Effect of dutasteride, tamsulosin and the combination on patient-reported quality of life and treatment satisfaction in men with moderate-to-severe benign prostatic hyperplasia: 4-year data from the CombAT study.

OBJECTIVE: To investigate the effect of combination therapy with dutasteride plus tamsulosin compared with each monotherapy on patient-reported health outcomes over 4 years in men with moderate-to-severe lower urinary tract symptoms (LUTS) because of benign prostatic hyperplasia (BPH). METHODS: CombAT was a 4-year international, double-blind, randomised, parallel-group trial in men (n = 4844) with moderate-to-severe symptoms of BPH and at increased risk of disease progression [age > or = 50 years, International Prostate Symptom Score (IPSS) > or = 12, prostate volume > or = 30 cc, serum prostate-specific antigen > or = 1.5 ng/ml to < or = 10 ng/ml and maximum urinary flow rate 5-15 ml/s with minimum voided volume > or = 125 ml]. Subjects were randomised to receive 0.5 mg dutasteride, 0.4 mg tamsulosin or the combination once daily for 4 years. The primary endpoint at 4 years was the time to event and proportion of subjects with acute urinary retention or undergoing BPH-related prostate surgery. Secondary endpoints included the health-outcomes measures, BPH Impact Index (BII), IPSS question 8 (IPSS Q8) and the Patient Perception of Study Medication (PPSM) questionnaire. RESULTS: At 4 years, combination therapy resulted in significantly superior improvements from baseline in BII and IPSS Q8 than either monotherapy; these benefits were observed from 3 months onwards compared with dutasteride and from 9 months (BII) or 12 months (IPSS Q8) onwards compared with tamsulosin. Also at 4 years, the PPSM questionnaire showed that a significantly higher proportion of patients was satisfied with, and would request treatment with, combination therapy compared with either monotherapy. CONCLUSIONS: Combination therapy (dutasteride plus tamsulosin) provides significantly superior improvements in patient-reported quality of life and treatment satisfaction than either monotherapy at 4 years in men with moderate-to-severe BPH symptoms.

[Spontaneous disappearance of pulmonary metastasis secondary to renal cell carcinoma after nephrectomy. Presentation of a case and review of the literature]. / Desaparición espontánea de metástasis pulmonares secundarias a carcinoma de células renales tras la nefrectomía. Aportación de un caso y revisión de la literatura.

Spontaneous disappearance of pulmonary metastasis is an occasionally occurring phenomenon, thus reflected in the literature. The article presents one case of spontaneous disappearance of pulmonary metastasis of clear cells renal carcinoma, histologically confirmed by fine needle puncture aspiration. After 36 months of follow-up, the patient shows no evidence of recurrence.

[Endoscopic treatment of ureteral lithiasis. Results of our second series of 100 cases]. / Tratamiento endoscópico de la litiasis ureteral. Resultados de nuestra segunda centena de casos.

The combined utilization of transurethral ureterorenoscopy (TUR) and extracorporeal shock wave lithotripsy (ESWL) have caused a revolution in the treatment of ureteral lithiasis. We present a total 113 TUR due to ureteral lithiasis performed in period of 20 months, from March 1988 to November 1989. In the last ten months of the study we used TUR an ESWL for the treatment of ureteral lithiasis. Results show success in 92.93% of the treatments; 8 cases of open surgery (7.07%), five of these were performed during the first 10 months of the study, when ESWL was not available, with only 2 serious complications (1.75%) and one death due to massive pulmonary embolism. TUR is an unsubstitutable technique for the treatment of ureteral lithiasis and when combined with ESWL obtains optimum results. It is our technique of choice in all cases non susceptible to treatment with in situ ESWL due to the impossibility of locating the lithiasis without auxiliary endourological manoeuvres.

Bilateral abscessed orchiepididymitis associated with sepsis caused by Veillonella parvula and Clostridium perfringens: case report and review of the literature.

Veillonella species is a gram-negative coccus which is part of the anaerobic normal flora in the oral cavity, small intestine, upper respiratory tract, vagina, and urinary tract. The role that this organism plays in infection is not well known, and it is generally associated with other bacteria. We present a case of bilateral abscessed orchiepididymitis associated with septicemia due to Veillonella parvula and, later, to Clostridium perfringens, with the development of severe renal insufficiency and septic shock, which resolved favorably with antibiotic therapy, treatment of shock, and hyperbaric oxygen therapy. In reviewing the literature, we have not found any other case of sepsis due to Veillonella sp. associated with urological disorders.