Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and ED.

PURPOSE OF REVIEW: Aim of our systematic review is to evaluate and summarize the efficacy and safety of tadalafil alone or in combination with tamsulosin for the management of lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). RECENT FINDINGS: Daily tadalafil, in particular 5 mg, according to retrieved studies, appears to be both safe and effective in treating LUTS/BPH and ED, compared with placebo or tamsulosin. The combination of daily tadalafil 5 mg and tamsulosin 0.4 mg allows a better improvement of LUTS compared with both the monotherapies, even if with an increased, but acceptable and tolerated, adverse events rate. After discontinuation of tamsulosin or tadalafil in patients previously treated with their combination, the improvement of LUTS retains significance compared with baseline. Tadalafil 5 mg should be considered a primary treatment option for patients with LUTS/BPH and ED. Evidence highlight an excellent tolerability, safety, and effectiveness profile, both alone or in combination with tamsulosin 0.4 mg. A better efficacy on LUTS relief has been observed for combination therapy, preserving also sexual function. The further switch to monotherapy allows to preserve LUTS relief, but tadalafil only is able to retain ED improvement. Our results support the evidence for a more and more tailored and modular LUTS treatment.

Prostatic inflammation: a potential treatment target for male LUTS due to benign prostatic obstruction.

BACKGROUND: The purpose of this narrative review is to evaluate the role of prostatic inflammation as a treatment target for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) and provide an update on the available therapies. METHODS: An extensive literature search was conducted for studies on established and investigational treatments with anti-inflammatory mechanism of action that has been assessed for the management of male LUTS due to BPO. RESULTS: Data on phosphodiesterase 5 inhibitors, nonsteroidal anti-inflammatory drugs, vitamin D3 receptor analogs, phytotherapy, statins, and lifestyle changes have been reviewed and analyzed. Preclinical evidence has shown the anti-inflammatory effect of these treatments on prostate. However, there is a wide variation in the degree of mature of each therapy. In addition, there are significant differences between the studies in terms of design, number of patients, and duration of follow-up. CONCLUSIONS: Several drugs classes have been investigated for their impact on prostatic inflammation and improvement of male LUTS. The reviewed data support the rationale for use of agents that may alter and improve the inflammatory environment in the prostate in men with LUTS, but further high-quality long-term studies are required for the exact positioning of the new drugs in daily practice.

Disseminated Bacillus Calmette-Guerin infections after intravesical therapy.

Intravesical instillation of Bacillus Calmette-Guerin (BCG) is the treatment of choice for superficial bladder carcinoma. Disseminated BCG infection presenting as granulomatous hepatitis or pneumonitis is a very rare complication of this treatment. Here we report a case series of seven patients previously treated with BCG presenting with pneumonitis. In two of the cases, identification of Mycobacterium bovis was achieved with molecular methods.

Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome.

The objective of this study was to evaluate the female sexual function in relation to hormonal status in pre- and postmenopausal women with obstructive sleep apnea (OSA). A total of 43 premenopausal (mean age 42.1±4.9) and 58 postmenopausal (mean age 59.9±4.8) women were included in the study. All women filled out the Epworth sleepiness scale (ESS), the Beck Depression Inventory (BDI) and the Female Sexual Function Index (FSFI). Testosterone, estradiol and progesterone were measured. After polysomnography, women were allocated to a not-severe OSA group (Apnea-Hypopnea Index (AHI) 10-30) and a severe OSA group (AHI >30). Healthy subjects comprised the control group. Severe OSA women in both pre- and post-menopausal group were found to have significantly lower mean FSFI score (16.5±4.0 and 16.9±4.7, respectively) compared with not-severe OSA (23.4±5.5, P<0.01 and 21.8±7.5, P<0.05) and control subjects (27.0±5.5, P<0.01 and 24.0±6.7, P<0.01). Progesterone, which was significantly lower in severe OSA premenopausal women (0.26±0.2) compared with not-severe OSA (0.55±0.14, P<0.01) and control group (0.62±0.16, P<0.01), correlated significantly with FSFI (r=0.39, P<0.01). Our study demonstrated that OSA is associated with sexual dysfunction in both premenopausal and postmenopausal women in a dose-related fashion. Regarding premenopausal women, our results indicated that progesterone may play a role in the association between OSA and female sexual dysfunction.

