Combination Of Alpha-blockers Research Articles

STUDY ON EVALUATION OF MEDICATION USE PATTERNS IN THE MANAGEMENT OF URETERAL STENT DISCOMFORT

Background: The insertion of double -j stents is considered as a routine and common Urological procedure. It can cause stent related discomfort, which affect nearly 80% of patients with indwelling ureteral symptoms, pharmacological management is one of the main trails that were done to reduce ureteral stent discomfort. This study aimed to evaluate the drug utilization patterns in management of ureteral stent discomfort. Methods: This prospective, observational study was conducted in the Department of Urology. 54 patients were enrolled into the study who underwent ureteral stent positioning, and evaluated the prescription patterns and by administration of validated USSQ for assessment of stent related symptoms. Results: 54 prescription patterns were evaluated and among them 39 are receiving Tamsulosin and 15 are receiving Tamsulosin + Tolterodine. During the follow up the USSQ scores were significantly low after the drug administration. The USSQ scores of Tamsulosin when compared with Tamsulosin in combination with tolterodine, there was significantly more improvement in the reduction of stent discomfort during the combination therapy. Conclusion: Alpha blockers (Tamsulosin), in patients with indwelling stents reduces the stent related symptoms. Combination of alpha blockers (Tamsulosin) and anticholinergics (Tolterodine) seems to have a better efficacy in improving the ureteral stent discomfort. KEY-WORDS: Ultrasonography, Ureteroscopy, Ureteroscopic lithotripsy, Ureteral stent symptom questionnaire (USSQ)

Korean guideline of desmopressin for the treatment of nocturia in men.

PurposeNocturia is the most bothersome of lower urinary tract symptoms in men. Desmopressin, a synthetic analog of the human hormone vasopressin, has been used for the treatment of nocturia. However, the guidelines include varying recommendations for the use of desmopressin for the management of nocturia in men. Therefore, the Korean Urological Association (KUA) developed recommendations for desmopressin for the treatment of nocturia in men.Materials and MethodsA rigorous systematic review was performed and Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to rate the certainty of evidence for patient outcomes and to develop the evidence into recommendations. The steering group, guidelines development group, systematic review team, and external review group consisted of members of the Korean Continence Society, Korean Society of Geriatric Urological Care, and KUA, respectively, who were involved in the guidelines development process.ResultsThe guidelines address the benefits, harms, patients’ values and preferences, costs, and resources related to desmopressin by using a single clinical question: What is the effectiveness of desmopressin compared to that of placebo, behavior modification, or other pharmacological therapies?ConclusionsThe guidelines development panel suggests desmopressin for men with nocturia instead of placebo, behavior modification, or alpha-blocker monotherapy (low certainty of evidence, weak recommendation). Additionally, the panel suggests desmopressin combination therapy with alpha-blockers for men with nocturia instead of alpha-blocker monotherapy or alpha-blocker combination therapy with anticholinergic agents (low certainty of evidence, weak recommendation).

Comparison of alpha-blockers and antimuscarinic for the treatment of double-J stent-related lower urinary tract symptoms.

Background: Double-J stent is well known for relieving urinary tract obstruction, but still, some patients might develop double-J stent-related urinary tract infection (UTI), lower urinary tract symptoms (LUTS), lower abdominal pain, and hematuria. This study aims to compare alpha-blockers and antimuscarinics for the treatment of double-j stent-related lower urinary tract symptoms.
 Methodology: Patients planned for double-J stent insertion undergoing the urological procedure for ureteric stones were recruited and randomly allocated into two groups. One group was labeled as the tamsulosin (T), and the other was labeled as the solifenacin succinate (S) group. Group" T" patients were prescribed tamsulosin 0.4 mg once at bedtime and solifenacin succinate 10mg once daily to group "S" for 2 weeks. Improvement in symptoms was checked by means of international prostate symptom score (IPSS)/ quality of life (QoL) score charts for LUTS in the out-patient clinic at baseline and at follow-up. 
 Results: When comparing the absolute changes in IPSS/QoL for LUTS scores, both groups showed significant improvement in double-J stent-related lower urinary symptoms, body pain, generalized body weakness, and sexual function, which affect their quality of life (QoL). The mean index score of all domains in both groups was significantly less (p<0.001). Tamsulosin and solifenacin succinate (S) group was found equally efficacious on urinary symptoms (26.01 ± 5.65 (pre); 5.74 ± 0.99 (post) vs. 26.61 ± 5.7 (pre); 26.01 ± 0.97 (post), (p≤0.001). Similarly, the score of QoI was also found equally efficacious in both groups in pre and post-insertion on two weeks (4.96 ± 0.7 (pre); 81.58 ± 0.64 (post) vs. 4.99 ± 0.81 (pre); 1.45 ± 0.5 (post) (p<0.001).
 Conclusion: On the basis of results, it is said that a combination of alpha-blockers and antimuscarinic agents has shown significant improvement to reduce double-J stent-related lower urinary symptoms, pain, and quality of life than a single drug alone.

