Tamsulosin Treatment Research Articles

Efficacy of Conservative Therapy versus Tamsulosin Added Therapy in Patients with Lower Ureteral Calculi and their Health Related Quality of Life

Background: Alpha-1 blockers reduce smooth muscle tension and alleviate spasms, thereby decreasing obstructions and relieving irritative symptoms in the lower urinary tract. This study aimed to assess the effectiveness of Tamsulosin and its impact on health-related quality of life in patients with distal ureteral calculi. Methods: A total of 120 patients with distal ureteral calculi were enrolled in this study and randomly assigned into two groups. Group 1 (n=60) received conservative therapy, while Group 2 (n=60) received Tamsulosin (0.4 mg daily) in addition to conservative therapy. All patients were monitored for pain, intensity of ureteric colic, and spontaneous stone expulsion. Health-related quality of life (HRQoL) was assessed for each patient using the RAND SF-36 Health Survey 1.0. Results: Spontaneous stone passage occurred in 52 patients (85%) in Group 1 and in all 60 patients (100%) in Group 2, with a statistically significant difference between the groups (P<0.001). Analysis by stone diameter further indicated significant differences favoring Tamsulosin treatment for stones ≤6 mm (P=0.04) and >6 mm (P=0.003). Health-related quality of life scores were significantly higher in the Tamsulosin group compared to the conservative therapy group. Conclusion: Tamsulosin, an alpha-1 blocker, is recommended for treating distal ureteral calculi, as it facilitates faster stone expulsion, increases expulsion rates, and enhances quality of life by reducing the frequency and severity of ureteric colic.

Alpha-1 antagonist treatment for eyelid retraction in patients with thyroid eye disease-a prospective pilot study.

Sympathetic overstimulation of Müller's muscle is a suggested mechanism underlying upper eyelid retraction in thyroid eye disease (TED). We examined the effect of tamsulosin, an alpha-1 antagonist, on eyelid retraction in patients with TED. A single-centre prospective study. Patients with TED and associated eyelid retraction were treated with oral 0.4 mg/day tamsulosin for 3 months. Upper eyelid margins-to-reflex distance (MRD1), vertical palpebral fissure height (PFH), subjective improvement, signs and symptoms of dry eye, and lubricants use were assessed at baseline and at each subsequent visit. Eleven suitable patients (mean age 47.5 ± 9.68, 8 females) enrolled in the study. Three patients discontinued the drug due to mild adverse effects (dizziness, bradycardia, nausea, and gastrointestinal distress), which resolved immediately upon stopping treatment. The other eight patients tolerated the drug well and reported no side effects. Five patients experienced an objective improvement in eyelid position and subjective improvement in eye discomfort. The mean MRD1 decreased by -1.04 ± 0.81 mm (P = 0.015), and mean PFH decreased by -1.46 ± 1.33 mm (P = 0.039). Mean duration of tamsulosin treatment was 84.63 ± 71.9 days. Patients discontinued the drug due to no improvement in MRD1 (n = 3), referral for eyelid surgery with stable inactive TED (n = 2), treatment with intravenous methylprednisolone due to worsening active TED (n = 2), and patient choice after 5 months of treatment with spontaneous resolution of symptoms (n = 1). Tamsulosin is a safe potential treatment for eyelid retraction in TED and can be used as a temporary alternative therapeutic approach for patients unsuitable for surgery.

Comparison of the Efficacy of Low Dose Tadalafil with Tamsulosin against Lower Urinary Tract Symptoms and Sexual Dysfunction after Low Dose Rate Prostate Brachytherapy.

Patients with clinically localized prostate cancer (PCa) can be curatively treated with different modalities, including low dose rate (LDR) prostate brachytherapy (PB). LDR-PB allows the patient a relatively short recovery time compared with other treatment modalities such as prostatectomy. However, PB might exert distinct impact on quality of life, lower urinary tract symptoms (LUTS) and sexual dysfunction (SD) are two major concerns. The aim of present study was to assess prospectively the efficacy of low dose tadalafil treatment on both SD and LUTS compared with tamsulosin treatment in patients treated PB for localized PCa. Patients scheduled for PB with I-125 seeds for low or intermediate-risk localized PCa at our institution were eligible for this study. The prescribed dose was set at 160 gray. Participants were randomized into two groups; those started treating with a daily use of 0.2 mg of tamsulosin hydrochloride or 5 mg of tadalafil just after PB. The duration of the study was 12 months and the patients were assessed for urinary and sexual function status at baseline, and 1, 3, 6, and 12 months after PB. The primary study endpoints were both changes from baseline in urinary and sexual function status. Between July 2015 and August 2020, 120 participants were enrolled in this study. The median age was 68 years with the median PSA of 6.5 ng/ml. A total 15 patients were excluded within 6 months after randomization. All subjective LUTS findings, including International Prostate Symptom Score (IPSS), and Over Active Bladder Symptom Score (OABSS), were significantly deteriorated at 1, 3, and 6 months after PB compared with baseline in both groups, respectively (p<0.05). Among objective LUTS findings, a significant decrease in maximum urinary flow rate (Qmax) was found at 1, 3, 6, and 12 months after PB compared with baseline in both groups, respectively (p<0.05). A significant increase in post void residual urine (PVR) was found at 1, 3, and 6 months after PB compared to baseline in tadalafil group, whereas no significant increase was seen in tamsulosin group. There were no statistically significant differences between the 2 groups in scores of the total International Index of Erectile Function (IIEF)-15 and Erection Hardness Score (EHS) before and at 1 month post PB. The EHS was significantly higher in tadalafil group compared with tamsulosin group at 3, 6 and 12 months (p = 0.001, p = 0.004, and p = 0.019, respectively). The EHS after PB in tadalafil group was not significantly decreased from baseline. After LDR-PB, tamsulosin treatment significantly decreased PVR compared with tadalafil. On the other hand, tadalafil contributed to maintain erection hardness compared with tamsulosin.

