Alpha-blockers Research Articles

Clinical Activity of Selpercatinib in RET Mutant Pheochromocytoma-Case Reports

Activating RET gene alterations have been reported in solid tumors including the rare cancer, pheochromocytoma (PHEO) found sporadically and in familial multiple endocrine neoplasia type 2 (MEN2) syndromes. Selpercatinib is a highly selective and potent small molecule RET kinase inhibitor that has demonstrated marked and durable anti-tumor activity in diverse RET-altered solid tumors. Described are the initial 3 PHEO patients treated with selpercatinib (LIBRETTO-001/NCT03157128). Case 1: 70-year-old white male with MEN2A and a history of medullary thyroid cancer (MTC) and PHEO s/p thyroidectomy and adrenalectomy, received MIBG in 1991 and 2016 due to symptom reoccurrence. Progressive metastatic disease associated with severe hypertension was treated with Lutate in 2017 and germline RET mutation p.Cys634Phe was confirmed. After developing severe back pain due to a T6 vertebral metastasis, he began selpercatinib treatment. As of Mar 2020, he has a partial response (PR) as assessed by investigator; his back pain resolved, normetanephrine and metanephrine levels decreased, and has ceased alpha and beta blockers. He remains on treatment with only grade 1-2 adverse events, none requiring interruption or dose modification. Case 2: 51-year-old white female with MEN2A and history of MTC and PHEO s/p thyroidectomy and adrenalectomy in 2010. She developed metastatic PHEO in 2013, with multiple bone, omentum, lung, liver, and spleen metastases. Between 2013 and 2018 she was treated with multiple courses of radiation and, additional surgical resections; a PR with sunitinib lasted 13 months followed by temozolomide/capecitabine treatment. A bone lesion biopsy in 2018 confirmed RET C618S mutation and with her disease progression and uncontrolled bone pain, she began selpercatinib treatment, experiencing a PR. After 5.5 months in the study, she discontinued treatment due to disease progression. Case 3: 45-year-old African American female diagnosed with sporadic PHEO in 1996, s/p multiple surgical resections. She received 2 cycles of cyclophosphamide/vincristine/dacarbazine without clinical benefit. I-131-MIBG therapy with autologous stem cell rescue in 2017 improved blood pressure, palpitations, and flushing but without tumor shrinkage while abdominal pain persisted. Somatic M918T RET-mutation was confirmed, and she began selpercatinib treatment in 2018 with symptom resolution and improved plasma metanephrine levels. She required dose reduction for grade 3 palmar-plantar erthrodysesthesia and had stable disease for 22 months until a new bone metastasis was identified. Due to ongoing clinical benefit, she remains on treatment despite disease progression. Conclusion: These are the initial reports of RET-mutant PHEO patients treated with selpercatinib adding to the diversity of RET-altered tumor types that may benefit from a selective RET inhibitor.

ASSESSMENT OF WHOQOL BREF DOMAINS AND ANTIHYPERTENSIVES PRESCRIPTION PATTERN IN HEMODIALYSIS PATIENTS

Background: ESRD is considered as an important cause of mortality worldwide. Patients with CKD on Hemodialysis treatment is very complex requires additional importance in prescribing antihypertensives and also patients on Hemodialysis have effects on functional state and quality of life (QOL). Objectives: The study aimed to assess prescribing pattern of antihypertensives and to demonstrate QOL in different domains of patients with ESRD underdoing hemodialysis. Materials and Methods: Study comprised of 85 patients with ESRD under hemodialysis conducted in multi-speciality hospital between September 2019 to February 2020.The data was collected from the records and by interviewing patients. Results: The mean age of the study population was 54.76±14.32, 72% were males, hypertension is the common cause of ESRD. Calcium channel blockers are the most commonly prescribed drugs followed by alpha blockers, diuretics, beta blockers, vasodilators etc. Comparing the four domains of ESRD patients, environmental domain was the highest with a mean score of 64.56±19.86while the physical health domain was the lowest with a mean score of55.6±12.60. Conclusion: Calcium channel blockers and alpha blockers are most commonly prescribed antihypertensives. The four domains were signicantly and positively interrelated with moderate to strong relationships

