Tamsulosin Therapy Research Articles

Population pharmacokinetics of tamsulosine in patients with benign prostatic hyperplasia.

The study aimed to determine the typical clearance and volume of distribution values of tamsulosin in patients with benign prostatic hyperplasia (BPH), and to identify factors with a measurable impact on the drug's elimination. This open-label, single-arm population pharmacokinetic study involved 65 adult men with BPH who had been on tamsulosin therapy for at least seven days. The steady-state serum concentrations of tamsulosin were measured using liquid chromatography-tandem quadrupole mass spectrometry. Population pharmacokinetic parameters, their variability, and influencing factors were estimated based on a two-compartment pharmacokinetic model using NONMEM software. The estimated tamsulosin clearance in BPH patients was 0.719L/h, and the steady-state volume of distribution was 32L. Neither renal nor liver function parameters had a statistically significant effect on tamsulosin clearance. However, a positive correlation was observed between hemoglobin levels and tamsulosin clearance in the BPH patient cohort. Our investigation reveals significant associations between tamsulosin pharmacokinetics and specific characteristics of patients with lower urinary tract symptoms (LUTS) due to BPH. The study highlights that tamsulosin clearance is associated with hemoglobin levels in patients with LUTS/BPH. This study underscores the importance of considering patient-specific factors when managing BPH treatment with tamsulosin, emphasizing associations rather than causative relationships.

A randomized control study on post-operative iris distortion following small-pupil cataract surgery using B-HEX pupil expander versus Malyugin ring

BackgroundThe aim of the study was to evaluate postoperative pupil distortion following small pupil cataract surgeries performed using B-HEX and Malyugin rings (MR). MethodsA randomized control trial was conducted from June 2020 to June 2023 at a tertiary eye-care hospital. The study consisted of 64 participants for cataract surgery with small pupil. There were two groups, one undergoing surgery with the use of B-HEX pupil expander and other with MR intraoperatively and the rest of the surgery was proceeded as per the convention. Areas of preoperative and postoperative images was calculated, put into an online software and pupil distortion was calculated in percentage. Two-tailed t-test was used to see the difference between the two groups. ResultsMean age at presentation was 70.5 ± 10.12 years. Most common cause for small pupil was tamsulosin therapy. Mean size of small-pupil was 3.0 ± 1.1 mm. With the application of two rings, mean pupillary area preoperatively was 4178.23 ± 1589.46 and postoperatively was 6100.44 ± 2658.28 following the use of MR, respectively and 30,002.93 ± 13,193.40 preoperatively and 37,648.26 ± 15,207.01 postoperatively following the use of B-Hex ring respectively. Comparing baseline area from pupillary area at 1-month follow-up, a significant increase was noted for both the rings. Also, MR caused significantly more pupillary distortion compared to B-HEX ring (p < 0.05). ConclusionMR causes significantly more pupillary distortion in the postoperative period compared to B-HEX ring. Though, both the rings cause pupillary distortion, these devices expand the surgical area adequately, ease the procedure, decrease risk of complications achieving good functional visual outcomes.

Association of CYP3A4*1B, CYP3A4*22 and CYP3A5*3 polymorphisms carriage with efficacy and safety of tamsulosin in patients with benign prostatic hyperplasia

