Effect of preoperative alpha-blockers on ureteroscopy outcomes: A meta-analysis of randomised trials.

Objectives: This work aims to determine the efficacy and safety of preoperative alpha-blocker therapy on ureteroscopy (URS) outcomes. Methods: In this systematic review and meta-analysis of randomised trials of URS with or without preoperative alpha-blocker therapy, outcomes included the need for ureteral dilatation, stone access failure, procedure time, residual stone rate, hospital stay, and complications. Residual stone rates were reported with and without adjustments for spontaneous stone passage, medication noncompliance, or adverse events leading to patient withdrawal. Data were analysed using random-effects meta-analysis and meta-regression. Certainty of evidence was assessed using the GRADE criteria. Results: Among 15 randomised trials with 1653 patients, URS was effective and safe with a stone-free rate of 81.2% and rare (2.3%) serious complications. The addition of preoperative alpha-blockers reduced the need for ureteral dilatation (risk ratio [RR] = 0.48; 95% CI = 0.30 to 0.75; p = 0.002), access failure rate (RR = 0.36; 95% CI = 0.23 to 0.57; p < 0.001), procedure time (mean difference [MD] = -6 min; 95% CI = -8 to -3; p < 0.001), risk of residual stone in the primary (RR = 0.44; 95% CI = 0.33 to 0.66; p < 0.001) and adjusted (RR = 0.52; 95% CI = 0.40 to 0.68; p < 0.001) analyses, hospital stay (MD = -0.3 days; 95% CI = -0.4 to -0.1; p < 0.001), and complication rate (RR = 0.46; 95% CI = 0.35 to 0.59; p < 0.001). Alpha-blockers increased ejaculatory dysfunction risk and were less effective for renal/proximal ureter stones. The certainty of evidence was high or moderate for all outcomes. The main limitation of the review was inconsistency in residual stone assessment methods. Conclusion: While URS is an effective and safe treatment for stone disease, preoperative alpha-blocker therapy is well tolerated and can further improve patient outcomes.

Is there a best timing for benign prostatic hyperplasia surgery?

INTRODUCTION: Treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) has shifted over the last decades, with medical therapy becoming the primary treatment modality while surgery is being reserved mostly to patients who are not responding to medical treatment or presenting with complications from BPH. Here, we aim to to discuss the optimal timing of surgical management of LUTS/BPH. MATERIALS AND METHODS: A literature search was conducted on Pub-Med/MEDLINE database to identify reports published from January 1990 until January 2022 by combining the following MeSH terms: "Lower Urinary Tract Symptoms"; "Prostatic Hyperplasia"; "Prostatic Hyperplasia/therapy"; "Prostatic Hyperplasia/complications"; "Treatment Outcome"; "Time-to-Treatment". Evidence supporting or not early surgical treatment of BPH was examined and reported in a pros and cons form. RESULTS: The "pro early surgery" highlighted the superior efficacy and cost-effectiveness of surgery over medical treatment for BPH, as well as the possibility of worse postoperative outcomes for delayed surgical treatment. The "con early surgery" considered that medical therapy is efficient in well-selected patients and can avoid the serious risks inherent to surgical treatment of BPH including important sexual side effects. CONCLUSIONS: Clinical trials comparing the outcomes for prolonged medical therapy versus early surgical treatment could determine which approach is more beneficial in the long-term in context of the aging population. Until then, both approaches have their advantages and patients should be involved in the treatment decision.

Immediate effect of alpha-blockers in predicting LUTS improvement in BPH patients.