Using artificial intelligence to identify anti-hypertensives as possible disease modifying agents in Parkinson's disease.

Drug repurposing is an effective means of increasing treatment options for diseases, however identifying candidate molecules for the indication of interest from the thousands of approved drugs is challenging. We have performed a computational analysis of published literature to rank existing drugs according to predicted ability to reduce alpha synuclein (aSyn) oligomerization and analyzed real-world data to investigate the association between exposure to highly ranked drugs and PD. Using IBM Watson for Drug Discoveryâ (WDD) we identified several antihypertensive drugs that may reduce aSyn oligomerization. Using IBM MarketScanâ Research Databases we constructed a cohort of individuals with incident hypertension. We conducted univariate and multivariate Cox proportional hazard analyses (HR) with exposure as a time-dependent covariate. Diuretics were used as the referent group. Age at hypertension diagnosis, sex, and several comorbidities were included in multivariate analyses. Multivariate results revealed inverse associations for time to PD diagnosis with exposure to the combination of the combination of angiotensin receptor II blockers (ARBs) and dihydropyridine calcium channel blockers (DHP-CCB) (HR = 0.55, p < 0.01) and angiotensin converting enzyme inhibitors (ACEi) and diuretics (HR = 0.60, p-value <0.01). Increased risk was observed with exposure to alpha-blockers alone (HR = 1.81, p < 0.001) and the combination of alpha-blockers and CCB (HR = 3.17, p < 0.05). We present evidence that a computational approach can efficiently identify leads for disease-modifying drugs. We have identified the combination of ARBs and DHP-CCBs as of particular interest in PD.

COMPARATIVE STUDY BETWEEN -BLOCKERS AND COMBINATION OF -BLOCKERS AND PHOSPHODIESTRASE 5- INHIBITORS IN TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

Background: Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting middle-aged men. This condition can be symptomatic or asymptomatic. Up to 15-25% of men aged 50-65 years have lower urinary tract symptoms (LUTS). Aim of the Work: To compare between the effect of alpha blocker (Tamsulosin 0.4 mg once at night) and a combination of alpha blockers (Tamsulosin 0.4 mg once at morning) and PDE5 inhibitors (Sildenafil 25 mg at night) in treatment of benign prostatic hyperplasia patients through evaluation of IPSS and post-voiding residual urine and uroflometry before and after treatment. Patients and Methods: This was a prospective study done on 30 patients fulfilling inclusion criteria at Eldemerdash hospital between 1-9-2017 till 1-9-2018 and this study has two phases: Phase (1): included 30 patients complaining of LUTS 2ry to BPH assessed by uroflowmetry and IPSS and post voiding residual urine.Before taking any drugs and after treatment by alpha blocker (tamsulosin 0.4mg capsule once daily at night) for 3 months. Phase (2): included the same 30 patients after treatment by phase (2) of alpha blocker (Tamsulosin 0.4 capsule once daily in the morning) and PDEI (sildenafil 25mg once daily in the night) for 3 months. These patient also assessed by IPSS, uroflowmetry and PVR urine. Results: The results of this study showed that there was a significant improvement after phase 1 treatment in IPSS, also there was a significant improvement after phase 2 more than phase 1. The PVRU and Q max was significantly improve after phase 1 but the change after phase 2 was insignificant. Conclusion: Sildenafil citrate in combination with tamsulosin improved LUTS more than tamsulosin monotherapy with the merit of a comparable safety profile in patients with LUTS/BPH.