Tamsulosin is a first-line drug in the treatment of lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH). Despite high estimates of its efficacy and safety, it rates may vary due to genetic polymorphisms of genes for the enzymes involved in the drugs metabolism.The aim of the work was to evaluate the carriage influence of genes polymorphisms of the CYP3A enzymes group of tamsulosin metabolizers on the efficacy and safety of therapy in patients with LUTS in BPH.Materials and methods. A total of 142 patients with LUTS, with an established BPH diagnosis (N40 according to ICD-10) were included in the study and underwent all stages. All patients received monotherapy with tamsulosin 0.4 mg/day for at least 8 weeks. An IPSS questionnaire with the definition of quality of life, a prostate ultrasound with the determination of the prostate volume and residual urine, as well as uroflowmetry, were used to evaluate the results of the treatment. Controls were performed at 2, 4 and 8 weeks from the start of the therapy. The carriage of polymorphic markers CYP3A4 (*1B, *22) and CYP3A5*3 was determined in patients; HPLC was used to determine drug concentrations in blood plasma and levels of cortisol and its metabolite 6-beta-hydroxycortisol in urine to assess the phenotypic activity of CYP3A.Results. No statistically significant associations between CYP3A phenotype (defined by CYP3A4 and CYP3A5 genotypes) and clinical parameters of the tamsulosin therapy efficacy and the safety assessment in the studied sample of patients were found (p &gt;0.05). Similar data were obtained for individual variants of CYP3A4*1B, CYP3A4*22, CYP3A5*3 (p &gt;0.05). The comparison of the tamsulosin residual equilibrium concentration values in patients in the study sample with respect to the carriers of CYP3A4 and CYP3A5 gene variants did not reveal the presence of significant differences in either CYP3A phenotypes and carriers and non-carriers of individual CYP3A4*1B (p=0.57), CYP3A4*22 (p=0.37) and CYP3A5*3 (p=0.76) variants. No association was found between the metabolic ratio of 6-beta-hydroxycortisol / cortisol in urine and the CYP3A phenotype encoded by a combination of genotypes of CYP3A4 and CYP3A5 gene variants (p &gt;0.05).Conclusion. A possible association between the carriage of CYP3A4*1B, CYP3A4*22, CYP3A5*3 variants, a CYP3A activity assessed by the content of an endogenous substrate of this isoenzyme and its metabolite in urine, the level of plasma concentration of the drug, and the efficacy and safety of tamsulosin, has not been confirmed. The contribution of CYP3A4 and CYP3A5 genetic polymorphisms to clinical parameters of the tamsulosin therapy requires a further study.

Semirigid ureteroscopy and tamsulosin therapy as dilatation methods before flexible ureteroscopy: evaluation and benefits

ObjectiveTo evaluate the effect of semirigid ureteroscopy and tamsulosin therapy as dilatation methods before flexible ureteroscopy advancement to the renal collecting system.Patients and methodsThis prospective study included patients with renal stones less than 2 cm who underwent retrograde flexible ureteroscopy and laser lithotripsy. The patients were randomized into two groups: group A patients were given a placebo for 1 week before flexible ureteroscopy, and group B patients were administered 0.4 mg of tamsulosin once daily for 1 week before surgery and underwent active dilatation using semirigid ureteroscopy before flexible ureteroscopy. The ability of the flexible ureteroscope to reach the collecting system in both groups during the same operative session was assessed. Operative outcomes and complications were collected and analyzed in both groups.ResultsA total of 170 patients were included in our study, with each group comprising 85 patients. In group B, the flexible ureteroscope successfully accessed the kidney in 61 patients, while in group A, the flexible ureteroscope was successful only in 28 cases (71.4% versus 32.9%). In group A, 33 (38.8%) patients had lower urinary tract symptoms compared to 17 (20.2%) patients in group B (P = 0.013).ConclusionUsing tamsulosin therapy and semirigid ureteroscopy as dilatation methods before flexible ureteroscopy increased the success of primary flexible ureteroscopy advancement to renal collecting system.

Profil Terapi Penggunaan Obat BPH (Benign Prostatic Hyperplasia) Tamsulosin dengan Dutasteride pada Pasien Pembesaran Prostat Jinak

Background: Benign Prostatic Hyperplasia (BPH) is a term for hyperplasia and hyperplasia. stromal cells prostate gland epithelium. Basically, BPH grows in men who are old and have testes that still produce testosterone. Previous studies suggest that the combination of tamsulosin and dutasteride provides a better therapeutic effect for BPH, significantly reducing the risk of developing BPH-related symptoms. Objectives: The purpose of this study was to identify the socio demographics of BPH patients including age and occupation, identify the type of BPH drug therapy and the effectiveness of Tamsulosin therapy and the combination of tamsulosin with dutasteride based on the duration of drug therapy in Outpatient BPH patients Method: the research was descriptive design with a cross-sectional by looking at the description of the type of BPH drug therapy. Results: From the results of the study, it was found that a sample of 136 BPH patients, BPH patients were more common in the age group 60-74 (75%), the most occupational status worked as independent workers (53.7%), the most type of therapy was combination therapy with tamsulosin and dutasteride (62.5%), and duration of combination therapy (tamsulosin with dutasteride) &gt;1 year (39%). Conclusion: The period of combination therapy is per the effectiveness of the duration of BPH drug therapy.

