Efficacy and tolerability of combination therapy with alpha-blockers and phosphodiesterase-5 inhibitors compared with monotherapy for lower urinary tract symptoms: Protocol for a systematic review and network meta-analysis.

PURPOSE: This study aimed to compare the efficacy and safety of combination therapy consisting of α-blockers and different phosphodiesterase type 5 inhibitors for lower urinary tract symptoms (LUTS) by performing a network meta-analysis. METHOD: Relevant articles were retrieved from the Cochrane Library, PubMed, and EMBASE databases. Bayesian network meta-analyses were performed with a random-effect model to compare the efficacy and safety of combination therapy with α-blockers and phosphodiesterase-5 inhibitors for LUTS. The odds ratio (OR), mean difference (MD) and surface under the cumulative ranking curve (SUCRA) were calculated with the GeMTC R package. RESULTS: Twenty randomized trials with 4131 patients were included in this network meta-analysis. Based on the SUCRA values, vardenafil (10 mg) combined with α-blockers ranked first, first and sixth; sildenafil (25 mg) combined with α-blockers ranked second, third and first; and tadalafil (20 mg) combined with α-blockers ranked third, second and fourth in IPSS, post void residual, and maximum flow rate, respectively. CONCLUSIONS: Combination therapy with α-blockers and phosphodiesterase-5 inhibitors was effective and well tolerated for LUTS. For men who prioritize high efficacy, vardenafil (10 mg) combined with α-blockers seems to be the treatment of choice. For men wishing to optimize minimally invasive treatment, sildenafil (25 mg) and tadalafil (20 mg) combined with α-blockers appears to have a possible advantage in terms of avoiding adverse effects.

Prediction of calcium level in melamine-related urinary calculi with helical CT: diagnostic performance evaluation and clinical significance.

The aim of the study was to investigate the relationship between CT-attenuation and stone calcium level in melamine-related urinary calculi (MRUC). A total of 25 MRUC with known composition and calcium level were included (11 uric acid stones, 2 calcium oxalate stones and 12 mixture stones of uric acid and calcium oxalate). Of all, 18 renal stones accepted alkalization therapy except for 5 lower urinary tract stones and 2 stones of unknown position. With well-matched composition, 61 adult urinary stones were included as controls. Every stone was scanned by helical CT (80 kV/120 kV, 300 mA, pitch 0.625 mm) and the highest CT-attenuation value measured. CT-attenuation values of MRUC increased gradually from uric acid stones, mixture stones to calcium oxalate stones, but were always lower than the values of controls. Furthermore, a strong positive correlation was found between stone CT-attenuation value and stone calcium level (n = 25, r (80kV) = 0.883, p = 0.000; r (120kV) = 0.855, p = 0.000). Compared with alkalization-therapy-alone group, stone CT-attenuation values and stone calcium level in the comprehensive-therapy group were significantly greater (CT(80kV) 1,057 ± 639 vs. 172 ± 61 HU, p = 0.001; CT(120kV) 783 ± 476 vs. 162 ± 60 HU, p = 0.001; Ca 19.83 ± 7.48% vs. 1.30 ± 1.51%, p = 0.000). Fisher's exact test suggested that the stones with higher CT-attenuation values tended to resist alkalization when 400 HU served as the cutoff value (P (80kV) = 0.002, P (120kV) = 0.000). In conclusion, the study was the first to illustrate that the CT-attenuation value could reflect calcium level in MRUC and found that stones with higher CT-attenuation value were not amenable to alkalization because they probably contained greater calcium. For those patients, we believe that comprehensive therapy will be the best choice.

Predictive value of spiral CT in composition changes of pediatric urinary stones / 中华泌尿外科杂志

Objective To investigate the predictive value of spiral CT in composition changes of pediatric urinary.Methods A total of 25 pediatric patients with urinary stones were investigated.Eighteen patients with renal stones were stratified into two groups:an alkalization therapy alone group ( n =9 ) and a comprehensive therapy group (n =9).Flame atomic absorption spectrum (AAS) was employed to measure calcium level of the pediatric urinary stones.Spiral CT was employed to measure the peak CT number in vitro of all the pediatric urinary stones and 61 adult urinary stones,which served as controls.Results All pediatric urinary stones contained calcium ( 0.11％ - 26.30％ ).A positive correlation was observed between the CT number of pediatric urinary stone and its stone calcium level ( r =0.855,P ＜ 0.01 ).Compared to the alkalization therapy alone group,the CT number and stone calcium level of pediatricrenal stones in the comprehensive therapy group were significant higher (stone CT number:162 ± 60 HU VS.783 ±476 HU,P ＜ 0.01 ; stone calcium level:1.30 ± 1.52％ VS 19.83 ± 7.48％,P ＜ 0.01 ).Compared to ≤400 HU pediatric renal stones,＞ 400 HU renal stones contained more calcium (21.71 ± 5.27％,1.65 ±1.82％,P ＜ 0.01 ) and failed to dissolve by alkalization therapy alone ( x2 =11.455,P ＜ 0.01 ).Conclusions CT could be a predictive tool for composition changes of pediatric urinary stones.In clinical CT scanning setting,＞400 HU pediatric urinary stones probably will contain more calcium and not be suitable for alkalization therapy alone.