INTRODUCTION: Indications for treating Benign Prostatic Hyperplasia include reversing signs and symptoms or preventing the progression of the disease. Alpha-blockers are the most effective, least costly, and best tolerated of the drugs for relieving LUTS. The aim of the study is to investigate the immediate impact of alpha-blocker medications on lower urinary tract symptoms (LUTS). MATERIALS AND METHODOLOGY: About 100 patients were included in the study-50 patients in each of the groups A (tamsulosin) and B (silodosin). The first visit was the baseline examination before starting alpha-blockers and included history, DRE, UFM, USG KUBP with PVR, IPSS, serum PSA, serum creatinine, urine analysis, urine culture, and sensitivity. All above parameters were also at 1 week, 1 month, and 3 months following starting of alpha-blockers respectively, and compared with baseline. RESULT: As of the first, second, third, and fourth visits, the mean Qmax in group A was 10.3 ± 3.3 s, 15.08 ± 2.80 s, 15.66 ± 3.18 s, and 15.12 ± 3.24 s, respectively, while in group B it was 10.1 ± 3.1 s, 14.88 ± 2.80 s, 15.18 ± 3.18 s, and 15.08 ± 3.24 s, respectively (p < 0.001). The mean voiding time was 40.87 ± 23.91 s, 36.41 ± 20.73 s, 34.85 ± 21.37 s, and 32.07 ± 21.81 s, respectively in group A, and 41.27 ± 15.49 s, 37.23 ± 21.34 s, 38.59 ± 20.83 s, and 33.10 ±22.08. In group A, the mean PVR and IPSS scores were improved and also improved in group B. CONCLUSION: The first dose of tamsulosin and silodosin improves UFM and predicts the mid-term change in UFM as well as IPSS indices in the treatment of BPH-related LUTS.

Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023.

PURPOSE: The purpose of this American Urological Association (AUA) Guideline amendment is to provide a useful reference on the effective evidence-based management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH). MATERIALS AND METHODS: The Minnesota Evidence Review Team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality (AHRQ) database to identify studies relevant to the management of BPH. The guideline was updated in 2023 to capture eligible literature published between September 2020 and October 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS: The BPH amendment resulted in changes to statements/supporting text on combination therapy, photoselective vaporization of the prostate (PVP), water vapor thermal therapy (WVTT), laser enucleation, and prostate artery embolization (PAE). A new statement on temporary implanted prostatic devices (TIPD) was added. In addition, statements on transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT) were removed and information regarding these legacy technologies was added to the background section. References and the accompanying treatment algorithms were updated to align with the updated text. CONCLUSION: This guideline seeks to improve clinicians' ability to evaluate and treat patients with BPH/LUTS based on currently available evidence. Future studies will be essential to further support these statements to improve patient care.

When Venom Meets the Heart: A Rare Case of Scorpion Sting-Induced Acute Myocardial Infarction.

Scorpion sting cases are everyday encounters in the Emergency Department (ED). However, scorpion sting-induced systemic manifestations are rarely seen. Signs and symptoms of envenomation involve the central nervous system, stimulation of the autonomic nervous system and rarely respiratory and heart failure leading to death. Cardiovascular manifestations are particularly prominent following stings by the Indian red scorpion. This case report is of an 18-year-old male patient who presented to ED with complaints of scorpion sting. Twelve lead electrocardiography (ECG) done was suggestive of acute inferior wall myocardial infarction with raised cardiac markers. He also had autonomic dysfunction in the form of hypertension, hypothermia and priapism. He was treated with an alpha-blocker, dual antiplatelets and analgesics. ECG changes reverted to normal the next day, and he was discharged. So, the anticipation of life-threatening complications of scorpion stings plays a vital role in the treatment and prognosis of patients presenting to ED.

Sympathetic Nervous System and Atherosclerosis.

Atherosclerosis is characterized by the narrowing of the arterial lumen due to subendothelial lipid accumulation, with hypercholesterolemia being a major risk factor. Despite the recent advances in effective lipid-lowering therapies, atherosclerosis remains the leading cause of mortality globally, highlighting the need for additional therapeutic strategies. Accumulating evidence suggests that the sympathetic nervous system plays an important role in atherosclerosis. In this article, we reviewed the sympathetic innervation in the vasculature, norepinephrine synthesis and metabolism, sympathetic activity measurement, and common signaling pathways of sympathetic activation. The focus of this paper was to review the effectiveness of pharmacological antagonists or agonists of adrenoceptors (α1, α2, ß1, ß2, and ß3) and renal denervation on atherosclerosis. All five types of adrenoceptors are present in arterial blood vessels. α1 blockers inhibit atherosclerosis but increase the risk of heart failure while α2 agonism may protect against atherosclerosis and newer generations of ß blockers and ß3 agonists are promising therapies against atherosclerosis; however, new randomized controlled trials are warranted to investigate the effectiveness of these therapies in atherosclerosis inhibition and cardiovascular risk reduction in the future. The role of renal denervation in atherosclerosis inhibition in humans is yet to be established.

