Persistent Storage Symptoms Research Articles

Efficacy and Safety of Add-on Treatment with Mirabegron for Benign Prostatic Hyperplasia Patients with Persistent Storage Symptoms after Alpha‌- blocker therapy.

Efficacy and Safety of Add-on Treatment with Mirabegron for Benign Prostatic Hyperplasia Patients with Persistent Storage Symptoms after Alpha‌- blocker therapy.

A randomized controlled trial evaluating low-intensity shockwave therapy for treatment of persistent storage symptoms following transurethral surgery for benign prostatic obstruction.

Low-intensity shockwave therapy (Li-SWT) can improve bladder function through enhancement of angiogenesis and nerve regeneration and suppression of inflammation and overactivity. In this trial, we aimed to evaluate the efficacy of Li-SWT on persistent storage symptoms after transurethral surgery (TUS) for benign prostatic obstruction (BPO). Between July 2020 and July 2022, 137 patients with persistent storage symptoms; urgency episodes/24 h ≥ 1 and daytime frequency ≥8, for at least three months after TUS for BPO were randomly allocated to Li-SWT versus sham versus solifenacin 10 mg/day in 3:1:1 ratio. The primary end point was the percent reduction from baseline in overactive bladder symptom score (OABSS) at 3-month follow-up. The changes in 3-day voiding diary parameters, quality of life (QoL) score, peak flow rate and residual urine at 3 and 6-month follow-up were compared. Treatment-related adverse effects were also evaluated. Baseline data were comparable between groups. The percent reduction from baseline in OABSS at 3-month follow-up was significantly higher in Li-SWT compared to sham (-55% versus -11%), and it was comparable between Li-SWT and solifenacin-10 (-55% versus -60%). Li-SWT achieved significant improvement like solifenacin-10 in 3-day voiding diary parameters and QoL score at 3-month follow-up. This improvement remained comparable between Li-SWT and solifenacin-10 at 6-month follow-up. No adverse effects related to Li-SWT were noted apart from tolerable pain during the procedure. Solifenacin-10 was associated with bothersome adverse effects in 73% of the patients with 11.5% discontinuation rate. Li-SWT ameliorates persistent storage symptoms and promotes QoL after TUS for BPO, with comparable efficacy and better tolerance compared to solifenacin.

Comparison of add-on medications for persistent storage symptoms after α-blocker treatment in BPH patients – a network meta-analysis

BackgroundPatients with benign prostatic hyperplasia (BPH) receive α-blockers as first-line therapy to treat lower urinary tract symptoms; however, some individuals still experience residual storage symptoms. Antimuscarinics, β3-agonists, and desmopressin are effective add-on medications. Nevertheless, there is currently no evidence for the appropriate choice of the first add-on medication. This systematic review aimed to investigate the clinical benefits of antimuscarinics, β3-agonists, and desmopressin, in addition to α-blockers, for persistent storage symptoms in BPH patients.MethodsA comprehensive literature search of randomized controlled trials (RCTs) comparing the efficacy of different add-on medications in BPH patients with persistent storage symptoms despite α-blocker treatment was conducted. Clinical outcomes included the International Prostate Symptom Score (IPSS), IPSS storage subscore, nocturia, micturition, and urgency. A network meta-analysis was performed to estimate the effect size. Surface under cumulative ranking curves (SUCRAs) were used to rank the included treatments for each outcome.ResultsA total of 15 RCTs were identified. Add-on imidafenacin and mirabegron resulted in significant improvement in all outcomes assessed. Other add-on medications such as desmopressin, tolterodine, solifenacin, fesoterodine, and propiverine showed positive benefits for most, but not all, outcomes. Based on the SUCRA rankings, add-on desmopressin was the best-ranked treatment for IPSS and nocturia, and add-on imidafenacin was the best for the IPSS storage subscore and micturition.ConclusionsBPH patients presenting with persistent storage symptoms despite α-blocker administration are recommended to include additional treatment. Desmopressin and imidafenacin may be considered high-priority add-on treatments because of their superior efficacy compared with other medications.