Molecular pathogenesis of non muscle-invasive bladder cancer: implications for novel targeted therapies.

Approximately 70% to 80% of patients with urothelial carcinomas of the bladder are initially diagnosed with non-muscle invasive disease. Superficial, non-muscle invasive bladder cancers (NMIBCs) are managed with cystoscopic transurethral resection of all visible lesions followed by intravesical chemotherapy and/or immunotherapy. Despite this treatment, up to 70% of these tumors will recur within five years and 15% will ultimately progress to muscle-invasive disease, suggesting that novel therapeutic strategies are necessary. Recent studies have greatly advanced our understanding of urothelial carcinogenesis and have highlighted the distinct molecular pathogenesis of NMIBCs versus muscle-invasive bladder tumors. It is now clear that diverse genetic and epigenetic events are driving the oncogenesis of NMIBCs, thereby attesting to their potential as therapeutic targets for these tumors. This article reviews the molecular pathogenesis of NMIBCs, discusses recently completed and ongoing clinical trials and anticipates the future direction of molecular targeted agents in this disease.

[Extensive stone formation in the prostatic bed following enucleation of an adenoma. Combined endourological treatment of an interesting case]. / Ausgedehnte Steinbildung in der Prostataloge nach Adenomenukleation. Endourologische Kombinationstherapie zur Behandlung dieses interessanten Falles.

We report on a patient with extensive stone formation in the prostatic bed 4 years after open suprapubic prostatectomy for benign prostatic hyperplasia. The patient was successfully treated with a combination of transurethral and percutaneous suprapubic lithotripsy in the same session.

The use of tamsulozin as adjunctive treatment after ESWL in patients with distal ureteral stone: do we really need it? Results from a randomised study.

Our study aimed to define the position of tamsulosin as adjunctive therapy in patients with stones of the distal ureter who had undergone extracorporeal shock wave lithotripsy (ESWL). In total, 61 consecutive patients (38 men and 23 women) with single distal radiopaque ureteral stone of > or =6 mm of diameter were enrolled. After ESWL patients were randomized in two groups. Non-steroidal anti-inflammatory drug (supp. diclofenac 50 mg) was given to both groups upon demand. In group B, all patients (30) received additionally tamsulozin 0.4 mg every day. Follow-up visits were performed 1, 2, 3 and 4 weeks after ESWL. Evaluation included a KUB plain film and an ultrasound examination. Efficacy was evaluated in terms of success rate, stone-free rate, expulsion time of the fragments and use of diclofenac. Two patients from the tamsulosin group experienced dizziness and one was withdrawn. The success rate was 58.06 and 66.66% for the control and the tamsulosin group, respectively, while the corresponding values for stone-free rate were 51.6 and 63.33%, respectively. The mean expulsion time of the fragments was 13.22 days for group A and 12.95 days for group B. These results did not achieve statistically significant difference (P > 0.05). The mean diclofenac dose was 118.9 mg in group A and 56.9 mg in group B. This difference was statistically significant (P = 0.02). Despite the relatively small number of patients, our data indicate that the use of tamsulosin after ESWL in this specific subgroup of patients does not result in improved success and stone-free rate and expulsion time. In contrast, a significantly reduced need for analgesics was found.

State anxiety during watchful waiting for urinary lithiasis.

OBJECTIVES: Guidelines on many disorders recommend a variable period of watchful waiting between diagnosis and indicated action. In this study, we assessed stress during the watchful waiting period for urinary lithiasis, a benign disorder treated with minimally invasive procedures, without the pitfall of the emotional burden of a terminal or debilitating disease or fear of impending major surgery and to assess the distress caused by waiting per se. Furthermore, we attempt to identify individual patients at risk of prolonged or debilitating psychological distress. METHODS: A total of 112 lithiasis patients with stones < or =5 mm completed the study. State and trait anxiety were assessed both at baseline and after the end of watchful waiting using STAI, and then they were informed of the indicated action for their case. RESULTS: During the 30 days of watchful waiting, patients experienced a significant increase in state anxiety scores, especially if they were male, had high state or trait anxiety scores at baseline, or if they had experienced more than one episode of colicky pain during the waiting period. CONCLUSION: Clinicians should be more flexible when they face the above group of patients, as far as the duration of watchful waiting period is concerned, because a long waiting sets those patients under significant emotional burden.