Effects of CYP2D6 allelic variants on therapy with tamsulosin in patients with benign prostatic hyperplasia.

Tamsulosin is a first-line drug for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Despite its high ratings for efficacy and safety, these parameters may vary due togenetic polymorphisms of CYP2D6 enzyme, which is involved in the metabolism of the drug. This variability may have great impact on the therapy of LUTS associated with BPH and may require an individualized approach to drug selection. The aim of the study was to assess the impact of genetic polymorphisms in CYP2D6 on the efficacy and safety of tamsulosin therapy in patients with LUTS associated with BPH. The study included 106 patients with LUTS/BPH (N40 according to ICD-10). All patients received monotherapy with tamsulosin 0.4 mg/day for at least 8weeks. Depending on the severity of symptoms, all patients were divided into 2 groups based on the IPSS score: the first group of patients had moderate symptoms (n=57), and the second group of patients had severe symptoms (n=49). The results of treatment were assessed using the IPSS questionnaire with determination of quality of life (QoL), transrectal ultrasound of the prostate with determination of prostate volume andpostvoid residual urine volume, and uroflowmetry. The carriage of allelic variants of CYP2D6 (*3, *4, *9, *10, and *41) were determined by polymerase chain reaction in all patients. In patients with moderate symptoms who was classified as «intermediate» metabolizers by CYP2D6, a statistically significant greater reduction in symptoms according to the overall IPSS scale at 8weeks (p=0.046) and the obstructive symptom subscale starting from 4weeks of treatment (p<0.05) was shown. Allelic variants of the CYP2D6 gene did not affect the frequency of adverse reactions to tamsulosin. The results of the study show that in patients with moderate LUTS associated with BPH who are «intermediate» metabolizers by CYP2D6, there is a better therapeutic effect of tamsulosin.

Stone Clearance in Patients with Upper Ureteric Stones Using Extracorporeal Shock Wave Lithotripsy Compared with Extracorporeal Shock Wave Lithotripsy Combined with Tamsulosin Therapy

Objective: To assess its role in stone clearance along with ESWLin patients with upper ureteric stones. Method: This clinical trial was conducted from February 2018 to December 2021 at the Department of Urology, Services Hospital Lahore.. Atotal of 164 patients (82 in each group) of both sexes between the ages of 18 and 70 years with upper ureteric stone (6mm-15mm) were included in this study. These patients were randomly divided into two groups. Patients in group A received ESWL alone, while patients in group B received ESWL in combination with tamsulosin therapy. Follow-up visits with CT KUB Plain were planned 4 weeks postoperatively to assess stone clearance Results: The mean age of patients was 44.01±10.88 years. The study included 124 (75.6%) male and 40 (24.4%) female patients. The mean size of stones was 9.59±2.72 mm. Both the groups were comparable in terms of mean age (p=0.539), mean stone size (p=0.936), age groups (p=0.507), stone size groups (p=0.817), and gender distribution (p=0.631). The stone clearance rate was significantly higher in patients treated with ESWLin combination with tasmsulosin therapy (92.7% vs. 65.9%; p=0.003) compared to ESWLalone. Conclusion: The clearance rate was significantly higher in patients treated with ESWL in combination with tasmsulosin therapy compared to ESWLalone.

Clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and the efficacy of treating lower urinary tract symptoms