This Month in Adult Urology.

This Month in Adult Urology.

Role of Antimuscarinics Combined With Alpha-blockers in the Management of Urinary Storage Symptoms in Patients With Benign Prostatic Hyperplasia: An Updated Systematic Review and Meta-analysis.

We evaluate the efficacy and safety of combining antimuscarinics with alpha-blockers to treat storage symptoms in men with benign prostatic hyperplasia. Searches were carried out on PubMed, MEDLINE, EMBASE, and Cochrane databases to identify randomized, placebo-controlled trials published before February 15, 2022, assessing the efficacy or safety of antimuscarinics in men with benign prostatic hyperplasia treated with alpha-blockers. Further meta-analyses were performed using standardized mean difference and risk ratio. A total of 12 randomized trials were included in the systematic review. The meta-analysis showed no impact of antimuscarinics on the number of urgencies per day (SMD -0.23 [95%CI: -0.64; -0.17]; P = .21). However, the use of antimuscarinics was associated with a small reduction of micturition episodes per day (SMD -0.19 [95%CI: -0.37; -0.01]; P = .045). With regard to side effects, post-void residual increased slightly in patients treated with antimuscarinics (SMD 0.26 [95%CI: 0.15; 0.37]; P < .01). In addition, there was a higher risk of acute urinary retention (RR 3.26 [95%CI: 1.35; 7.86]; P = .02), dry mouth (RR 3.43 [95%CI: 1.86; 6.32]; P < .001), and constipation (RR 2.92 [95%CI: 1.48; 5.73]; P < .001) with the use of antimuscarinics. Finally, the risk of treatment interruption due to adverse events was higher for the patients treated with antimuscarinics (RR 1.74 [95%CI: 1.27; 2.38]; P < .01). The addition of antimuscarinics to alpha-blockers was not associated with a substantial reduction in urgencies and micturition episodes in benign prostatic hyperplasia patients with storage symptoms. In addition, the toxicity profile was not in favor of antimuscarinic use in these patients.

Prevalence and Predictors of Bladder Outlet Obstruction in Women With Chronic Urinary Symptoms and a History of Urethral Sling Surgery.

The objective of this study is to review patients with chronic urinary symptoms and remote urethral sling surgery to determine the prevalence and predictors of obstruction. A single-center retrospective review was performed on patients referred with chronic lower urinary tract symptoms (>6 months) and a history of urethral sling surgery. Obstruction was identified by urodynamics using the Blaivas criteria or fluoroscopy. Clinical findings for patients with and without obstruction were compared. Logistic regression was applied to identify predictors of urodynamic obstruction. The need for sling revision and post-revision outcomes were evaluated. In total 105 patients were included, median age 61 years (IQR 19), median time since sling surgery 5.0 years (IQR 8). Sixty percent (63/105) met the definition for obstruction. Patients with obstruction had higher mean detrusor pressure at maximum urinary flow rate (35 vs 19 cm H2O) and lower maximum urinary flow rate (6.0 vs 14 mL/s; P < .05). A tight suburethral band and increased post-void residuals were significantly associated with urodynamic obstruction (P < .05). Fifty-nine (59/105; 56%) patients underwent suburethral sling excision. The incidence of improvement in storage and voiding symptoms at 6 months was 43% and 87%, respectively. At 30 months post-excision, the probability of being incontinence-free was 56% (95% CI 41, 69) and the probability of being free from redo sling surgery was 75% (95% CI 55, 87). Obstruction is common in patients with chronic urinary symptoms and history of urethral sling surgery. Patients undergoing sling revision should be observed for persistent storage symptoms and recurrent incontinence.