PUK13 FEXAPOTIDE TRIFLUTATE VERSUS PHARMACOTHERAPY AS INITIAL THERAPY FOR PATIENTS WITH MODERATE-TO-SEVERE BENIGN PROSTATE HYPERPLASIA: A COST-EFFECTIVENESS ANALYSIS

To assess the price range in which fexapotide triflutate (FT), a novel injectable, is cost-effective relative to current oral medications (5alpha-reductase inhibitor, alpha-blocker, 5alpha-reductase inhibitor and alpha-blocker combination therapy) as initial therapy followed by delayed surgery for patients with moderate-to-severe benign prostate hyperplasia with lower urinary tract symptoms (BPH-LUTS). A microsimulation decision-analytic model was developed to model the progression of BPH-LUTS and to project the costs and quality-adjusted life years (QALY) of the target population. The cost-effectiveness analysis was performed from a societal perspective with a time horizon of 4 years using 2019 US dollars for all costs. The microsimulation model considered treatment patterns associated with nonadherence to oral medication and progression to surgery. Model parameters were estimated from literature and expert opinion. Simulations are performed with 1000 patients per run for 1000 iterations for each initial treatment option. Among oral medications, alpha-blockers are the most cost-effective option; using a willingness-to-pay (WTP) threshold of $150,000 per QALY, the net monetary benefit (NMB) is $520,081. Relative to alpha-blockers, FT slightly increased QALYs per patient (3.55 vs. 3.47 QALYs). At price per injection of $13,000, FT is about as cost-effective as alpha-blockers with NMB $519,991; the difference in NMB between FT at this price and alpha-blockers is $6.0 (95% uncertainty interval -$248.6 to $260.5). One-way sensitivity analysis showed this result is most sensitive to costs of alpha-blockers and FT and disutility of BPH-LUTS. At price per injections of $5,000, $10,000 and $15,000, the probability that FT is either cost-effective or dominant compared to alpha-blockers using a WTP threshold of $150,000 per QALY is 98.4%, 75.1% and 32.4%, respectively. Comparing to the most cost-effective oral medication option (alpha-blockers), FT would be cost-effective at a price per injection below $13,000 assuming a willingness-to-pay threshold of $150,000 per QALY.

Combination Alpha Blocker and Phosphodiesterase 5 Inhibitor Versus Alpha-Blocker Monotherapy for Lower Urinary Tract Symptoms Associated with Benign Prostate Hyperplasia

Purpose: The prevalence of erectile dysfunction (ED) is higher in patients with lower urinary tract symptoms (LUTS). Phosphodiesterase 5 inhibitors (PDE5is) can improve both ED and LUTS and therefore is useful for these patients. Our aim of this study is to evaluate whether combination therapy of alpha blockers and PDE5i is more effective than alpha-blockers monotherapy for the treatment of LUTS. Materials and Methods: A systematic review and meta-analysis were undertaken to assess the difference between the combination therapy and alpha-blockers monotherapy by searching published randomized controlled trials from electronic databases PubMed, Embase, and the Cochrane Library up to April 2018. Results: A total of 13 randomized controlled studies with 1173 patients were included in our meta-analysis. Compared with alpha-blocker monotherapy, the combination therapy obtained a significantly better improvement in International Prostate Symptom Score (IPSS) (1.73, 95% confidence interval [CI]: 1.1–2.35), voiding subscore (0.99, 95% CI: 0.54–1.44), storage subscore (0.57, 95% CI: 0.03–1.1), peak flow rate (0.69 cc/s, 95% CI: 0.27–1.1), and erectile function (EF) symptom score. Meta-regression showed that baseline IPSS, baseline peak flow rate, baseline prostate volume, age, baseline EF symptom score, and dosage of PDE5is were not associated with the difference in IPSS improvement. Conclusion: A combination of alpha blockers and PDE5is has better therapeutic effects than alpha-blocker monotherapy on LUTS related to benign prostate hyperplasia.