Prostatic Abscesses in a Patient Receiving Tumor Necrosis Factor-Alpha Inhibitor Therapy for Hidradenitis Suppurativa: A Case Report.

This report is the first to present the case of a patient who developed bacterial abscess-forming prostatitis while undergoing treatment with adalimumab, a tumor necrosis factor-alpha blocking therapy, for hidradenitis suppurativa. A 36-year-old male presented with persistent anogenital pain and dysuria for approximately three weeks. Two days before presentation at the emergency room (ER), a rubber band ligation was performed to address suspected hemorrhoids stages I-II. In the ER, clinical and laboratory examinations suggested acute prostatitis, prompting the initiation of antibiotic therapy. In the absence of an adequate response, magnetic resonance imaging was performed, which identified a complex abscess and fistulation system originating from the right prostatic lobe. Following the insertion of a drain, adalimumab was discontinued, and antibiotic therapy was intensified, resulting in the resolution of the abscess. After six weeks, follow-up showed the patient to be free of symptoms. This case highlights a rare adverse event of patients using immunomodulating medications and may help physicians to manage similar cases in the future. Immunomodulating drugs can lead to the development of prostatic abscesses in young patients, necessitating attentive and careful clinical examination with a low threshold for further diagnostic workup in uncommon case presentations.

The efficacy of antibiotic and alpha-blocker combination therapy versus antibiotic monotherapy in chronic prostatitis/chronic pelvic pain syndrome: A systematic review.

OBJECTIVES: This study attempted to explore the efficacy of a combination of alpha-blockers and antibiotics compared with antibiotic monotherapy in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: We searched PubMed/MEDLINE, Cochrane/CENTRAL, EBSCOHost/CINAHL, ProQuest, and Scopus on January 2020. Randomized controlled trials comparing antibiotic monotherapy with combination therapy of antibiotics and alpha-blockers in CP/CPPS patients lasting at least 4 weeks were included. The study eligibility assessment, data extraction, and study quality assessment were carried out by each author independently and in duplication. RESULTS: A total of six low- to high-quality studies with 396 patients were included in the study. Two reviews reported lower National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total scores in the monotherapy arm at Week 6. Only one study reported otherwise. On Day 90, the NIH-CPSI score was found to be lower in the combination group. In the pain, urinary, and quality-of-life domain, most studies agree that combination therapy is not superior to monotherapy. However, on Day 90, all domains were found to be lower in the combination therapy. Responder rates were found to vary between studies. Only four out of six studies reported a response rate. Responder rates were lower in the combination group at 6 weeks of observation. On Day 90, responder rates were found to be better in the combination group. CONCLUSIONS: The combination therapy of antibiotics and alpha-blockers is not substantially better than antibiotic monotherapy in the first 6 weeks of treatment for CP/CPPS patients. This might not be applicable to a longer duration of treatment.

Development of a machine learning-based predictive model for prediction of success or failure of medical management for benign prostatic hyperplasia.