Prediction of Persistent Storage Symptoms after Transurethral Resection of Prostate in Patients with Benign Enlargement of Prostate

Introduction: Benign enlargement of prostate (BEP) is one of the common problem in elderly male. Most of the patients present with lower urinary tract symptoms (LUTS) which consist of voiding symptoms and storage symptoms. Transurethral resection of prostate (TURP) is the gold standard treatment option for BEP. TURP improves both obstructive and storage symptoms in majority of cases. But sometimes storage symptoms persist after TURP. This study was done to predict the factors for persistence of storage symptoms after TURP by evaluating clinical and urodynamic variables. Objective: To predict the factors for persistence of storage symptoms after transurethral resection of prostate (TURP) by evaluating clinical and urodynamic variables. Materials and Method: This was a prospective analytic study done in the department of Urology, Bangabandhu Sheikh Mujib medical university (BSMMU), Shabagh, Dhaka. In this study, total 60 patients of BEP with the indication of TURP were enrolled. Preoperative data includes Age of the patient, International prostate symptoms score(IPSS), IPSS storage sub score, Qmax, QoL scores, Maximum cystometric capacity(MCC), Post void residue(PVR), PdetQmax, Bladder contractility index (BCI) and postoperative data includes post-operative IPSS storage sub score, Qmax were recorded and analyzed. Result: Among preoperative variables, Age (&gt;65y) and IPSS storage sub score has highest predictive value. Bladder contractility index (BCI) and MCC have significant predictive value. Qmax and PVR have also predictive value. Conclusion: This study result shows elderly patient of higher age group, preoperative high IPSS storage sub score, smaller MCC &amp; high BCI have chance of persistence of storage symptoms. Bangladesh J. Urol. 2021; 24(2): 135-140

Surgical outcome of male patients with chronic central nervous system disorders and voiding dysfunction due to bladder outlet obstruction.

Voiding dysfunction is common in patients with chronic central nervous system (CNS) diseases and has great impact on quality of life. Patients with chronic CNS disorders might have concomitant detrusor overactivity, detrusor underactivity, and voiding dysfunction. Although bladder outlet surgeries could relieve bladder outlet obstruction (BOO), patients might have persistent or exacerbated storage symptoms. This study investigated surgical outcome of patients with chronic CNS disorders after bladder outlet surgery. A total of 63 male patients with cerebrovascular accident (CVA, n = 44), Parkinson's disease (PD, n = 11), and early-stage dementia (n = 8), had received bladder outlet surgery after videourodynamic proven BOO refractory to medical treatment. The preoperative and postoperative lower urinary tract symptoms (LUTS) and uroflowmetry parameters were assessed. If the storage symptom subscore decreased or increased by 1, the outcome was considered improved or exacerbated after treatment. When patients had improvement in maximum flow rate (Qmax) and voiding efficiency (VE) and decreased voiding symptom subscore, they were considered having improvement of voiding dysfunction. The mean age was 71.1 ± 9.8years and mean duration from diagnosis of BOO to surgical intervention was 15.1 ± 25.0months. Overall, there was significant improvement in voiding LUTS and urinary retention after surgery. The post-void residual volume (PVR), corrected Qmax (cQmax), and VE significantly improved after surgery. In subgroup analysis, although voiding symptoms improved in CVA patients, urgency and exacerbated urgency incontinence persisted after surgery. In PD patients, there was improvement in voiding condition such as PVR, cQmax and VE, but the storage symptoms did not change after surgery. Patients with dementia had no improvement both in storage and voiding symptoms. Bladder outlet surgeries are effective to relieve voiding dysfunction in patients with CVA and PD, but have little effect on storage LUTS in patients with chronic brain lesions.

