Silodosin versus naftopidil in Japanese patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized multicenter study.

OBJECTIVES: Silodosin is a novel drug that is highly selective to subtype alpha 1A and, since 2006, has been used in Japan for treating benign prostatic hyperplasia. This study aimed to compare the clinical effects of the alpha-adrenoceptor antagonist, silodosin, with those of naftopidil in patients presenting lower urinary tract symptoms associated with benign prostatic hyperplasia. METHODS: This was a randomized, open-label, controlled multicenter study carried out in Japan. Overall, 121 participants with lower urinary tract symptoms associated with benign prostatic hyperplasia were randomized to receive silodosin (4 mg twice daily) or naftopidil (50 mg once daily) for 4 or 8 weeks. Patients were divided into four groups: the alpha-blocker-naive groups received silodosin (35 patients) or naftopidil (33 patients) and the drug-switching groups changed from tamsulosin to silodosin (26 patients) or naftopidil (27 patients). The outcomes parameters were the International Prostate Symptom Score, quality of life, maximum urinary flow rate and post-void residual urine volume. P < 0.05 was considered statistically significant by using the Wilcoxon signed-rank and rank-sum tests, and analysis of covariance. RESULTS: In all the groups, silodosin and naftopidil significantly improved the total International Prostate Symptom Score and quality of life. However, silodosin obtained significantly better improvement in total International Prostate Symptom Score in the alpha-blocker-naive patients at 4 and 8 weeks. The maximum urinary flow rate and residual urine did not change significantly in all the treatment groups. CONCLUSIONS: The present study confirms the clinical usefulness of silodosin in the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia.

Surgical management of the urinary tract in patients with locally advanced colorectal cancer.

OBJECTIVES: To review cases of colorectal cancer requiring urologic management to clarify the role the urologist should play in the surgical procedures. A deterrent to radical surgery for advanced colorectal carcinoma with urinary involvement is the technical complexity and associated morbidity and mortality of this procedure. METHODS: Thirty-six tumors in 35 patients, including 19 sigmoid cancers (Stage II, 17; Stage III, 2), 12 rectal cancers (Stage II, 11; Stage III, 1), and 5 local recurrences of colorectal carcinoma in the pelvis were reviewed. All tumors had invaded the bladder, prostate, or ureter. The demographic and clinical characteristics, type of operative procedure, and postoperative complications were analyzed. RESULTS: Of the patients with a sigmoid tumor, partial cystectomy was performed in 15 patients who underwent a bladder-sparing procedure; an ileal conduit and ileal neobladder were created in 2 patients each who required cystectomy. Four patients with rectal cancer underwent a bladder-sparing procedure: partial cystectomy in 1, partial cystectomy with ileal ureter in 1, and prostatectomy in 2. The remaining 8 patients underwent cystectomy with the following types of reconstruction: colonic neobladder in 1, ileal neobladder in 4, Indiana pouch in 1, ileal conduit in 1, and ureterocutaneostomy in 1 patient. The bladder was spared in a greater percentage of patients with sigmoid cancer than in those with rectal cancer. The incidence of complications was greater in patients with rectal cancer and local recurrence than in those with sigmoid tumors. The complication rate was especially low in patients who underwent a bladder-sparing procedure (10.5%) compared with patients who required cystectomy (58.3%). The survival in patients with sigmoid cancer who underwent bladder-sparing surgery also was better than in those who underwent cystectomy. CONCLUSIONS: The treatment of advanced colorectal cancer is best managed by a committed team that includes an experienced urologist. Urologists play a critical role in determining the surgical options and creating appropriate urinary diversions to achieve curative resection with the highest quality of life.