OBJECTIVE: To develop a novel predictive model for identifying patients who will and will not respond to the medical management of benign prostatic hyperplasia (BPH). METHODS: Using data from the Medical Therapy of Prostatic Symptoms (MTOPS) study, several models were constructed using an initial data set of 2172 patients with BPH who were treated with doxazosin (Group 1), finasteride (Group 2), and combination therapy (Group 3). K-fold stratified cross-validation was performed on each group, Within each group, feature selection and dimensionality reduction using nonnegative matrix factorization (NMF) were performed based on the training data, before several machine learning algorithms were tested; the most accurate models, boosted support vector machines (SVMs), being selected for further refinement. The area under the receiver operating curve (AUC) was calculated and used to determine the optimal operating points. Patients were classified as treatment failures or responders, based on whether they fell below or above the AUC threshold for each group and for the whole data set. RESULTS: For the entire cohort, the AUC for the boosted SVM model was 0.698. For patients in Group 1, the AUC was 0.729, for Group 2, the AUC was 0.719, and for Group 3, the AUC was 0.698. CONCLUSION: Using MTOPS data, we were able to develop a prediction model with an acceptable rate of discrimination of medical management success for BPH.

Risk Analysis of Prostate Cancer Development Following Five-alpha Reductase Inhibitor Treatment for Benign Prostate Hyperplasia.

BACKGROUND/AIM: The clinical hazard of prostate cancer development after five-alpha reductase inhibitors (5ARI) treatment among benign prostate hyperplasia (BPH) patients is still controversial. The aim of this study was to evaluate the epidemiological features of BPH patients treated in a single institute to identify risk factors associated with prostate cancer development. PATIENTS AND METHODS: We retrospectively analyzed patients who were diagnosed with BPH and received alpha blockers (AB) only or 5ARI between January 2007 and December 2012 and followed up until death or December 2020. The primary study outcome was prostate cancer and high-grade prostate cancer. RESULTS: Of the 5,122 included patients, 14.9% (762/5,122) received 5ARI during their BPH treatment. The median age, initial prostate specific antigen (PSA) levels and the PSA change were significantly higher in the 5ARI group compared to those of the AB group. The prostate cancer diagnosis rate was higher in the 5ARI group, and the percentage of high-grade prostate cancer was not different between the two groups. In total, 1,715 (33.5%) patients were recorded dead, and the median follow-up period was longer in the 5ARI group. In Cox regression analysis, only age and initial PSA levels were significantly associated with prostate cancer. Late PSA was the only independent factor associated with high-grade prostate cancer development. CONCLUSION: Our real-world data revealed that age, initial PSA, and late PSA levels were associated with prostate cancer and high-grade prostate cancer diagnosis among BPH patients. Furthermore, 5ARI use had no effect on prostate cancer patient survival. However, PSA assessment during follow-up is still required in our institutional practice to avoid delayed diagnosis.

[Alpha-blockers or hexanic extract of Serenoa repens for 6 months: sub-analysis of the PERSAT study]. / Alpha-bloquants ou extrait hexanique de Serenoa repens pendant 6 mois : sous-analyse de l'étude PERSAT.

OBJECTIVE: The objective of this sub-analysis of the PERSAT study was to evaluate the efficacy of hexanic extract of S. Repens (HESr) and alpha-blockers (AB), at 6 months in patients with moderate to severe LUTS/BPH. METHODS: The PERSAT observational study was conducted in France by general practitioners on patients with BPH with an IPSS≥12 score. The primary endpoint was the percentage of responders (decrease in total IPSS score ≥ 3) at 6 months. Improvement in quality of life (IPSS-QoL) as well as patient satisfaction were also measured. RESULTS: Of the 759 patients in the study, 324 treated with HESr and 309 with AB were reviewed at 6 months, with no change in treatment during follow-up. Characteristics at inclusion were globally similar with a mean IPSS of 18.2±4.9. The response rates at 6 months (IPSS-total decrease ≥ 3) were 93.7% and 94.8% for patients treated with HESr and AB, with a mean decrease in IPSS score of 10.1±5.6 points, which reached 13.6 and 14.8 points respectively, in severe patients (IPSS>19), without major difference between groups. More than 95% of HESr or AB patients reported a significant overall improvement in their LUTS/BPH. The most frequently reported adverse events with AB were ejaculation disorders (4.9%) and hypotension (4.2%) and with HESr digestive disorders (1.5%). CONCLUSION: This sub-analysis of the PERSAT cohort reported the clinical efficacy of HESr and AB as a first-line treatment in the management of moderate or severe LUTS/BPH patients.