PD38-08 EFFICACY OF LOW-INTENSITY SHOCK WAVE THERAPY ON PERSISTENT STORAGE SYMPTOMS AFTER TRANSURETHRAL SURGERY FOR BENIGN PROSTATIC OBSTRUCTION: PRELIMINARY RESULTS OF A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 May 2022PD38-08 EFFICACY OF LOW-INTENSITY SHOCK WAVE THERAPY ON PERSISTENT STORAGE SYMPTOMS AFTER TRANSURETHRAL SURGERY FOR BENIGN PROSTATIC OBSTRUCTION: PRELIMINARY RESULTS OF A RANDOMIZED CONTROLLED TRIAL Mohammed Hegazy, Khaled Zaky Sheir, Mohamed Ahmed Gaballah, and Ahmed Mohamed Elshal Mohammed HegazyMohammed Hegazy More articles by this author , Khaled Zaky SheirKhaled Zaky Sheir More articles by this author , Mohamed Ahmed GaballahMohamed Ahmed Gaballah More articles by this author , and Ahmed Mohamed ElshalAhmed Mohamed Elshal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002596.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aimed to evaluate the efficacy of low-intensity shock wave therapy (Li-SWT) on persistent storage symptoms after transurethral surgery (TUS) for benign prostatic obstruction (BPO) in a randomized controlled study. METHODS: Patients with persistent storage symptoms for at least 3 months after TUS for BPO were eligible once they have urgency episodes/24 hrs ≥1 and daytime frequency ≥8. Patients were allocated to Li-SWT versus sham versus standard of care (solifenacin 10 mg once daily) in 3:1:1 ratio. Li-SWT was applied to suprapubic and perineal regions once-weekly for 8 weeks. The treatment efficacy was assessed by overactive bladder symptoms score (OABSS) at baseline, 4, 8 and 12 weeks as well as international index of prostate symptom score (IPSS), quality of life (QoL), uroflowmetry and post-void residual urine volume (PVR) at baseline and 8 weeks. Moreover, patient compliance and treatment-related adverse effects were evaluated. Visual analogue scale (VAS) ranging from 0-10 was used for pain evaluation during Li-SWT sessions. RESULTS: A total of 115 patients were enrolled (72, 18 and 25 patients in Li-SWT, sham and solifenacin group respectively). Baseline data were comparable between groups. OABSS at 4, 8 and 12 weeks as well as IPSS and QoL at 8 weeks showed significant improvement from the baseline level in Li-SWT and solifenacin groups compared to sham group (P=0.001). Solifenacin was associated with bothersome antimuscarinic adverse effects in 84% of the patients and it was intolerable in 9.5% of them. However, no adverse effects related to Li-SWT were noted apart from local pain during the procedure (mean VAS = 4.18±1.31). CONCLUSIONS: Li-SWT ameliorates persistent storage symptoms and promotes the QoL after TUS for BPO. It can be used as an alternative treatment to muscarinic receptor blockers with similar efficacy and without bothersome adverse effects. Source of Funding: No source of funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e648 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammed Hegazy More articles by this author Khaled Zaky Sheir More articles by this author Mohamed Ahmed Gaballah More articles by this author Ahmed Mohamed Elshal More articles by this author Expand All Advertisement PDF DownloadLoading ...

Persistent storage symptoms following Y-V plasty reconstruction for the treatment of refractory bladder neck contracture.