Introduction. Benign prostatic hyperplasia (BPH) is a common condition in aging men that is often associated with lower urinary tract symptoms (LUTS).Objective. To determine the clinical portrait of an "ordinary" patient with benign prostatic hyperplasia and develop an algorithm for improving the efficacy of treating lower urinary tract symptoms in benign prostatic hyperplasia.Materials &amp; methods. The study included 112 BPH-patients who received tamsulosin therapy or a combination of tamsulosin + solifenacin for three months. After three months of therapy, the patients were divided into two groups depending on the effectiveness of therapy: group 1 — a positive result (n = 77); group 2 — no positive effect (n = 35). Due to the lack of efficacy in patients of group 2, a multichannel urodynamics was performed, according to the results of which the patients were prescribed treatment with a subsequent assessment of the result after 3 months.Results. After 3 months of therapy in patients of group 1, a decrease in pollakiuria was noted. Regression of obstructive and irritative symptoms was also observed, and the urination-associated quality of life (QoL) improved. The maximum urine flow rate (Q max) remained unchanged mainly. By the sixth month, the frequency of urination continued to decrease (11.05 vs 9.32 episodes; p = 0.022), as well as the improvement of other parameters (IPSS, QoL, Q max and post-void residual urine volume (PVR) (80.87 vs 56.17 ml; p = 0.012). The indicators of patients of group 2 following three months of therapy remained without significant changes. Sixteen patients underwent transurethral prostate resection, 19 patients underwent therapy correction, which allowed reducing the number of episodes of daily pollakiuria. The total IPSS score decreased by 4.37 compared to baseline (IPSS (obstructive) — 13.79 vs 7.26 pts; p = 0.032). The QoL value was 2.84 pts, Q max — 14.90 mL/s, PVR — 10.58 mL.Conclusion. 19.8% of BPH-patients are resistant to drug therapy. The ineffectiveness of therapy may be due to the severe BOO. In the absence of the effect of the therapy within 3 months, it is recommended to perform multichannel urodynamics. Correction of therapy according to the multichannel urodynamics data improves its effectiveness by the sixth month of treatment. Indicators of IPSS, Q max and PVR after 3 months of therapy allow predicting the effectiveness of therapy, or suspect the need for surgical treatment.

Evaluation of intermittent tamsulosin in treating symptomatic patients with benign prostatic hyperplasia

The purpose of this study is to evaluate and assess the effect of intermittent tamsulosin treatment as a trial to increase the drug safety (in terms of reducing the drug side effects, particularly retrograde ejaculation) while maintaining the effect in reducing the symptoms and assess its impact on the patients' quality of life. Patients who enrolled in this study were suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and were using 0.4 mg tamsulosin daily to relieve their symptoms but complained of ejaculatory problems. A baseline assessment involves medical history and evaluation of ejaculatory function abdominopelvic ultrasound, postvoid residual volume (PVR) estimation, the International Prostate Symptom Score (IPSS), quality of life assessed using global satisfaction, vital signs, physical examination including digital rectal examination, and renal function. During the study, patients consented to take 0.4 mg tamsulosin intermittently every other day and to proceed with their sexual activities on the days they did not take the drug in. Baseline assessment was repeated and recorded after 3 months from starting the treatment. The adverse effects and compliance were analyzed in all patients. Twenty-five patients had a mean baseline IPSS of 6.6 ± 1 and baseline PVR of 87.6 ± 15.1 ml. At the 3rd month, the mean PVR was 100.4 ± 15.1 ml and the mean IPSS was 7.3 ± 1.1. Moreover, 20 out of the total number of 25 patients (80%) reported improvement in their ejaculation. All our 20 patients who showed improvement in their ejaculatory function are either satisfied or very satisfied (4 or 5), in regard to the global satisfaction rate. Intermittent tamsulosin therapy (0.4 mg/every other day) is well-tolerated and shows a potential advantage in recovery in patients who suffer from LUTS/BPH and complaining from abnormal ejaculation, especially absent ejaculate. Although there was a significant change in PVR and IPSS after using intermittent tamsulosin therapy. Most patients show a higher overall satisfaction with the treatment compared to the standard dose (0.4 mg/daily). A study on a larger scale is still needed to confirm our results.

Молекулярно-генетические предикторы эффективности и безопасности терапии тамсулозином

Individual differences in efficacy and safety of drugs between patients are a significant problem in modern pharmacotherapy. The bodys pharmacological response to the administration of a particular drug is determined by multiple factors, where up to 50% of the variability of the pharmacological response may be determined by the genetic variability of the body. The article presents an up-to-date review of the data on genetic polymorphisms influencing the efficacy and safety of tamsulosin therapy in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia.