Prophylactic administration of alpha-blockers for the prevention of post-operative urinary retention following inguinal hernia repair: A meta-analysis of randomized control trials.

BACKGROUND: Inguinal hernia repair is a commonly performed surgical procedure performed in adult males. Urinary retention following surgery is a known complication likely due to the adrenergic over-stimulation of smooth muscles in the bladder neck and prostate. This effect could potentially be mitigated by the use of alpha-blocker medications. A meta-analysis of randomized control trials (RCTs) was performed to analyse the evidence behind the use of alpha-blockers in the prevention of post-operative urinary retention (POUR). METHODS: A comprehensive search of PubMed, Embase, MedLine and Scopus was undertaken adhering to PRISMA guidelines. RCTs using alpha-blockers as a single point intervention were included. Data were analysed using a random-effects model. Risk of Bias (ROB) was assessed according to Cochrane guidelines. RESULTS: Seven RCTs including 680 patients were included. The use of alpha-blockade reduced the incidence of urinary retention requiring catheterization (OR:0.23, 95% CI:0.07-0.70, p:0.009). No serious side-effects of alpha-blockers were reported. CONCLUSION: Alpha-blockers are a safe and effective intervention to reduce the incidence of urinary retention following inguinal hernia repair surgery.

Elements for Trial Without Catheter (TWOC) Success in Benign Prostatic Hyperplasia Patients: Lessons We Have Learned.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a progressive disease that causes low urinary tract symptoms (LUTS). As prostatic volume grows, the prostatic urethra may become completely obstructed, resulting in full urine retention and acute hypogastric pain. Our research aimed to identify the optimal trial without catheter (TWOC) therapeutic approach and identify those factors that are associated with the recurrence of complete urinary retention (CUR). METHODOLOGY: The study enrolled with complete urinary retention and BPH were included in the study, after the insertion of a Foley catheter. The patients received tamsulosin 0.4 mg/day as an alpha-blocker treatment. In our investigation, patients who encountered complete urinary retention were randomly categorized into four groups based on the duration of urinary catheterization as determined by the attending urologist. RESULTS: Maintaining the urethrovesical catheter for three to seven days was related to the highest success of spontaneous urination, which was statistically significant compared to other study groups. (p=0.0007). Age over 70 years, no alpha-blocker before the urinary retention episode, and prostatic volume exceeding 50 ml were all associated with decreased TWOC efficacy. We found the highest rates of spontaneous urination were after three to seven days of urinary catheterization. CONCLUSION: BPH and complete urine retention can be managed by TWOC in many cases. Several factors affect the test's efficacy. Prolonged urinary catheter maintenance over seven days, prostatic volume over 50 ml, and age over 70 years are poor prognostic indicators.

Silodosin Improves Pain and Urinary Frequency in Bladder Pain Syndrome/Interstitial Cystitis Patients.

Purpose: Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) is a bladder-related chronic inflammatory disease. Data indicate that stress enhances the excitability of bladder nociceptors through the stimulation of alpha1A-adrenoceptors. Stress is known to play a crucial role in BPS/IC patients. We aimed to assess the efficacy and safety of daily silodosin in refractory BPS/IC female patients and its correlation with stress coping. Materials and Methods: An open-label trial was conducted with 20 refractory BPS/IC patients. Evaluations occurred at baseline and the 8th and 12th weeks. Primary endpoint was bladder pain evaluated by visual analogue scale (VAS). Secondary endpoints included daily frequency, nocturia and maximum voided volume obtained from a 3-day bladder diary, the O'Leary−Sant Symptom Score, and two questions accessing stress coping. Patients initiated daily doses of 8 mg silodosin, which could be titrated to 16 mg. Median values with percentiles 25 and 75 (25; 75) were used. Wilcoxon signed-rank test was used for comparisons. A minimally important difference of 3 points for pain was established to define clinically relevant improvement. Results: Median age was 56 years. Median pain score decreased from 8.00 (6.00; 8.00) at baseline to 4.00 (2.00; 5.50) (p < 0.001), meaning that the primary endpoint was reached. Total urinary frequency decreased from 14.00 (13.00; 21.00) to 9.00 (7.50; 11.00) (p < 0.05), and all the other secondary endpoints also showed a statistically significant improvement. Eleven patients improved by ≥3 pain points in VAS, meaning that 65% of patients that ended the study protocol achieved clinical significant improvement or, in the full analysis set, that 55% of the 20 initial patients improved significantly. Fourteen (82%) decreased by ≥2 micturitions/day. Overall, the cohort's stress coping was low. Conclusions: Silodosin can be an effective and well-tolerated treatment for refractory BPS/IC female patients.