Voiding Dysfunctions and Prevention after Prostate Biopsy. Prospective Observational Study

The possible side effects of transrectal ultrasonography-guided prostate biopsy (TRUS-Bx), which is one of the most common procedure of urology practice, are common but tend to limit themselves. TRUS-Bx may be associated with Lower Urinary System Symptoms (LUTS). We aimed to investigate the effects of TRUS-Bx on LUTS and the factors that decrease or increase these effects and to provide information about the exposure periods of these factors. This study is a prospective observational study involving patients undergoing prostate biopsy between August 1st, 2019 to 2020. Detailed history was obtained and physical examinations were evaluated from all patients. Patients' age, PSA levels, prostate volumes, Body-Mass-Index measurements and use of alpha blocker were recorded. The effects of recorded information of patients with prostate biopsy on LUTS and uroflowmetry parameters were investigated. A total of 143 patients were included in the study after determining the exclusion criteria. A significant correlation was found only between Qmax changes after TRUS-Bx and the use of alpha blockers. All patients, have decreased Qmax flow rate observed at postprocedure 1th day compared to baseline values. During the controls performed in the 4th week, while the decrease in patients using alpha blockers reached a significantly higher value than its baseline value, it could not return to its baseline value in patients who do not use alpha blockers. Prostate biopsy is expected to cause a temporary LUTS. The effects on this LUTS can be corrected with the use of alpha blockers.

Hong Kong Geriatrics Society and Hong Kong Urological Association consensus on personalised management of male lower urinary tract symptoms in the era of multiple co-morbidities and polypharmacy.

Lower urinary tract symptoms (LUTS) are common complaints of adult men. Benign prostatic hyperplasia (BPH) represents the most common underlying cause. As the incidence of BPH increases with age, and pharmacological treatment is a major part of the disease's management, the majority of patients with LUTS are managed by primary care practitioners. There are circumstances in which specialist care by urologists or geriatricians is required, such as failure of medical treatment, adverse effects from medical treatment, or complications from BPH. Referral choices can be confusing to patients and even practitioners in different specialties under such circumstances. There is currently no local consensus about the diagnosis, medical management, or referral mechanism of patients with BPH. A workgroup was formed by members of The Hong Kong Geriatrics Society (HKGS) and the Hong Kong Urological Association (HKUA) to review evidence for the diagnosis and medical treatment of LUTS. A consensus was reached by HKGS and HKUA on an algorithm for the flow of male LUTS care and the use of uroselective alpha blockers, antimuscarinics, beta-3 adrenoceptor agonists, and 5α-reductase inhibitors in the primary care setting. This consensus by HKGS and HKUA provides a new management paradigm of male LUTS.

Comparative effectiveness of Tamsulosin and Tadalafil therapy in ureteral stents-related symptoms (uSRS)

IntroductionLower Urinary Tract Symptoms (LUTS) can be a complication of ureteral stent insertion. Clinically, PDE5 inhibitors (Tadalafil) and alpha blockers (Tamsulosin) are the preferred drugs for treating lower urinary tract symptoms after ureteral stent insertion, also called ureteral stents-related symptoms (uSRS). This study aims to compare the effectiveness of 0.4mg/day Tamsulosin and 10mg/day Tadalafil for treating uSRS. MethodsThis study used a double-blinded experimental design. Fifty patients with uSRS were randomly assigned to one of 2 groups; group I (n=25) received 10mg/day Tadalafil, while group II (n=25) received 0.4mg/day Tamsulosin. The Ureteral Symptoms Score Questionnaire (USSQ) was administered on the 7th, 14th, 21st, and 28th day after insertion of the ureteral stent. p values of <0.05 were considered to be statistically significant. ResultsThe administration of 10mg/day Tadalafil had a good effect in reducing the LUTS score: mean scores were VS=11.03, p=4.21, GC=3.8, WA=1.29, SA=1.94, and AS=3.21. The administration of 0.4mg/day Tamsulosin also had a good effect in reducing the LUTS score: mean scores were VS=13.73, p=9.89, GC=3.85, WA=4.31, SA=0.59, and AS=4.69. ConclusionAdministration of 10mg/day Tadalafil had significantly better results compared to 0.4mg/day Tamsulosin in improving uSRS, except in VS week 2 and in GC weeks 2 and 4.