Comparison of Outcome of Unilateral Modified Bladder Neck Incision and Tamsulosin Therapy in the Treatment of Primary Bladder Neck Obstruction in Young Men

Background: Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck does not open appropriately or completely during voiding. Symptoms caused by primary bladder neck obstruction includes storage symptoms (Frequency, Urgency, Urge incontinence, nocturia) and voiding Symptoms (Poor urinary stream, hesitancy, incomplete emptying of bladder). Objective: To compare outcome of unilateral modified bladder neck incision with tamsulosin therapy in primary bladder neck obstruction in young men. Materials and Methods: This hospital based quasi-experimental study was conducted in the department of urology, Sir Salimullah Medical College Mitford Hospital. Patients with the diagnosis of primary bladder neck obstruction included in this study. Total 44 cases were included. Among them 18 were treated with unilateral modified BNI (Group A) and 26 were treated with tamsulosin therapy (Group B). Results: The mean age was found 31.11±4.77 years in group A and 34.15±5.42 years in group B. At 3rd and 6th month mean uroflowmetry (Qmax) was statistically significant (p&lt;0.05) when compared between two groups. However, in group A and group B uroflowmetry (Qmax) was significantly increased when compared initial vs 3rd month and initial vs 6th month respectively. The study observed that after 3rd month following the treatment the retrograde ejaculation was not found in group A and 1(3.8%) found in group B. At 6th month retrograde ejaculation was not also found in group A and found 2(7.7%) in group B. At 3rd and 6th month retrograde ejaculation was not statistically significant (p&gt;0.05). Conclusion: The outcome of unilateral modified BNI is better than tamsulosin therapy. All others adverse effect of both medical and surgical treatment was mild and transient that was acceptable in clinical practice. Sir Salimullah Med Coll J 2022; 30: 155-160

A metabolomics study: Could plasma metabolites be a guide for the prevention of tamsulosin side effects?

The understanding of precision medicine, which aims for high efficacy and low toxicity in treatments, has gained more importance with omics technologies. In this study, it was aimed to reach new suggestions for low-toxicity treatment by clarifying the relationship between tamsulosin side effects and metabolome profiles. Plasma samples of control and tamsulosin-treated rats were analyzed by LC-Q-TOF/MS/MS. MS/MS data was processed in XCMS software for the identification of metabolite and metabolic pathway analysis. Data were classified with MATLAB 2019b for multivariate data analysis. 34m/z values were found to be significantly different between the drug and control groups (P≤0.01 and fold analysis≥1.5) and identified by comparing METLIN and HMDB databases. According to multivariate data analysis, α-Linolenic Acid, Thiamine, Retinoic acid, 1.25-Dihydroxyvitamin D3-26.23-Lactone, L-Glutamine, L-Serine, Retinaldehyde, Sphingosine 1-phosphate, L-Lysine, 23S.25-Dihydroxyvitamin D3, Sphinganine, L-Cysteine, Uridine 5'-diphosphate, Calcidiol, L-Tryptophan, L-Alanine levels changed significantly compared to the control group. Differences in the metabolisms of Retinol, Sphingolipid, Alanine-Aspartate-Glutamate, Glutathione, Fatty Acid, Tryptophan, and biosynthesis of Aminoacyl-tRNA, and Unsaturated Fatty Acid have been successfully demonstrated by metabolic pathway analysis. According to our study, vitamin A and D supplements can be recommended to prevent side effects such as asthenia, rhinitis, nasal congestion, dizziness and IFIS in the treatment of tamsulosin. Alteration of aminoacyl-tRNA biosynthesis and sphingolipid metabolism pathways during tamsulosin treatment is effective in the occurrence of nasal congestion. Our study provides important information for tamsulosin therapy with high efficacy and low side effects in precision medicine.

Penilaian Erection Hardness Score Pasien Benign Prostatic Hyperplasia yang Ditangani dengan Tamsulosin dan Kombinasi Tamsulosin-Dutasteride

The goal of Benign Prostate Hyperplasia (BPH) therapy is to relieve symptoms and maintain disease progression as well as the side effects of drugs and their benefits for improving the quality of life and sexual quality. This study aimed to assess the effect of tamsulosin therapy with combination therapy of tamsulosin and dutasteride on the erection hardness score (EHS) in men with LUTS due to BPH. This study is a cross-sectional study which assesses and compares differences in erection hardness scores (EHS) of patients with benign prostatic hyperplasia (BPH) before and after tamsulosin therapy and the combination of tamsulosin + dutasteride. After three months of therapy, the group of subjects given tamsulosin had an IPSS score of 12.87 (p=0.00), IIEF-5 15.43 (p=0.51), EHS 2.6 (p=0.08), while the tamsulosin + dutasteride group had an IPSS score 12.53(p=0.00), IIEF-5 15.83 (p=0.02), and EHS 2.6 (p=0.01). The decrease in EHS was more statistically significant in treatment with tamsulosin + dutasteride combination therapy compared with tamsulosin monotherapy, this was due to the effect of each drug combined.