Priapism – A rare side effect of alpha blockers: Report of 2 cases and literature review / Priapismo – Un efecto secundario raro de los alfabloqueantes: informe de dos casos y revisión de la literatura

Priapism is a prolonged unintended erectile state unrelated to sexual stimulation or sexual desire. There is a very rare relationship between the use of alpha blockers and the development of priapism. Here, we describe 2 cases of alpha blocker induced priapism and a literature review. One of these cases is related to the use of silodosin and the other is related to the use of tamsulosin. So far, 18 alpha blocker induced priapism cases have been reported. We are presenting the first case of silodosin induced priapism and the eighth case of priapism secondary to tamsulosin. Despite silodosin having a much greater affinity for the α1-a receptor than the α1-b receptor, as represented in this case it can cause this rare side effect. Before starting alpha blocker treatment, side effects such as priapism, which may be very rare but may cause serious problems, should be kept in mind. (AU)

El priapismo es un estado eréctil prolongado no intencionado y no relacionado con la estimulación o el deseo sexual. Existe una relación muy infrecuente entre el uso de alfabloqueantes y el desarrollo de priapismo. Describimos aquí dos casos de priapismo inducido por alfabloqueantes y una revisión de la literatura. Uno de estos casos guarda relación con el uso de silodosina, y el otro con el uso de tamsulosina. Hasta el momento se han reportado 18 casos de priapismo inducido por alfabloquantes. Presentamos aquí el primer caso de priapismo inducido por silodosina y el octavo caso de priapismo secundario a tamsulosina. A pesar de que silodosina tiene mucha mayor afinidad por el receptor α1-a que el receptor α1-b, según lo representado en este caso, puede causar este efecto secundario raro. Antes de iniciarse tratamiento con alfabloquantes deben tenerse en cuenta los efectos secundarios, tales como priapismo, que pueden ser muy raros pero pueden causar problemas graves. (AU)

Priapism - A rare side effect of alpha blockers: Report of 2 cases and literature review.

Priapism is a prolonged unintended erectile state unrelated to sexual stimulation or sexual desire. There is a very rare relationship between the use of alpha blockers and the development of priapism. Here, we describe 2 cases of alpha blocker induced priapism and a literature review. One of these cases is related to the use of silodosin and the other is related to the use of tamsulosin. So far, 18 alpha blocker induced priapism cases have been reported. We are presenting the first case of silodosin induced priapism and the eighth case of priapism secondary to tamsulosin. Despite silodosin having a much greater affinity for the α1-a receptor than the α1-b receptor, as represented in this case it can cause this rare side effect. Before starting alpha blocker treatment, side effects such as priapism, which may be very rare but may cause serious problems, should be kept in mind.

Acute urinary retention.

Acute urinary retention is a common clinical presentation in emergency departments in the UK and is responsible for over 30 000 hospital admissions annually. Awareness of the latest advice and guidelines regarding its presentation, investigation and management is paramount to improve patient outcomes and reduce morbidity. Immediate management of acute urinary retention relies on timely bladder decompression by catheterisation. Knowledge of the routes and types of catheterisation, including the associated risks, complications and contraindications, is essential to allow rapid and early intervention, thus preventing further complications. Differences in the presentation of patients with acute urinary retention reflect varying aetiologies, the knowledge of which determines long-term management and prognosis.