PT238 - Combination of alpha blocker and phosphodiesterase 5 inhibitors versus alpha blocker monotherapy for lower urinary tract symptoms associated with benign prostate hyperplasia: A systematic review and meta-analysis

PT238 - Combination of alpha blocker and phosphodiesterase 5 inhibitors versus alpha blocker monotherapy for lower urinary tract symptoms associated with benign prostate hyperplasia: A systematic review and meta-analysis

PT239 - Is the combination of alpha-blocker and phosphodiesterase-5 inhibitor better in improving the lower urinary tract symptoms and erectile dysfunction in comparison to monotherapy? A systematic review and meta-analysis

PT239 - Is the combination of alpha-blocker and phosphodiesterase-5 inhibitor better in improving the lower urinary tract symptoms and erectile dysfunction in comparison to monotherapy? A systematic review and meta-analysis

Prospective Randomized Controlled Study Evaluating Efficacy of Alpha-Blockers, Antimuscarinics or Combination Therapy in Relieving Ureteral Stent-Related Symptoms

AbstractBackground: Double-J ureteral stent placement is a routine urologic procedure after most of urological interventions. Great efforts are being done to decrease stent symptoms including; improving stent materials, physical properties, and design. Also the application of a combination of alpha-blockers and antimuscarinics are used in our study.Aim of Study: We evaluated the effectiveness and safety of tamsulosin, solifenacin, and combination of both in reducing double-J stent-related lower urinary symptoms.Patients and Methods: A total of 120 patients with double-J ureteral stenting were randomly divided, post-operatively, into 4 groups. In Group A (n=30), tamsulosin 0.4mg was given, Group B (n=30) received solifenacin 10mg daily, Group C (n=30) received solifenacin 10mg and tamsulosin 0.4mg daily, and Group D (n=30) received placebo (control group). Two weeks after discharge was the first time of evaluation (pre-treatment assessment), using an arabic validated version of USSQ. The second visit was after 4 weeks from surgery just before stent removal (post-treatment assessment).Results: There were statistical significance in urinary symptoms, pain, general health and work performance scores in favour of Group III as compared to the tamsulosin group, the solifenacin group, and the control group (p-value <0.001).Conclusion: Combined therapy of tamsulosin and solif-enacin significantly alleviated symptoms associated with double-J stents as compared to either medication alone.

Comparison of Characteristics of Benign Prostatic Hyperplasia (BPH) Patients Treated with Finasteride and Alpha Blocker Combination Therapy Versus Alpha Blocker Monotherapy in China: An Analysis of Electronic Medical Record Data.

Benign prostatic hyperplasia (BPH) is commonly treated with 5-alpha-reductase inhibitor/alpha blocker combination therapy or with alpha blocker monotherapy. However, in China, the characteristics of BPH patients receiving 5-alpha-reductase inhibitor/alpha blocker combination therapy or alpha blocker monotherapy remain largely unknown. Therefore, this study compared the characteristics of BPH patients receiving either the 5-alpha-reductase inhibitor finasteride in combination with an alpha blocker or an alpha blocker as monotherapy in clinical practice in China. Data were obtained from a large electronic medical record database from four tertiary hospitals in major cities in China (2009-2016). BPH patients aged ≥ 50years with ≥ 1 alpha blocker fill on/after the first BPH diagnosis were selected. Patients were further classified as receiving combination therapy (≥ 1 overlapping day of supply for finasteride and an alpha blocker) or alpha blocker monotherapy (did not receive any 5-alpha-reductase inhibitor). Patient characteristics, visit type (in- vs. outpatient) at treatment initiation, and comorbidities were evaluated during the 6-month baseline period and compared between the two groups using two sample t tests and chi-square tests/Fisher's exact tests. A total of 2666 and 2738 patients received combination therapy and monotherapy, respectively. The combination group was older (70.3 vs. 67.3years, p < 0.0001) and had more patients initiated in an inpatient setting (46.0% vs. 26.4%, p < 0.0001). Compared with the monotherapy group, the combination group had more comorbidities, such as hypertension (48.3% vs. 35.6%, p < 0.0001), cardiovascular disease (65.3% vs. 48.0%, p < 0.0001), and diabetes (21.1% vs. 15.7%, p < 0.0001), and a higher Charlson comorbidity index (0.9 vs. 0.7, p < 0.0001). Chinese BPH patients using finasteride/alpha blocker combination therapy were older and had a higher comorbidity burden than those using alpha blocker monotherapy. These findings provide Chinese healthcare decision-makers with a better understanding of the patient characteristics generally associated with BPH combination therapy vs. alpha blocker monotherapy. Merck Sharp and Dohme (China) Co., Ltd., Shanghai, China.

Urinary manifestations in Isaacs's syndrome. Our experience in 8 cases.