EFFECT OF CYSTOSCOPY AND URETHRAL DILATATION VS CYSTOSCOPY ALONE WITH TAMSULOSIN IN WOMEN WITH VOIDING DYSFUNCTION: A RETROSPECTIVE COMPARATIVE STUDY

Background:To analyze the data of cystoscopy and urethral dilatation with tamsulosin therapy in comparison to cystoscopy alone with tamsulosin in women with voiding dysfunction and overactivity. Methods: Retrospective data of women with overactive bladder symptoms and a maximum ow rate of &lt;15 mL/sec on a voided volume of over 150 mLand/or a postvoid residual volume &gt;100 mLwho underwent dilatation and tamsulosin therapy were compared with the patients who had undergone cystoscopy and tamsulosin. Symptom assessment and urodynamic evaluation was done at baseline, 6 weeks and 6 months postoperatively. Results: In total, 67 patients (34 in dilatation and tamsulosin [group A] and 33 in cystoscopy and tamsulosin [group]) were included in this study. After 6 weeks and 6 months, the American urological association symptom score decreased by 12.46 and 9.84 in group A and by 8.88 and 6.55 in group B. Changes in voided volume, maximum ow rate and post-void residual volume at 6 weeks and 6 months were signicant in both the groups (P=0.001). On comparing both the groups, improvements in all the parameters were numerically higher in group Aat 6 weeks. Mild bleeding was seen in ve cases of group A, no other adverse events were noted. Conclusion: A signicant improvement in clinical as well as urodynamic parameters was seen in both the groups individually at both 6 weeks and 6 months posttreatment. However, the intergroup comparison revealed that the addition of urethral dilatation to cystoscopy fares better than cystoscopy alone but for short term.

Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study.

BackgroundContinuous α1a-blockade is the first-line treatment for lower urinary tract symptoms (LUTS) among older men with suspected benign prostatic hyperplasia. Variable efficacy and safety for individual men necessitate a more personalized, data-driven approach to prescribing and deprescribing tamsulosin for LUTS in older men. ObjectiveWe aim to evaluate the feasibility and usability of the PERSONAL (Placebo–Controlled, Randomized, Patient-Selected Outcomes, N-of-1 Trials) mobile app for tracking daily LUTS severity and medication side effects among older men receiving chronic tamsulosin therapy. MethodsWe recruited patients from the University of California, San Francisco health care system to participate in a 2-week pilot study. The primary objectives were to assess recruitment feasibility, study completion rates, frequency of symptom tracking, duration of tracking sessions, and app usability rankings measured using a follow-up survey. As secondary outcomes, we evaluated whether daily symptom tracking led to changes in LUTS severity, perceptions of tamsulosin, overall quality of life, medication adherence between baseline and follow-up surveys, and perceived app utility. ResultsWe enrolled 19 men within 23 days, and 100% (19/19) of the participants completed the study. Each participant selected a unique combination of symptoms to track and recorded data in the PERSONAL app, with a median daily completion rate of 79% (11/14 days). The median duration of the app session was 44 (IQR 33) seconds. On a scale of 1 (strongly disagree) to 5 (strongly agree), the participants reported that the PERSONAL app was easy to use (mean 4.3, SD 1.0), that others could learn to use it quickly (mean 4.2, SD 0.9), and that they felt confident using the app (mean 4.4, SD 0.8). LUTS severity, quality of life, and medication adherence remained unchanged after the 2-week study period. Fewer men were satisfied with tamsulosin after using the app (14/19, 74% vs 17/19, 89% at baseline), although the perceived benefit from tamsulosin remained unchanged (18/19, 95% at baseline and at follow-up). In total, 58% (11/19) of the participants agreed that the PERSONAL app could help people like them manage their urinary symptoms. ConclusionsThis pilot study demonstrated the high feasibility and usability of the PERSONAL mobile app to track patient-selected urinary symptoms and medication side effects among older men taking tamsulosin to manage LUTS. We observed that daily symptom monitoring had no adverse effects on the secondary outcomes. This proof-of-concept study establishes a framework for future mobile app studies, such as digital n-of-1 trials, to collect comprehensive individual-level data for personalized LUTS management in older men.