Comparison of the Efficacy of Male Sexual Activity Versus Alpha-Blockers in the Expulsion of Distal Ureteric Stones: A Systematic Review and Meta-Analysis.

Globally, the prevalence of urolithiasis is increasing, with limited effective treatment options. Though debate exists within the literature, the use of medical expulsive therapy (MET) for distal ureteric stones in the form of alpha-blockers is commonplace. Alpha-blockers work via the inhibition of norepinephrine, resulting in a small degree of distal ureteric relaxation. Nitric oxide (NO), the main neurotransmitter involved in penile erection, causes smooth muscle relaxation of the distal ureter. It is hypothesised that these alternative pathways may achieve the same desire clinical effect. To our knowledge, this is the first meta-analysis comparing the efficacy of male sexual activity, in the form of intercourse or masturbation, to alpha-blockers in the expulsion of ureteric stones. We conducted a comprehensive search of electronic databases (PubMed, MEDLINE, EMBASE, SCOPUS, CENTRAL and Google Scholar), identifying studies comparing male sexual activity versus alpha-blockers, in male patients with distal ureteric stones. The Cochrane risk-of-bias tool was used to assess the included studies. For data analysis, a random effects model was used in the event of significant heterogeneity (>75%), with fixed-effects modelling in the event of low-moderate heterogeneity. A search of electronic databases found three randomised control trials (RCTs), enrolling a total of 262 patients. There was no statistically significant difference observed when patients engaged in sexual activity rather than alpha-blocker, when looking at stone expulsion rate at two weeks (P=0.36), expulsion rate at four weeks (P=0.57), or the mean stone expulsion time (P=0.21). Furthermore, there was no significant difference observed when looking at analgesic requirements (P=0.43), or the requirement for additional procedures (P=0.57). Our meta-analysis demonstrated that male sexual activity as an alternative therapy for distal ureteric stones had comparable outcomes to the use of alpha-blocker, proving a viable alternative therapy in those patients wishing to avoid pharmacological management.

The Role and Efficacy of Coenzyme Q10 in the Management of Erectile Dysfunction in a Hypertensive Male: An Interventional Study.

Introduction Erectile dysfunction (ED) is a prevalent medical condition that affects millions of men globally. A number of pharmacological and complementary options are used in the management of ED, including Coenzyme Q10 (CoQ10). Oxidative stress has been linked to the progression of ED, and Co Q10 protects against oxidative damages and improves erectile function as well as the activity of antioxidant enzymes. This study aimed to determine the efficacy of CoQ10 in the treatment of erectile dysfunction in hypertensive males. Method An open-labeled parallel arm interventional study was conducted in the cardiology unit of Hayatabad Medical Complex Hospital, Peshawar, Pakistan, from March 2020 to March 2021. Hypertensive male patients (n = 230) were randomly allocated to either receiving 200-gram CoQ10 daily along with their current antihypertensive therapy (n=104) or anti-hypertensive treatment only (n=105). The patient's erectile function was assessed at baseline and three months using the International Index of Erectile Function Test (IIEF-5) during the study period. Result Of the total 230, 209 (90.87%) patients were included in the final analysis. There were no significant differences in demographics, history of illness, co-morbid conditions, and current medication of both groups. After three months, 21 (20.1%) participants scored more than 17 in the IIEF-5 and no longer had ED. Overall, no significant difference was found in the mean IIEF-5 score between the study group and control group (14.41 ± 4.49 Vs. 15.61 ± 4.82; p=0.06). However, in subgroup analysis, significant improvement in the study group was seen in participants with mild ED (p=0.03). Conclusion With the demonstration of its efficacy in hypertensive patients with mild ED, co-enzyme Q10 supplementation can be proposed as a potential candidate in patients with long-term hypertension and can play a role in erectile dysfunction.