A RARE CASE OF PHEOCROMOCYTOMA IN PREGNANCY EXACERBATED BY METOCLOPRAMIDE

Objective: Pheocromocytoma (PHEO) is a rare catecholamines secreting tumor presenting with variable clinical setting, mostly with headaches, sweating, palpitation and poor controlled arterial hypertension. In 85–90% of cases, tumors are of adrenal gland origin while in 10–15% are commonly located in paravertebral sympathetic plexus. The prevalence of PHEO in hypertensive patients ranges between 0.1 and 0.6%; PHEO is extremely rare during pregnancy with a prevalence of 1 in 54000 pregnancies thus, delayed diagnose may cause life-threatening situations. Accurate identification of PHEO during the antenatal period reduces the risk of mortality for mother and fetus. Design and method: We described a case of 33 years old pregnant woman with a one-year history of grade I hypertension. Results: The patient has been previously evaluated by endocrinologist for the onset of “striae rubrae” associated with illness, muscle pain, asthenia, anxiety, palpitations and weakness; lab tests were negative for hypercortisolism thus clinicians hypothesized a “functional syndrome”. However, during the 28th week of gestation she was admitted to the emergency room because of severe headache and severe arterial hypertension. CT brain scan was negative for acute events, lab tests showed mild hypokalemia and proteinuria. An in depth revaluation of the clinical history revealed a treatment with metoclopramide taken one week earlier. Conclusions: Metoclopramide can stimulate catecholamine- and granin-derived peptide secretion from PHEO cells through activation of serotonin type 4 (5-HT4) receptors and induced PHEO crisis. Thus, under suspicion of PHEO exacerbated by metoclopramide we performed lab tests resulted positive for catecholamines secretion while aldosterone and renin levels were normal. Abdomen ultrasound and MRI showed oval lesion located in right adrenal gland confirming diagnosis of PHEO. We started treatment with alpha and beta blockers associated with calcium-antagonist; at 33th week, patient underwent a caesarean section and after seven weeks a videolaparoscopic right adrenalectomy, obtaining a normalization of blood pressure levels.

The Association Between Alpha-1 Adrenergic Receptor Antagonists and In-Hospital Mortality From COVID-19.

Effective therapies for coronavirus disease 2019 (COVID-19) are urgently needed, and pre-clinical data suggest alpha-1 adrenergic receptor antagonists (α1-AR antagonists) may be effective in reducing mortality related to hyperinflammation independent of etiology. Using a retrospective cohort design with patients in the Department of Veterans Affairs healthcare system, we use doubly robust regression and matching to estimate the association between baseline use of α1-AR antagonists and likelihood of death due to COVID-19 during hospitalization. Having an active prescription for any α1-AR antagonist (tamsulosin, silodosin, prazosin, terazosin, doxazosin, or alfuzosin) at the time of admission had a significant negative association with in-hospital mortality (relative risk reduction 18%; odds ratio 0.73; 95% CI 0.63–0.85; p ≤ 0.001) and death within 28 days of admission (relative risk reduction 17%; odds ratio 0.74; 95% CI 0.65–0.84; p ≤ 0.001). In a subset of patients on doxazosin specifically, an inhibitor of all three alpha-1 adrenergic receptors, we observed a relative risk reduction for death of 74% (odds ratio 0.23; 95% CI 0.03–0.94; p = 0.028) compared to matched controls not on any α1-AR antagonist at the time of admission. These findings suggest that use of α1-AR antagonists may reduce mortality in COVID-19, supporting the need for randomized, placebo-controlled clinical trials in patients with early symptomatic infection.