Terapia skojarzona mirabegronem z tamsulosyną w leczeniu pęcherza nadaktywnego u mężczyzn z objawami z dolnych dróg moczowych

Men with lower urinary tract symptoms (LUTS) treated with α-blockers may experience overactive bladder (OAB) symptoms and receive antimuscarinic drugs. Mirabegron (B3-adrenoreceptor agonist) is an alternative add-on therapy, that has been shown to be more effective than placebo in improving OAB symptoms. Superior results observed for tamsulosin plus mirabegron in mean volume voided per micturition, urgency episodes per day, and total urgency and frequency score. Higher rates of drug related treatment emergent adverse events were noted with tamsulosin plus mirabegron. The results of PLUS reveal the utility of mirabegron and tamsulosin therapy in the treatment of men with benign prostatic hyperplasia who developed symptoms of overactive bladder. The MATCH study confirmed that combination therapy for 12 weeks in men with symptoms of LUTS and OAB was more effective than placebo and was well tolerated.

Efficacy of cystone versus tamsulosin in treatment of stent-related lower urinary tract symptoms

Objective: Double-J stent is a common tool used in urological procedures that is inserted for 2–6 weeks, but it may induce abdominal and flank pain, incontinence and irritative urinary symptoms. Alleviation of such symptoms would be useful to improve the patients’ quality of life. Accordingly, in this study, the efficacy of cystone versus tamsulosin in the treatment of double-J stent-related lower urinary tract symptoms was determined. Materials and methods: In this randomised clinical trial, 128 patients who required double-J stent insertion after transureteral lithotripsy during 2018–2019 were enrolled. They were randomly assigned to receive either cystone, tamsulosin, both, or placebo. The international prostate symptom score and visual analogue score data were recorded at baseline, after 2 and 4 weeks across the groups. Results: The international prostate symptom score and visual analogue score factors were statistically different across the case groups receiving cystone, tamsulosin and both drugs versus placebo ( P=0.001). Two weeks after drug administration, the visual analogue score and international prostate symptom score were not statistically different in the tamsulosin, cystone and dual therapy groups; however, after 4 weeks the cystone group had the lowest symptoms. Conclusion: Both tamsulosin and cystone are efficient drugs which would relieve stent-related lower urinary tract symptoms. The administration of cystone with or without tamsulosin for 4 weeks may have the best result in reducing the visual analogue score and international prostate symptom score. Level of evidence: Level I, 1b, therapeutic study, randomised controlled trial

Association of Glycolysis-Enhancing α-1 Blockers With Risk of Developing Parkinson Disease