Isaacs's syndrome (IS), is a rare neurological disorder, characterized by sustained muscular activity, fasciculations, cramps, myokymia, excessive sweating, and occasional elevation of creatine phosphokinase (CPK) enzyme. To report our experience in patients with IS and urinary manifestations, describing clinical findings, test's results, and response to treatment. Methods An observational, retrospective analysis of patients with IS and urinary manifestations treated at German Hospital of Buenos Aires between 2001 and 2011 was done. Diagnosis was performed with clinical examination and electromyography (EMG) of external sphincter of the anus and/or urethra. Demographic, clinical, and treatment variables were analyzed. International Prognostic Scoring System (IPSS) at diagnosis and follow up was made. Eleven IS patients were recruited, of whom 8 (72.72%) were females with a mean age 47.87 years (DS ± 13.95) and presented associated lower tract urinary symptoms (LUTS). Six of them (75%) had voiding and 2 (25%) filling symptoms. Urodynamic and electromyographic findings reproduced symptomatology in all patients. Patients with voiding symptomatology were treated with combination of alpha-blockers with benzodiazepines; membrane stabilizings agents; antiepileptics; neurotropic; corticoids; posterior tibial nerve stimulation and botulinum toxin, achieving improvement in 4/6. The two patients with storage symptoms were treated in first instance with anticholinergic drugs, one of which did not respond completely was added oral pentosansulfate and electrical stimulation, reversing the symptomatology. Four patients had associated pathologies: Hashimoto's thyroiditis; Sjögren's syndrome; dysautonomia, and myasthenia gravis. In our experience, IS urinary manifestations are common and usually has a good evolution with adequate treatment for each patient.

Conduite à tenir en cas d’association d’un alpha-bloquant et d’un inhibiteur puissant du cytochrome 3A4

Combination of alpha-blockers with potent CYP3A4 inhibitors is either contra-indicated or not recommended. We searched data supporting this classification and guiding prescribers when such an interaction occurs. We analyzed reports published by the French agency for drug safety, reference books and performed search in databases of pharmacokinetics studies and case or case series related with these interactions. The classification of the potential severity of these interactions defined by the French agency for drug safety evolved over time. Our literature search did not identify any cases or case series reporting serious clinical consequences of such interactions and no pharmacoepidemiological studies on the association between alpha-blockers and inhibitors of CYP3A4. The content of the summaries of product characteristics indicate that the combination of ketoconazole with alfuzosin, silodosin and tamsulosin increases the area under the curve of the alpha-blocker 3 fold. Data demonstrating the clinical consequences of an association between alpha-blocker and a potent CYP3A4 inhibitor are lacking. The 3 fold increase of the area under the curve for alfuzosin, silodosin and tamsulosin associated with ketoconazole while the association with the two first is contra-indicated and is not recommended with the third raises questions. This lack of data leaves doctors and pharmacists in a situation of uncertainty on how to proceed when such an interaction occurs.

Pharmacological treatment of benign prostatic hyperplasia

The pharmacological treatment of benign prostatic hyperplasia (BPH) is indicated when men suffer from lower urinary tract symptoms (LUTS) but there are no absolute indications for prostate surgery or severe bladder outlet obstruction. Phytotherapy can be used in men with mild to moderate LUTS and alpha-blockers can quickly and effectively decrease the LUTS and symptomatic disease progression. Phosphodiesterase type 5 inhibitors (PDE5-I) are an alternative to alpha-blockers when men experience bothersome side effects from alpha-blockers or erectile dysfunction. If patients predominantly have bladder storage symptoms and a small prostate, muscarinic receptor antagonists are a viable treatment option. The combination of alpha-blocker plus muscarinic receptor antagonist is more efficacious in reducing LUTS than the single drugs alone. The 5 alpha-reductase inhibitors (5ARI) can significantly decrease LUTS and disease progression (e.g. acute urinary retention and need for prostate surgery) in men with larger prostates (> 30-40ml). The combination of 5ARI plus alpha-blocker can reduce LUTS and disease progression more effectively than drug monotherapy. Combination therapy with PDE5-I (tadalafil) plus 5ARI (finasteride) reduces LUTS more substantially than 5ARI alone and, additionally, PDE5-Is reduce the sexual side effects during 5ARI treatment.

