully after the initial trial without catheter at one week. However, 12 of them developed urinary retention during the follow up and required surgery. CONCLUSION: Treatment with an alpha adrenoceptor blocker followed by a single trial without catheter can avoid prostatic surgery in 40% of patients with acute urinary retention due to benign prostatic enlargement.

Proposta para o uso de doxozosina e dexametasona para facilitar a micçäo espontânea após cirurgia ginecológica e/ou uroginecológica / Proposal for the use of doxozosine and dexametasone to facilitate the spontaneous miction after gynecologic and/or urogynecologic surgery

Estamos mostrando nossa experiência com o uso de doxazosina e dexametasona no tratamento e na prevençäo da retençäo urinária após colpossuspensäo abdominal. Estamos propondo o uso destas drogas com a finalidade de facilitar a micçäo espontânea após cirurgia ginecológica e/ou uroginecológica

Poliradiculomielopatia causada por citomegalovirus en pacientes con SIDA / Cytomegalovirus polyradiculomyelopathy in AIDS

Se presenta una serie de 7 pacientes con SIDA en quienes se diagnosticó poliradiculomielopatía causada por Citomegalovirus (CMV-PRAM), con el objetivo de evaluar la eficacia del tratamiento con ganciclovir, foscarnet, o la combinación de ambos agentes. Se realizaron evaluaciones clínicas y neurológicas al momento de presentación y durante el tratamiento para el CMV. La fuerza muscular fue establecida de acuerdo a la escala del Medical Research Council (MRC). Se clasificó la respuesta al tratamiento de acuerdo al grado de mejoría en la fuerza muscular. En 6 de los 7 pacientes se observó una mejoría en la fuerza muscular con tratamiento anti-CMV alcanzando grado 4, o una mejoría de por lo menos 3 grados de acuerdo a la escala MRC. El paciente restante tuvo una respuesta intermedia. CMV-PRAM puede ser tratada con ganciclovir o la combinación de ganciclovir y foscarnet con buenos resultados.

O uso do misoprostol na retençäo urinária persistente / The use of misoprostol in women with urinary persistent retention

Em estudos realizados em mulheres mostramos a importância da administraçäo intravesical de misoprostol, para tratar a retençäo urinária persistente (RUP) após cirurgia ginecológica

O emprego do misoprostol para facilitar a micçäo espontânea / Use of misoprostol for facilitate spontaneous urination

Em estudo realizado em mulheres mostramos a importância da administraçäo intravesical de misoprostol para o tratamento de retençäo urinária e também para possibilitar a micçäo espontânea 24 horas após cirurgia para correçäo de IUE por via abdominal.