Efficacy of Alpha Blockers in Relieving Symptoms of JJ Stent

Introduction: JJ stenting has been routinely used in endourology with a wide variety of implications. These stents have beneficial effects in postoperative period improving surgical outcome. Though they are widely used in urology practice, JJ stents cause lower urinary tract symptoms (LUTS) in majority of patients. The objective of this study was to test the hypothesis that alpha blockers reduce lower urinary tract symptoms (LUTS) after rigid ureterorenoscopy in postoperative time period up to 3 weeks. Study Design: It was a randomized clinical trial (RCT). Setting: The study was conducted in KRL hospital, Islamabad. Patients presenting in outpatient / emergency department were selected for the study. Duration of Study: Six months (15th July 2016 to 15th Jan’ 2017) Methods: A prospective randomized study was conducted in total 100 patients undergoing rigid ureterorenoscopy (URS). Patients were randomized into an intervention Group A and Control Group B. In Group A tamsulosin 0.4mg was given after rigid ureterorenoscopy, while in Group B no tamsulosin was given except placebo. Primary outcome were lower urinary tract symptoms (LUTS), which were measured by international prostate symptoms score (IPSS) up to 3 weeks postoperatively. Results: The mean IPSS at 3rd week in postoperative phase of rigid URS for Group A was 4.76± 4.14315 and in Group B was 27.28 ± 5.03879 with the P value of 0.0001 which was statistically significant and also less than 0.05. So IPSS was statistically lower in Group A as compared to Group B up to 3 weeks post operatively. In conclusion, a significant statistical difference was found for Double J (DJ) stent related symptoms between the two groups. Conclusion: Alpha blockers reduce lower urinary tract symptoms (LUTS) in postoperative period of rigid ureterorenoscopy up to 3 weeks.

Is there any priority between the alpha blockers on voiding functions after transrectal ultrasound guided prostate biopsy?

Transrectal ultrasound-guided prostate biopsy is the gold standard in the diagnosis of prostate cancer. Major and minor complications may develop at varying rates after prostate biopsies, one of which is voiding impairment. This study aimed to evaluate whether all alpha1-blockers were effective in preventing voiding impairment after a transrectal ultrasound-guided prostate biopsy and if so, was one superior to the others. This study included 240 patients who underwent a transrectal ultrasound-guided 12-core prostate biopsy and were prospectively randomized. Of the patients, 40 received 10 mg alfuzosin, 40 received 4 mg doxazosin, 40 received 8 mg silodosin, 40 received 0.4 mg tamsulosin, and 40 received 5 mg terazosin beginning on the day before the biopsy and for the following 30 days. The international prostate symptom score (IPSS), maximal flow rate, and post-void residual urine were recorded in all the patients before the procedure and on post-biopsy days 7 and 30. All he patients were followed up and questioned about voiding difficulty and acute urinary retention after the procedure. In all the alpha1-blocker groups, the IPSS and post-void residuals were statistically significantly lower, and the maximal flow rate was statistically significantly greater on post-biopsy days 7 and 30 compared with the baseline values (p<0.05). No patient in any of the alpha1-blocker groups developed acute urinary retention after the biopsy. To prevent voiding impairment and deterioration in the quality of life after a prostate biopsy, preemptive therapy with alpha1-blockers may have a protective role, especially in patients with large prostate volumes.

Identification of novel therapeutic targets for contrast induced acute kidney injury (CI-AKI): alpha blockers as a therapeutic strategy for CI-AKI