MP20-11 URINARY STONE CHEMICAL ANALYSIS VS. INFRARED SPECTROSCOPY: A MICRO-CT ASSISTED COMPARATIVE BI-CENTER STUDY

RESULTS: At day seven, the voiding, storage symptoms scores and IPSS were significantly lower in group A, B and C in comparison to group D (control group) (p<0.05). In group C the improvement in the symptoms was significantly better than in group A (tamsulosin group) or B alone (tolterodine group) (p<0.05). At day 14, the voiding symptoms and IPSS were significantly lower in group A, B, C (combined tamsulosin and tolterodine group) than control group D. the improvement was better in combined tamsulosin and tolterodine group. CONCLUSIONS: The Combination of alpha blocker (tamsulosin) and anticholinergic (tolterodine) has better effect in improving the lower urinary tract symptoms associated with double J ureteral stent placement after ureteroscopy.

Clinical outcome in male patients with detrusor overactivity with impaired contractility.

PurposeTo review the clinical outcomes of patients with voiding dysfunction who have detrusor overactivity with impaired contractility (DOIC) diagnosed with urodynamic studies.MethodsUrodynamic reports from 2005 to 2009 were reviewed, and 54 male patients had findings consistent with DOIC. Patients with acontractile or neuropathic bladders were excluded. Clinical outcomes were obtained from patient records.ResultsOf 54 men, 8 presented with voiding symptoms, 17 had storage symptoms, and 29 had mixed symptoms. Twenty-two had a previous transurethral resection of the prostate. The median follow-up was 12 months. Four patients received no intervention. Two patients were taught intermittent self-catheterization. Five patients underwent surgery to reduce outlet resistance and all reported improvement. Forty-three patients were started on pharmacotherapy; symptomatic improvement was reported by 9 of 16 patients commenced on anticholinergics alone, 6 of 16 on alpha-blockers alone, and 4 of 5 treated with a combination of alpha-blockers and anticholinergics. Eleven patients experienced no difference on pharmacotherapy and 2 reported deterioration. One patient developed acute urinary retention (18 months after commencing treatment with alpha-blockers). No patient had urosepsis.ConclusionsAnticholinergics and alpha-blockers appear to be safe in patients with DOIC. The risk of urinary retention and sepsis is low. The majority of patients report symptomatic benefit from either drugs or surgical treatment.

İşeme ve Depolama Semptomları Olan Erkeklerde Trospium Klorid Eklenmesinin Rolü

Objective: In patients who suffer from Lower Urinary Tract Symptom (LUTS) and overactive bladder (OAB), the quality of life is affected negatively. The aim of this study was to assess the efficacy and safety of trospium chloride, which is here used for the first time in an alpha-blocker and anticholinergic combination therapy for older men who suffer from benign prostate hypertrophy (BPH)-related LUTS with OAB. Material and Methods: This prospective, randomized, placebo controlled, double-blind trial included men aged ?45 years with LUTS and OAB. Subjects were randomized into trospium chloride 45 mg with terazosin 5 mg or placebo with terazosin 5mg for 12 weeks. At baseline and week 12, subjects were evaluated using total prostate serum antigen, uroflowmetry, and post voiding residual urine (PVRU) and completed the International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire (OAB-q), 3-day bladder diaries, BPH impact index, and Urolife quality of life questionnaire form. The patients were monitored for side effects and safety at 4, 8 and 12 weeks. Results: While the improvement in maximum and average urination streams, PVRU, bladder capacity, IPSS, OAB, BPH impact index scores was not significant, ther was significant improvement in Urolife quality of life questionnaire score and voiding frequency in favour of the trospium chloride group (0.0009 and 0.0216 respectively). There was no statistically significant difference in side effect profile between the groups. Conclusion: In men with BPH-related OAB trospium chloride and alpha-blocker combination treatment is effective and safe. The improvement in quality of life is remarkable.