Refractory bladder neck contracture (BNC) following transurethral prostatectomy is rare and difficult to manage. Success rate of endoscopic treatment decline considerably after repeated treatments. Bladder neck reconstruction are often the last resort to treat refractory BNC failing endoscopic treatments. In general, experience is limited with this type of bladder neck reconstruction, particularly in adult patients. This study aims to determine the success rate, functional and patient-reported outcomes (PRO) of open Y-V plasty in treatment of refractory BNC after transurethral prostatectomy. The study also aims to determine the rate, and potential predictors of persistent storage symptoms after Y-V plasty. Between January 2016 and February 2021, 18 consecutive patients with refractory BNC who underwent open Y-V plasty were included in this study. All patients presented with voiding dysfunction after two or more failed attempts of endoscopic treatments followed by a 3-month period of outpatient serial dilation program. Clinicopathological data were extracted from medical records including baseline demographics, aetiology of BNC, previous endoscopic treatment, operative time, length of stay, complications, uroflow findings, International Prostate Symptom Score (IPSS) and OAB-V8. Primary outcome was the success of open YV plasty, defined as no need for further instrumentation such as indwelling catheterization, urethral dilatation, urethrotomy, or open surgery. Simple linear regression analysis was performed to determine predictor factors for postoperative OAB-V8. Variables that showed p < 0.25 were included in the multiple linear regression analysis. Most common aetiology of BNC was transurethral resection of prostate gland (n = 18, 100%). Mean age at surgery age (SD) was 65.5 (7.3) years. Mean follow-up was 14.8 (7) months. Success rate was 100%. Postoperative Qmax improved significantly [pre-OP 6.7 (8.1) ml/s vs.post-OP was 14.8 (7.3) ml/s, p < 0.001]. Mean postvoid residual decreased significantly [pre-OP 223.3 (254.3) ml vs.post-OP 45.1 (71.0) ml, p < 0.01)]. Persistent storage symptoms were reported in 61% of patients. BMI and baseline IPSS score are significant predictors for the postoperative OAB V8 change (adjusted b (95% confidence interval) = 1.037 (0.2-1.9), 0.64 (0.28-0.99), respectively, R2 = 0.59). Y-V plasty reconstruction for refractory BNC represents a feasible and successful option with high success rate and favorable outcomes. While functional and patient-reported outcomes had significantly improved post-operatively, persistent storage symptoms after this procedure still exist. BMI and baseline IPSS score are significant predictors for persistent storage symptoms after bladder neck reconstruction.

A0444 - Efficacy of low-intensity shock wave therapy on persistent storage symptoms after transurethral surgery for benign prostatic obstruction: Preliminary results of a randomized controlled trial

A0444 - Efficacy of low-intensity shock wave therapy on persistent storage symptoms after transurethral surgery for benign prostatic obstruction: Preliminary results of a randomized controlled trial

Efficacy of Combination Treatment with Tadalafil and Mirabegron in Patients with Benign Prostatic Hyperplasia Who Presented with Persistent Storage Symptoms After Tadalafil Monotreatment: A Prospective, Multicenter, Open-Labeled Study.

The aim of this study is to evaluate the efficacy and safety of tadalafil, a phosphodiesterase type 5 inhibitor, plus mirabegron, a β3-adrenoreceptor agonist, in patients with benign prostatic hyperplasia who presented with persistent storage symptoms after tadalafil monotreatment. The registration of this study started in August 2016 and ended in July 2019. The inclusion criteria included patients aged ≥ 50 years who were diagnosed with benign prostatic hyperplasia and who presented with overactive bladder symptoms. Patients were treated with oral tadalafil 5 mg once daily for 4 weeks. Then, its efficacy was evaluated. Patients who responded to the treatment received oral tadalafil 5 mg once daily for 4 more weeks (monotreatment group). Meanwhile, those who did not respond received oral tadalafil 5 mg and mirabegron 50 mg, which is an add-on treatment, once daily for 4 more weeks (combination therapy group). After 8 weeks, the monotreatment group (n = 19) and the combination group (n = 56) had significantly better total Overactive Bladder Symptom Score and International Prostate Symptom Score and International Prostate Symptom Score voiding and storage subscale scores. Moreover, the two groups experienced significant improvements in the total Overactive Bladder Questionnaire and Nocturia Quality of Life Questionnaire scores, and Nocturia Quality of Life Questionnaire Bother/Concern subscale score after 8 weeks. However, there were no cases of urinary retention or serious adverse events. Combination treatment with tadalafil and mirabegron is effective and safe for patients with benign prostatic hyperplasia who presented with persistent storage symptoms after tadalafil monotreatment. Hence, tadalafil plus mirabegron is a promising therapeutic option, and it can improve overactive bladder related-quality of life.

Pharmacotherapy of patients with benign prostate enlargement and storage symptoms in everyday clinical practice.