Iodinated contrast is used for imaging and invasive procedures and it can cause contrast induced acute kidney injury (CI-AKI), which is the third leading hospital-acquired health problem. The purpose of the present study was to determine the effect of α-adrenergic receptor-1b (Adra1b) inhibition by using terazosin on change in kidney function, gene, and protein expression in C57BL/6J male mice, 6-8 weeks with chronic kidney disease (CKD). CKD was induced by surgical nephrectomy. Twenty eight days later, 100-µL of iodinated contrast (CI group) or saline (S group) was given via the carotid artery. Whole-transcriptome RNA-sequencing (RNA-Seq) analysis of the kidneys was performed at day 2. Mice received either 50-µL of saline ip or terazosin (2 mg/kg) in 50-µL of saline ip 1 hour before contrast administration which was continued every 12 hours until the animals were euthanized 2 and 7 days later. The kidneys were removed for gene expression, immunohistochemical analysis, and blood serum analyzed for kidney function. Differential gene expression analysis identified 21 upregulated and 436 downregulated genes (fold change >2; P < 0.05) that were common to all sample (n = 3 for both contrast and saline). We identified Adra1b using bioinformatic analysis. Mice treated with terazosin had a significant decrease in serum creatinine, urinary Kim-1 levels, HIF-1α, apoptosis, and downstream Adrab1 genes including Ece1, Edn1, pMAPK14 with increased cell proliferation. Contrast exposure upregulated Adra1b gene expression in HK-2 cells. Inhibition of Adra1b with terazosin abrogated Ece1, Edn1, and contrast-induced Fsp-1, Mmp-2, Mmp-9 expression, and caspase-3/7 activity in HK-2 cells.

Associations in corticocapsular adhesions.

To determine the patient-related factors that contribute to intraoperative corticocapsular adhesions (CCA) during phacoemulsification cataract extraction (PCE). Prospective, single surgeon, multi-year study of consecutive patients undergoing PCE was performed. At the conclusion of each procedure, the surgeon recorded the CCA and perceived surgeon stress score. Patient variables included gender, age, diabetes mellitus, intake of oral alpha blockers, floppy iris, laterality, pseudo-exfoliation, and intraocular lens power. During the 10-year study, 1097 eyes underwent surgery and CCA was diagnosed intraoperatively in 41 eyes. On multi-variable analysis, the following patient characteristics were associated with intraoperative CCA: diabetes mellitus (p = 0.002), age >80 years (p = 0.002), presence of posterior capsular cataract (p = 0.046), severe nuclear sclerosis (p = 0.004), and absence of pseudo-exfoliation (p = 0.043). Diabetes mellitus, advanced age and posterior subcapsular cataract are associated with CCA necessitating generous repetitive hydrodissection.

EVALUATION OF EFFICACY OF SILODOSIN VERSUS SILODOSIN WITH DEFLAZACORT IN EXPULSION OF LOWER URETERIC CALCULI

Objectives: To compare the efcacy of silodosin versus silodosin with deazacort in expulsion of lower end ureteric calculi, in terms of episodes of pain,stone expulsion rate,stone expulsion time ,analgesic requirements and side effects Introduction: Ureteric calculi represent 20% of urinary stones. Ureteroscopy and Shock wave lithotripsy proven the method of treatments for lower ureteric stones; however, they are expensive and not risk free. Aconservative approach is becoming more popular as a result of advances in pharmacological therapy which reduces the symptoms and helps in stone expulsion. We performed a randomized controlled prospective study to evaluate the efcacy of Deazacort in combination with alpha blocker silodosin in medical management of symptomatic lower Ureteric stones of ≤8 mm size. Material and methods: A prospective randomised controlled study was conducted on 60 patients, age ≥ 18 , who had unilateral lower ureteric stone of ≤ 8 mm. Patients were divided into three groups. Group 1 received silodosin 8 mg for 14 days,Group 2 received silodosin 8 mg plus deazacort 30mg daily for 14 days and Group 3 (control) received diclofenac potassium (75 mg ) when required. The patients were followed-up by ultrasonography ,plain radiograph KUB and computed tomography (in some cases). Results: There was a higher stone expulsion rate of 95% in Group 2 as compared to Group 1(85%) and Group 3(35%) . Group 2 showed a signicant advantage for stone expulsion time ,decreased pain episodes and analgesic use. Two patients, one in group 1 and group 2, reported retrograde ejaculation. Conclusion: The results showed that silodosin with deazacort , increases the stone expulsion rate, decrease the stone expulsion time, decreases the mean number of pain episodes and decreases the mean analgesic dosage requirement. But larger study is required to establish its efcacy for expulsion rate which will be statistically signicant.