Change in International Prostate Symptom Storage Subscore After Long-term Medical Therapy in BPH Patients: Finasteride and Alpha-blocker Combination Therapy in Men With Moderate-to-severe LUTS/BPH in Korea

To evaluate the efficacy and the change of International Prostate Symptom Score (IPSS) storage subscore after combination therapy (α-blocker and finasteride) in patients with lower urinary tract symptoms (LUTS) consistent with moderate-to-severe benign prostatic hyperplasia (BPH) and compared with α-blocker-only treatment. A total of 1315 patients seen in 5 urology centers in Korea from January 2001 to August 2007, with LUTS secondary to BPH were enrolled. Patients were divided into 4 groups according to treatment pattern (α-blocker monotherapy vs combination therapy) and IPSS storage subscores (≥6 vs <6). The changes from baseline in prostate volume, prostate-specific antigen concentration, IPSS, and Q(max.) were analyzed. We also determined the statistical differences among 4 groups in the IPSS, Q(max.), quality of life score (QoL), and prostate volume. Of the 1315 men, 217 (16.5%) completed the month 48 visit. All groups showed significant improvements in the IPSS total score, IPSS voiding subscores, and QoL at 1 year. However, the high storage subscore group at baseline showed a significantly higher improvement in IPSS total scores and IPSS voiding subscores compared with the low storage subscore group at year 4. IPSS storage subscores were improved only in patients with high storage subscores at baseline, especially in combination treatment group. The mean change in QoL score from baseline to year 4 was significantly improved in high storage subscore groups. Data from this retrospective analysis suggest that long-term combination treatment would be beneficial, especially to patients with severe storage symptoms at baseline.

Factores predictivos para la expulsión de la litiasis ureteral

Medical treatment, extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are therapeutic options for ureteral stones. EWSL and endoscopic treatment of ureteral stones have a high success rate. However it has surgical as well as anaesthetic risks. For many patients, a medicinal treatment without invasive procedures is an option. Watchful waiting does not always result in stone clearance and may be associated with recurrent renal colic. The study of the prognostic factors for expulsion and the medical therapy will help us to select candidates for medical expulsive treatment. Objectives To evaluate the characteristics of the stones and the medication administered (alpha blockers, NSAIDs or a combination of both) as predictors of spontaneous passage of the stone. Material and methods A retrospective observational study of 260 patients with 278 ureteral stones was conducted. Primary endpoint was stone expulsion. Univariate and multivariate analysis were conducted testing the effect of stone location, size and composition, and medication (alpha-blockers, NSAIDs, or combination) on stone clearance. Results 34,2% of the stones studied were spontaneously eliminated. Stone location (pelvic ureter, OR= 1,823, p=0,013), size (<5 mm, OR=3,37, p<0,02), and medication (combination of alpha blockers and NSAIDs, OR= 8,70, p<0.001) were predictors of spontaneous clearance. Multivariate analysis confirmed size (p=0,006) and medication (p<0,001) as independent predictive factors. The use of the combination of NSAIDs and alpha-blockers versus observation multiplied times 8,21 (95% CI 3.37–20,01) the possibilities of spontaneous expulsion. Conclusions Size of stone and medication were confirmed as independent factors for spontaneous expulsion of ureteral stones.

Prognostic factors of spontaneous expulsion in ureteral lithiasis

Medical treatment, extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are therapeutic options for ureteral stones. EWSL and endoscopic treatment of ureteral stones have a high success rate. However it has surgical as well as anaesthetic risks. For many patients, a medicinal treatment without invasive procedures is an option. Watchful waiting does not always result in stone clearance and may be associated with recurrent renal colic. The study of the prognostic factors for expulsion and the medical therapy will help us to select candidates for medical expulsive treatment. ObjectivesTo evaluate the characteristics of the stones and the medication administered (alpha blockers, NSAIDs or a combination of both) as predictors of spontaneous passage of the stone. Material and methodsA retrospective observational study of 260 patients with 278 ureteral stones was conducted. Primary endpoint was stone expulsion. Univariate and multivariate analysis were conducted testing the effect of stone location, size and composition, and medication (alpha-blockers, NSAIDs, or combination) on stone clearance. Results34.2% of the stones studied were spontaneously eliminated. Stone location (pelvic ureter, OR=1.823, p=0.013), size (<5mm, OR=3.37, p<0.02), and medication (combination of alpha blockers and NSAIDs, OR=8.70, p<0.001) were predictors of spontaneous clearance. Multivariate analysis confirmed size (p=0.006) and medication (p<0.001) as independent predictive factors. The use of the combination of NSAIDs and alpha-blockers versus observation multiplied times 8.21 (95% CI 3.37–20.01) the possibilities of spontaneous expulsion. ConclusionsSize of stone and medication were confirmed as independent factors for spontaneous expulsion of ureteral stones.