Storage symptoms significantly deteriorate the quality of life in men with benign prostate enlargement (BPE). Muscarinic receptor antagonists (MRAs) and β3-adrenergic receptors agonists alone, or in combination with selective α1-alpha-antagonists, are considered the most effective medicines relieving storage symptoms. The aim of this study was to analyze the pharmacotherapy of storage symptoms in men with BPE, and their compliance with the European Association of Urology (EAU) guidelines. The survey was conducted in 2018 by 261 urologists among 24,613 men with lower urinary tract symptoms (LUTS) and BPE treated pharmacologically. Data concerning recent severity of non-neurological LUTS, storage symptoms and pharmacotherapy were collected. Storage symptoms were reported by 12,356 patients (50.2%) with BPE, more frequently nocturia (75.8%), than urinary urgency (57.8%) and frequency (44.3%). Patients with storage symptoms were more frequently prescribed with MRAs and mirabegron (43.1% vs. 5.0% and 2.4% vs. 0.3%, respectively; p<0.001). Of note, 54.5% of patients with storage symptoms were treated neither with MRAs, nor β3-adrenergic receptors agonists. In the subgroup with storage symptoms, the increasing severity of LUTS accounted for more frequent prescription of MRA (2.1% vs. 29.1% vs. 42.8% in patients with mild, moderate, and severe LUTS, respectively). Decision tree analysis revealed that patients with urinary urgency and urinary frequency, as well as younger ones with urinary urgency but without urinary frequency, were more frequently prescribed with MRAs. Urinary urgency and frequency are associated with increased utilization of MRAs in men with BPE in everyday clinical practice. The attitude of Polish urologists toward management of persistent storage symptoms in BPE patients is in line with the EAU guidelines.

Predisposing factors of persistent storage symptoms after holmium laser enucleation of the prostate in patients with benign prostatic hyperplasia and their correlations to the symptom recovery period

Bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms (LUTS) in older men. Although medical treatments can reduce BPH-related LUTS and even prevent invasive treatments, at least one in five men who complain of LUTS due to BPH will eventually need surgery. Of LUTS, storage symptoms persist in 20 to 40% of patients even after the obstruction is resolved. The present study aims to investigate the predisposing factors of the persistent storage symptoms after HoLEP in patients with BPH and their correlations to the recovery time of the symptoms. A total of 127 patients with complaints of storage symptoms and who underwent transurethral HoLEP surgery at Pusan National University Hospital from May 2014 to June 2017 were included in this study. Urodynamic studies were performed in all patients, and BOO was confirmed by urodynamic studies before HoLEP. All patients were asked to complete the IPSS (also known as the American Urological Association score) and the Overactive Bladder Symptom Score (OABSS) questionnaire to evaluate LUTS on the day before HoLEP and 3 months after HoLEP. Patients were divided into group I, which included patients with persistent storage symptoms after HoLEP, and group II, which included patients without storage symptoms after HoLEP. Of a total of 127 patients, 68 were included in group I, and the remaining 59 were included in group II. In the univariable analysis, group I showed statistically significantly older mean age, higher mean peak detrusor pressure during filling cystometry, and lower mean MCC than group II. Multivariate analysis of these three variables showed that only mean age and mean peak detrusor pressure during filling cystometry had statistically significant differences. In group I, 12 patients had storage symptoms until 12 months after surgery. When comparing these patients with the remaining 56 patients, only mean age showed statistically significant differences. Old age and high peak detrusor pressure during filling cystometry were the predictors of persistent storage symptoms after HoLEP. Furthermore, older patients were unlikely to recover storage symptoms until 12 months after operation.