Low dose targeted alpha blockers for refractory bladder symptoms in children: a single centre experience

Low dose targeted alpha blockers for refractory bladder symptoms in children: a single centre experience

Defining the disease course of TNFα blockers-associated Multiple Sclerosis

Tumour Necrosis Factor alpha (TNFα) blockers are common and effective treatments for several autoimmune diseases but can be associated with neuroinflammatory events. We describe the disease course of ten patients who developed CNS demyelinating events while exposed to TNFα blockers. We divided them into two groups: eight patients with Relapsing Multiple Sclerosis and two isolated optic neuritis. In our cohort, TNFα blockers-associated Multiple Sclerosis does not seem to be associated with a more aggressive course and can be managed with MS-specific DMTs, chosen considering the clinical course and the concomitant autoimmune disease. Our findings need confirmation in larger cohorts to further characterize the disease course of TNFα blockers-associated Multiple Sclerosis.

2-Pentadecyl-2-oxazoline ameliorates memory impairment and depression-like behaviour in neuropathic mice: possible role of adrenergic alpha2- and H3 histamine autoreceptors

Neuropathic pain (NP) remains an untreatable disease due to the complex pathophysiology that involves the whole pain neuraxis including the forebrain. Sensory dysfunctions such as allodynia and hyperalgesia are only part of the symptoms associated with neuropathic pain that extend to memory and affectivity deficits. The development of multi-target molecules might be a promising therapeutic strategy against the symptoms associated with NP. 2-pentadecyl-2-oxazoline (PEA-OXA) is a plant-derived agent, which has shown effectiveness against chronic pain and associated neuropsychiatric disorders. The molecular mechanisms by which PEA-OXA exerts its effects are, however, only partially known. In the current study, we show that PEA-OXA, besides being an alpha2 adrenergic receptor antagonist, also acts as a modulator at histamine H3 receptors, and report data on its effects on sensory, affective and cognitive symptoms associated with the spared nerve injury (SNI) model of neuropathic pain in mice. Treatment for 14 days with PEA-OXA after the onset of the symptoms associated with neuropathic pain resulted in the following effects: (i) allodynia was decreased; (ii) affective/cognitive impairment associated with SNI (depression, spatial, and working memories) was counteracted; (iii) long-term potentiation in vivo in the lateral entorhinal cortex-dentate gyrus (perforant pathway, LPP) was ameliorated, (iv) hippocampal glutamate, GABA, histamine, norepinephrine and dopamine altered levels after peripheral nerve injury were reversed, (v) expression level of the TH positive neurons in the Locus Coeruleus were normalized. Thus, a 16-day treatment with PEA-OXA alleviates the sensory, emotional, cognitive, electrophysiological and neurochemical alterations associated with SNI-induced neuropathic pain.

Noradrenergic activation induced by yohimbine decreases interoceptive accuracy in healthy individuals with childhood adversity.

Acute stress affects interoception, but it remains unclear if this is due to activation of the sympatho-adreno-medullary (SAM) or hypothalamic-pituitary-adrenocortical axis. This study aimed to investigate the effect of SAM axis activation on interoceptive accuracy (IAcc). Central alpha2-adrenergic receptors represent a negative feedback mechanism of the SAM axis. Major depressive disorder and adverse childhood experiences (ACE) are associated with alterations in the biological stress systems, including central alpha2-adrenergic receptors. Here, healthy individuals with and without ACE as well as depressive patients with and without ACE (n = 114; all without antidepressant medication) were tested after yohimbine (alpha2-adrenergic antagonist) and placebo. We assessed IAcc and sensibility in a heartbeat counting task. Increases in systolic and diastolic blood pressure after yohimbine confirmed successful SAM axis activation. IAcc decreased after yohimbine only in the healthy group with ACE, but remained unchanged in all other groups (Group × Drug interaction). This effect may be due to selective upregulation of alpha2-adrenergic receptors after childhood trauma, which reduces capacity for attention focus on heartbeats. The sympathetic neural pathway including alpha2-adrenergic circuitries may be essential for mediating interoceptive signal transmission. Suppressed processing of physical sensations in stressful situations may represent an adaptive response in healthy individuals who experienced ACE.