Parkinson disease (PD) is a common neurodegenerative disease. A treatment that prevents or delays development of PD is a critical unmet need. Terazosin and closely related drugs were recently discovered to enhance glycolysis and reduce PD progression in animal models and human clinical databases. To determine whether use of terazosin, doxazosin, and alfuzosin is associated with a decreased risk of developing PD. This cohort study used active comparator control and propensity score-matched data from Danish nationwide health registries, including the Danish National Prescription Registry, the Danish National Patient Registry, and the Danish Civil Registration System, from January 1996 to December 2017 and data from the Truven Health Analytics MarketScan database from January 2001 to December 2017. Men without PD who newly initiated terazosin/doxazosin/alfuzosin therapy or tamsulosin therapy, which is used for a similar indication (benign prostatic hyperplasia or unspecified urinary problems) but does not enhance glycolysis, and had at least 1 year of follow-up after medication start were included. In Denmark, the database included all residents, while the Truven database is a compilation of insurance claims across the US. Data were analyzed from February 2019 to July 2020. Patients who used terazosin/doxazosin/alfuzosin vs tamsulosin. Additional dose-response analyses were carried out. Differences in the hazard of developing PD identified by diagnoses or use of PD-specific medications between patients who ever used terazosin/doxazosin/alfuzosin or tamsulosin. A cohort of 52 365 propensity score-matched pairs of terazosin/doxazosin/alfuzosin and tamsulosin users were identified in the Danish registries, of which all were male and the mean (SD) age was 67.9 (10.4) years, and 94 883 propensity score-matched pairs were identified in the Truven database, of which all were male and the mean (SD) age was 63.8 (11.1) years. Patients in the Danish cohort who used terazosin/doxazosin/alfuzosin had a hazard ratio (HR) for developing PD of 0.88 (95% CI, 0.81-0.98), and patients in the Truven cohort had an HR of 0.63 (95% CI, 0.58-0.69). There was a dose-response association with short-duration, medium-duration, and long-duration use of terazosin/doxazosin/alfuzosin users having a decreasing HR in both the Danish cohort (short: HR, 0.95; 95% CI, 0.84-1.07; medium: HR, 0.88; 95% CI, 0.77-1.01; long: HR, 0.79; 95% CI, 0.66-0.95) and Truven cohort (short: HR, 0.70; 95% CI, 0.64-0.76; medium: HR, 0.58; 95% CI, 0.52-0.64; long: HR, 0.46; 95% CI, 0.36-0.57). These data suggest that users of terazosin/doxazosin/alfuzosin are at lower hazard of developing PD compared with users of tamsulosin. Future work is needed to further assess this association.

An Exploratory Analysis of Tamsulosin for Overactive Bladder (OAB) in Men With Varying Voiding Symptom Burden

To evaluate tamsulosin (α-blocker therapy) for male overactive bladder (OAB) and to examine if indicators of concomitant benign prostatic hyperplasia are associated with OAB symptom improvement. This was a planned, exploratory analysis of a 4-week, α-blocker (tamsulosin 0.4 mg) run-in phase of the Male Overactive Bladder Trial in Veterans (MOTIVE). Participants with urinary urgency and urinary frequency (> 8 voids/24 hours) completed bladder diaries, answered symptom questionnaires (AUA-7 SI), and had post-void residual and noninvasive uroflowmetry measurement. A total of 116 male Veterans aged 42-88 years with OAB participated. There were statistically significant reductions in voiding frequency (11.3 > 10.0 voids/24 hours, P < .0001), urgency scores (mean 2.5-2.2 points, P < .0001), and nightly nocturia (2.1 > 1.8, P < .001). Only baseline AUA-7 SI total and voiding subscale categories (mild, moderate, severe) were associated with significant reduction in AUA-7 SI total score. For continuous variables, only AUA-7 SI baseline total score was associated with AUA-7 SI storage symptom changes. No other baseline measures were associated with changes in urgency, frequency, or nocturia. Initiation of short course tamsulosin therapy in men was associated with statistical reduction in OAB symptoms. Baseline post-void residual, uroflow rate, and the voiding symptom subscore of the AUA-7 SI were not predictive of OAB symptom improvement with tamsulosin. These findings merits further exploration.

A Case Report of Sleep-Related Painful Erection Successfully Treated with Paroxetine

Sleep-Related Painful Erection (SRPE) is a rare condition characterized by recurrent, painful penile erections occurring when awakening from the Rapid Eye Movement (REM) sleep stage. The cause of SRPE is still unknown, the therapeutic strategies still in an expert-based opinion phase and there is no consensus yet. We present a case of a 23-year-old patient suffering from SRPE for 1 year, the smart bracelet which has a sleep monitoring function showed his sleep was fragmented by awakenings at the end of all the REM period. Several treatments such as tamsulosin and highfrequency hyperthermia therapy and Chinese herbal medicine did not prompt any improvement of his condition, but after taking a single daily dose of paroxetine 20mg for twelves weeks, both the frequency and intensity of SRPE gradually decreased. Even though the antidepressants to which paroxetine belongs were included as one of the abandoned treatments in recent review, in our case, paroxetine showed a long-term and stable effect on patients with SRPE, it indicates that the therapeutic effect of paroxetine on SRPE deserves further study and observation.