Efficacy and Safety of Vibegron Add-on Therapy in Men With Persistent Storage Symptoms After Receiving Alpha 1-Blocker or Phosphodiesterase 5 Inhibitor: A Preliminary Study

OBJECTIVETo investigate the efficacy and safety of vibegron add-on therapy in men with persistent storage symptoms receiving α-1 blockers or PDE5 inhibitor for benign prostatic hyperplasia and then determine the independent factors affecting the efficacy of vibegron. METHODSVibegron 50 mg was administered for 12 weeks to 42 patients (72.0 ± 8.2 years) with persistent storage symptoms who had taken α-1 blockers (22 patients) or PDE5 inhibitor (20 patients). The primary endpoint was change in the overactive Bladder (OAB) Symptom Score from baseline to end of treatment. The secondary endpoints were changes in each question of several questionnaires, maximum flow rate and residual urine volume. Finally, independent factors affecting the efficacy of vibegron were investigated. RESULTSTotal OAB Symptom Score was significantly decreased (6.21 ± 3.12 vs 4.38 ± 2.46; P < .001). Although each score of several questionnaires, especially for storage symptoms, improved significantly, no significant improvement was found in stress incontinence, straining, bladder pain and urethral pain in the Core Lower Urinary Tract Symptom score. Maximum flow rate and residual urine volume did not change, and no patient discontinued vibegron because of adverse events. Multiple regression analysis showed that OAB Symptom Score, Core Lower Urinary Tract Symptom score, prostate volume and monotherapy with α-1 blocker were independent factors affecting the efficacy of vibegron. CONCLUSIONAdd-on therapy of vibegron to monotherapy with α-1 blockers or PDE5 inhibitor for patients with benign prostatic hyperplasia and persistent storage symptoms was effective and safe.

385 - Efficacy and safety of combination treatment with tadalafil and mirabegron for persistent storage symptoms despite tadalafil treatment in patients with benign prostatic hyperplasia

385 - Efficacy and safety of combination treatment with tadalafil and mirabegron for persistent storage symptoms despite tadalafil treatment in patients with benign prostatic hyperplasia

P-02-51 Add-On Treatment With Mirabegron in Men With Benign Prostatic Hyperplasia Complaining Persistent Storage Symtoms after Tamsulosin Monotherapy Improves Quality of Life

Persistent storage symptoms after medication with alpha blocker decrease quality of life (QoL) and may disturb sexual activity. Therefore, we evaluated the effect of add on therapy with mirabegron in patient with benign prostatic hyperplasia (BPH) and persistent storage symptoms after treatment with tamsulosin. We evaluated International prostatic symptom score (IPSS), overactive bladder symptom score (OABSS), PSA, prostate volume (PV), maximum flow rate (Qmax), post voided volume (PVR) before and after treatment. Patients showing baseline OABSS question 3 ≥ 4 was included in this study and treat with tamsulosin 0.2 mg as an initial drug for 1 month. After 1 month, add-on treatment with solifenacin 5 mg or mirabegron 50 mg was done to the patients who did not show improvement of OABSS scores with tamsulosin 0.2 mg. Two months later we evaluated the changes of OABSS, IPSS, Qmax and PVR. After combination treatment for 2 months, there were no significant differences of IPSS scores between the patients received add-on treatment with solifenacin and mirabegron. However, improvement of IPSS QoL score of the patients treated with mirabegron and tamsulosin (3.64±1.55) compared with solifenacin and tamsulosin (4.25±0.71).

Add-on treatment with mirabegron may improve quality of life in patients with benign prostatic hyperplasia complaining of persistent storage symptoms after tamsulosin monotherapy.

Background:The aim of this study was to evaluate the change in lower urinary tract symptoms and quality of life (QoL) after combination therapy of solifenacin and mirabegron in patients with benign prostatic hyperplasia presenting with persistent storage symptoms after treatment with tamsulosin.Material & Methods:We evaluated the International Prostatic Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), prostate-specific antigen, prostate volume, peak flow rate (Qmax), and post-voided residual volume (PVR) before and after treatment. Patients showing baseline OABSS ⩾3 were included and treated with tamsulosin 0.2 mg as an initial drug for 1 month. After 1 month, add-on treatment with solifenacin 5 mg or mirabegron 50 mg was provided to patients who did not show improvement in OABSS with tamsulosin 0.2 mg. After 2 months, we evaluated changes in OABSS, IPSS, Qmax, and PVR.Results:After combination therapy for 2 months, there were no significant differences between patients receiving add-on treatment with solifenacin and those receiving mirabegron. However, the IPSS QoL score improved in patients treated with mirabegron and tamsulosin more than in those treated with solifenacin and tamsulosin (p < 0.05).Conclusion:A combination of tamsulosin and mirabegron might improve the QoL of patients presenting with persistent storage symptoms after tamsulosin monotherapy. Better QoL due to mirabegron compared with solifenacin could be associated with fewer adverse effects, such as dry mouth and constipation.