Urinary basic fibroblast growth factor in bladder cancer patients. Histopathological correlation and clinical potential.

INTRODUCTION: Angiogenesis plays a significant role in the growth and progress of cancer, thus we evaluated the levels of urinary basic fibroblast growth factor (bFGF) in bladder cancer (Ca) patients and investigated any possible correlation between this angiogenic factor with tumor stage and grade. MATERIALS AND METHODS: Urine samples from 41 patients with bladder Ca, 11 patients with history of bladder Ca but negative follow-up cystoscopy, 18 patients with benign prostate hyperplasia (BPH) and 15 normal healthy volunteers were assayed using an enzyme-linked immunosorbent assay for bFGF. Resulting values were normalized against urine creatinine and expressed as pg/g. RESULTS: The median urinary bFGF level of patients with active disease, history of bladder carcinoma and negative follow-up cystoscopy, BPH, and healthy volunteers were 2,717, 1,009, 1,414 and 1,100 pg/g, respectively. There was a statistically significant difference between median bFGF levels of patients with active bladder Ca and those of the other groups (p = 0.000). Eleven patients with invasive bladder Ca had a median bFGF value of 6,880 pg/g that was significantly increased (p = 0.002) compared to the median of 2,312 pg/g of those with superficial tumors (Ta 14, T1 16). Grades 1, 2 and 3 carcinoma were found in 5, 19 and 17 patients which had a median bFGF of 2,717, 1,762 and 3,617 pg/g, respectively, but the difference was not statistically significant (p = 0.13). CONCLUSIONS: Our results confirm the implication of bFGF in the biology of bladder cancer, and demonstrate that urinary bFGF concentration seems to be significantly related to the stage but not to the grade of the disease supporting the proposed mechanisms of release of bFGF. Further studies are required in order to validate the potential clinical applications of bFGF for specific groups of bladder cancer patients.

Present practice and development of minimally invasive techniques, imaging and training in European urology: results of a survey of the European Society of Uro-Technology (ESUT).

OBJECTIVES: The European Society of Urological Technology (ESUT) conducted a survey in order to assess and record the current trend between European urologists with regard to the application of new technologies in BPH, stone disease and imaging and to identify differences amongst urologists. MATERIAL AND METHODS: A total of 854 certified urologists and residents coming from European countries answered the ESUT survey during the XVIth Annual EAU Meeting in Geneva in 2001. The respondents were classified according to the geographical origin (Eastern, Southern and Northern Europe), year of certification (before 1980, and every 5 years hereafter) and power of the department in beds (less than 25, 26-50, and more than 50) in order to identify any differences in the replies mainly due to economical reasons, national or hospital policy and personal attitudes. RESULTS: According to the replies, in Eastern Europe more procedures related to BPH and stones are performed comparing to Northern and Southern Europe (165.8 versus 77.1 and 100.6/month/department, respectively). However, the Northern European urologists have access to every type of lithotriptor and most of the different minimally invasive treatments for BPH in a higher percentage, followed by the Southern and the Eastern European urologists. The most widespread intracorporeal lithotriptor is the pneumatic and the most common alternative minimally invasive BPH treatment is electrovaporization (80.7% and 45.6%, respectively). Holmium laser is the most frequent choice (40.1%) when the surveyed urologists were asked to choose which of the minimally invasive techniques would like to have access to. In total 79.4% (54.1% alone and 25.3% in collaboration with the radiologists) of the respondents perform the ultrasound studies while the remaining 20.6% declare that only the radiologists do the studies. Of the surveyed urologists, 92.8%, 89.6% and 94.9% are interested in hands-on courses, simulators and live surgery, respectively. CONCLUSIONS: The data obtained from the 854 surveyed European urologists and residents can be used as a tool to highlight the disparity between European countries and to advance training of European urologists.

Sclerosing sertoli cell tumor of the testis--a case report and review of the literature.

To date, only I I cases of sclerosing Sertoli cell tumors have been reported in the literature, representing a distinctive subtype of Sertoli cell tumor in humans. We present a 12th case with a review of the current urological and pathological literature.