ASSESSMENT OF COMPARATIVE PATIENT SATISFACTION AND SIDE-EFFECTS ASSOCIATED WITH TAMSULOSIN VERSUS SILODOSIN THERAPY IN BENIGN PROSTATE HYPERPLASIA

Objective: The aim of our study was to assess the comparative patient satisfaction and side-effects of the currently prescribed drugs – tamsulosin and silodosin for benign prostatic hyperplasia (BPH).&#x0D; Methods: A prospective study was conducted in a total of 110 BPH patients from the Department of Urology for a period of 6 months. Fifty-five patients in each group received silodosin 8 mg or tamsulosin 0.4 mg once daily. Data were collected using a suitably designed pro forma and the patient satisfaction was assessed with patient’s perception of study medication (PPSM) scale. International prostate symptom score (IPSS) was used for assessing the severity of symptoms.&#x0D; Results: The current study found that the treatment had a significant effect on improving scores of PPSM and IPSS at which all changes were significant at p&lt;0.01 (paired t-test). An independent t-test showed that silodosin group had a greater improvement in PPSM scores – PPSM total by 40.4%, PPSM global by 43.7%, and PPSM pain by 0.39% which was supported by corresponding decline in IPSS scores. The side effects reported for tamsulosin were headache (5.5%), dizziness (5.5%), dry mouth (3.6%), and postural hypotension (14.4%) and those reported for silodosin were myalgia (5.5%), dizziness (7.3%), diarrhea (1.8%), and postural hypotension (10.9%).&#x0D; Conclusion: Patient satisfaction was improved by both the alpha blockers but silodosin showed a significantly greater increase in patient satisfaction than tamsulosin. Thus, silodosin is the better drug of choice.

Efficacy of Alpha Blockers in Relieving Symptoms of JJ Stent

Introduction: JJ stenting has been routinely used in endourology with a wide variety of implications. These stents have beneficial effects in postoperative period improving surgical outcome. Though they are widely used in urology practice, JJ stents cause lower urinary tract symptoms (LUTS) in majority of patients.

Efficacy of Alpha Blockers in Relieving Symptoms of JJ Stent

Introduction: JJ stenting has been routinely used in endourology with a wide variety of implications. These stents have beneficial effects in postoperative period improving surgical outcome. Though they are widely used in urology practice, JJ stents cause lower urinary tract symptoms (LUTS) in majority of patients.

Effect of the symptom-based alpha-blocker treatment on lower urinary tract symptoms in women: systematic review and meta-analysis.

Aims:The aim of this study was to evaluate the effects of alpha blockers in women with lower urinary tract symptoms.Methods:We conducted systematic review and meta-analysis on published a priori protocols. We searched multiple data sources for published and unpublished randomized controlled trials in any language. Primary outcomes included urologic symptom scores, quality of life, and overall adverse events. We performed meta-analysis using RevMan 5.3 and rated the certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluation.Results:Alpha blockers likely reduced urological symptom score (mean difference: −1.50, 95% confidence interval: −2.91 to −0.09; moderate certainty of evidence). Alpha blockers may improve quality of life (standardized mean difference: −0.35, 95% confidence interval: −0.85 to 0.15; low certainty of evidence) and have little to no difference in overall adverse events (risk ratio: 1.09, 95% confidence interval: 0.55 to 2.15; low certainty of evidence). Based on five studies comparing combination therapy with alpha blockers and anticholinergics to anticholinergic monotherapy, combination therapy likely results in little to no difference in urological symptom score (mean difference: −0.35, 95% confidence interval: −1.98 to 1.27; moderate certainty of evidence) and quality of life (mean difference: −0.11, 95% confidence interval: −0.48 to 0.27; moderate certainty of evidence). We are very uncertain about the effect of combination therapy on overall adverse events (risk ratio: 1.07, 95% confidence interval: 0.40 to 2.84; very low certainty of evidence).Conclusion:Alpha blocker monotherapy for the women with lower urinary tract symptoms regardless of the underlying cause likely has satisfactory efficacy compared with placebo. However, combination therapy with anticholinergics likely has no additional effect on urologic symptom score and quality of life compared with anticholinergic monotherapy.