Efficacy of adding mirabegron to alpha-adrenoreceptor blocker in patients with benign prostatic hyperplasia with persistent overactive bladder symptoms: A prospective study.

PurposeTo compare the efficacies of mirabegron 50 mg addition after alpha-adrenoreceptor blocker in terms of reducing storage symptoms in patients with BPH.Materials and MethodsFifty-eight patients that had been taking alpha-adrenoreceptor blocker for more than 8 weeks, but had an OABSS of greater than 3 points, were initially enrolled. One group added any alpha-adrenoreceptor blocker with mirabegron 50 mg (n=39; the mirabegron group) and the other group received alpha-adrenoreceptor blocker only (n=19; the control group) for 8 weeks.ResultsIn the control group, mean total IPSS decreased from 15.7 to 13.1 (p=0.298) and in mirabegron group, mean total IPSS decreased from 19.4 to 16.5 (p=0.024). Mean storage symptom scores reduced in the control and mirabegron groups from 8.5 to 7.9 (p=0.584) and from 9.1 to 7.6 (p=0.015), respectively, and mean QoL scores from 3.7 to 3.1 (p=0.052) and 3.6 to 3.2 (p=0.027), respectively. Mean overall OABSS in the control and mirabegron groups reduced from 8.4 to 7.2 (p=0.173) and from 8.8 to 7.3, respectively (p=0.005); mean OABSS Q3 from 3.6 to 2.9 (p=0.073) and from 3.5 to 2.7 (p=0.002), respectively; and mean OABSS Q4 from 2.4 to 2.0 (p=0.306) and from 2.7 to 2.0 (p=0.016), respectively. The change of mean Qmax and PVR was insignificant in 2 groups.ConclusionsIPSS total scores, storage symptom scores, QoL, overall OABSS, OABSS Q3 and Q4 were more improved significantly by alpha-adrenoreceptor blocker with mirabegron 50 mg in BPH patients with persistent overactive symptoms. Mirabegron 50 mg addition is considered to patients with persistent storage symptoms after alpha-adrenoreceptor blocker.

Expression of bladder α1-adrenoceptor subtype after relief of partial bladder outlet obstruction in a rat model.

PurposeMany patients with benign prostatic hyperplasia require treatment for persistent storage symptoms, even when the obstruction is successfully relieved by surgery. Previous studies identified a characteristic increase in α1D-adrenoceptor levels in the bladder in a bladder outlet obstruction (BOO) model. Here, we investigated the expression of α1-adrenoceptor subtypes in the bladder after relief of partial BOO (pBOO) in a rat model.Materials and MethodsA total of 60 female Sprague–Dawley rats were randomly divided into three groups (sham-operated, pBOO, and pBOO relief groups), and the expression of α1-adrenoceptor subtypes in the urothelium and detrusor muscle tissues was examined by western blot.ResultsThe expression of the α1D-adrenoceptor was significantly higher in the urothelium and detrusor muscle tissue of the pBOO and pBOO relief groups than in the corresponding tissue of the sham-operated group. Additionally, the α1A-adrenoceptor was predominant in the sham-operated group but significantly decreased in the urothelium in the pBOO group. No significant differences were found in α1A-adrenoceptor levels in detrusor muscle or whole bladder.ConclusionsOur results showed that α1D-adrenoceptor levels were consistently increased with pBOO, even after relief, suggesting that the α1D-adrenoceptor might be a cause of persistent storage symptoms after relief of pBOO.