Evaluation of Storage Symptoms Improvement and Factors Affecting, After Relief of Obstruction in Patients With Benign Prostatic Enlargement.

OBJECTIVES: To evaluate the improvement of storage symptoms in accordance with voiding symptoms and assess the prognostic factors that influence the relief of storage symptoms after transurethral resection of the prostate (TURP). METHODS: Between August 2017 and November 2019, 75 patients indicated for TURP were included in the study, we assessed the improvement of storage symptoms and factors that may influence storage symptoms persistence after TURP such as Age, Overactive bladder symptoms (OABS) score (Blaivas 2007) and Urodynamic parameters such as maximum flow rate (Q MAX), maximum cystometric capacity (MCC), bladder contractility index (BCI), phasic and terminal detrusor overactivity (DO). Assessment of patients was done before and 6 months after TURP by international prostate symptom score (IPSS), quality of life score (QLSS), OABSS (Blaivas score 2007), and urodynamic studies. RESULTS: Mean age of the patients was 67.88±7.82 years. The patients with persistence of storage symptoms were significantly older 70.43±8.32 vs 67.04±7.49 respectively P-value = 0.022, also IPSS score was significantly higher in patients with resolution of symptoms (26.83±3.91 vs 24.35±3.68 P = .017). Terminal D.O and Q max were significantly higher in patients with persistence of storage symptoms (26.3% and 8.1 vs 8.9% and 6 respectively). MCC was significantly higher in a patient with resolution vs persistence of storage symptoms (345.18±90.89 mL vs 242.16±72.73) respectively P = 0.001 There was no significant difference between both groups regarding duration of symptoms, prostate size, prostatic specific antigen (PSA), QOL score, OABS score, and maximum detrusor pressure CONCLUSION: more elderly patients with MCC less than 250 ccs and terminal DO were associated with worse outcomes and persistence of storage symptoms post TURP.

Efficacy of silodosin on the outcome of semi-rigid ureteroscopy for the management of large distal ureteric stones: blinded randomised trial.

OBJECTIVE: To evaluate the efficacy of silodosin therapy, as a new α-adrenergic receptor (α-AR) blocker, on the success rate of semi-rigid ureteroscopy (URS) for the management of large distal ureteric stones. PATIENTS AND METHODS: This prospective study recruited 127 adult patients with single distal ureteric stone of ≥1 cm. The patients were randomly allocated to two groups: the first group included 62 patients who received silodosin (8 mg) for 10 days before URS (Silodosin group), whilst the second group included 65 patients who received placebo, in the form of multivitamins, for 10 days before URS (Placebo group). All patients underwent URS and a pneumatic lithoclast was used for stone fragmentation. RESULTS: The mean (SD) operative time was shorter in the Silodosin group compared with the Placebo group, at 41.61 (4.67) vs 46.85 (4.6) min, respectively. Furthermore, advancing the ureteroscope to access the stone failed in a statistically significant number of patients in the Placebo group compared with the Silodosin group (13 vs two, respectively). The complication rate was significantly higher in the Placebo group compared with the Silodosin group (20% vs 6.4%, P = 0.036). Additionally, the need for postoperative analgesia was significantly lower in the Silodosin group compared with the Placebo group (8.1% vs 26.2%, P = 0.009). CONCLUSION: Silodosin therapy prior to URS management of large distal ureteric stones seems to be associated with better advancing of the ureteroscope to access the stone, shorter procedure time, higher stone-free rate, lower incidence of complications, and lesser need for postoperative analgesia.

Comparative Study between Silodosin and Tamsulosin in Expectant Therapy of Distal Ureteral Stones.

OBJECTIVE: To compare the efficacy and safety of silodosin against tamsulosin as medical expulsion therapeutic agent in stone lower 1/3rd ureter. PATIENTS AND METHODS: One hundred fifty patients divided equally into 2 groups I and II received silodosin 8 mg and tamsulosin 0.4 mg respectively. Patients aged 18 years or older having single unilateral stone 10 mm or less were included in the study. Patients with bilateral or multiple stones, marked hydronephrosis, previous open or endoscopic surgery and having urinary infection were excluded. Patients were followed weekly for 4 weeks by ultrasonography, plain radiography of the urinary tract and CT of the urinary tract when indicated. RESULTS: Silodosin showed better results against tamsulosin as stone expulsion rate in silodosin and tamsulosin groups was 82.4 and 61.5% respectively with significant difference (p = 0.007). Also, the stone expulsion time was significantly lower in silodosin against tamsulosin groups as it was 9.4 ± 3.8 vs. 12.7 ± 5.1 days in group I and II respectively (p = 0.001). The adverse effects were comparable with non-significant more retrograde ejaculation in the silodosin group. CONCLUSION: Silodosin showed better efficacy in the stone expulsion rate and time with comparable safety of both drugs, with nonsignificant more retrograde ejaculation in silodosin.