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.

Factors Affecting the Outcome of Medical Treatment in Cats with Obstructive Ureteral Stones Treated with Tamsulosin: 70 Cases (2018-2022).

Simple SummaryOther than surgical approaches the treatment options for feline ureterolithiasis are limited compared to those of human medicine. After various studies on ureteral muscle relaxation drugs, tamsulosin has been used as a treatment for distal ureteral stones in human medicine. However, the available clinical veterinary data on the efficacy of drugs that relax the ureter are limited. Thus, this study aimed to investigate the factors affecting the outcome of tamsulosin treatment for feline ureterolithiasis. With tamsulosin treatment, the ureteric stone passage was confirmed in 22 out of 70 cats, with a success rate of 31.43%. Negative factors with statistical significance for stone passage in this study were high baseline creatinine levels, female sex, proximal location of stones, and large diameter stones. The results of this study suggest that tamsulosin can be considered for the treatment of ureterolithiasis in cats with small distal ureteral stones. In addition, this study serves as an important reference for determining whether medical treatment of feline ureteral obstruction using tamsulosin can be attempted.The incidence of diseases associated with feline ureteral obstruction is increasing; however, non-surgical treatment options are limited. This study evaluated the outcome of medical treatment in cats with obstructive ureteral stones treated with tamsulosin and identified potential factors predicting spontaneous stone passage. We retrospectively reviewed 70 client-owned cats treated at the Western Referral Animal Medical Center, Seoul, Korea, from 2018 to 2022. All the cats had obstructive ureterolithiasis and were treated using tamsulosin. The baseline characteristics of the cats, stone diameter and location, and stone passage outcomes were analyzed. Stone passage occurred in 22 cats; the remaining 48 cats showed no change in stone locations. Sex, creatinine, and diameter and location of stones were potential risk factors associated with successful stone passage, but age, weight, and side of the stone were not. No serious adverse events related to tamsulosin treatment were observed. This is the first study to identify the risk factors predictive of the spontaneous stone passage of cats with obstructive ureterolithiasis after tamsulosin treatment. Tamsulosin could be an alternative treatment for ureteral obstruction in male cats with smaller distal ureteral stones and low baseline serum creatinine levels. These findings could help develop guidelines for treating feline ureterolithiasis.

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.

Tamsulosin alters the pharmacokinetics of metformin via inhibition of renal multidrug and toxin extrusion protein 1 and organic cation transporter 2 in rats

Among the endocrine and metabolic disorders, type-2 diabetes mellitus (T2DM) and benign prostatic hyperplasia (BPH) are common progressive diseases related to aging. Metformin and tamsulosin as the first-choice drug for patients with T2DM and BPH, respectively, are often co-administered to male patients with T2DM and BPH. However, whether concomitantly administering metformin and tamsulosin leads to drug-drug interactions (DDIs) remains unclear.This study aimed to evaluate the effect of tamsulosin on the pharmacokinetics of metformin and explore the relevant underlying mechanism. The plasma, urine, and tissue concentrations of metformin were analyzed using HPLC, and metformin cell uptake was analyzed using LC-MS/MS. In addition, western blotting was used to investigate the expression of Oct1, Oct2, and Mate1. As demonstrated by comparison with metformin alone, tamsulosin significantly increased the area under concentration-time curves (AUC0−t), the maximum plasma concentration (Cmax) and the decreased 24 h cumulative urinary excretion of metformin after single or multiple-dose administration in rats, as well as increased the kidney tissue concentration of metformin after multiple-dose. In addition, tamsulosin treatment significantly inhibited the expression of Mate1 and Oct2 in rat kidneys, but Oct1 and Mate1 did not show a significant difference in the liver. Consistently, tamsulosin inhibited OCT2 and MATE1 expressions and decreased metformin uptake in HEK293 cells. Notably, serum LCA level in the co-administration group was increased by 34% and 39% after multiple-dose (7 and 14 consecutive days, respectively) administration compared to the metformin alone group. Altogether, our data suggest that tamsulosin could increase systemic exposure and reduce excretion of metformin via inhibiting Oct2 and Mate1-mediated transport cooperatively.

Effects of tamsulosin and tamsulosin+solifenacin combination therapy for the treatment of ureteral stent related lower urinary tract symptoms

Objective: To evaluate the effect of tamsulosin and tamsulosin+ solifenacin combination therapy in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents. Study design: Prospective observational comparative study Place and duration of study: Department of urology & Renal transplantation (dr. psims and rf) from March 2019 to October 2020. Methods: Total 100 patients having lower urinary tract symptoms after DJ stent insertion were selected for the study. DJ stenting was done in these patients following ureterorenoscopy (URS) and intracorporeal lithotripsy, percutaneous nephrolithotomy (PCNL), ureterolithotomy, pyelolithotomy, pyeloplasty and in patients with obstructive uropathy. All the patients were allocated two different groups. Group A received Tamsulosin 0.4 mg & Group B received Tamsulosin 0.4 mg and Solifenacin 5 mg daily once a day every day. The IPSS questionnaire was filled on day of per urethral catheter removal and on the day of DJ stent removal. Results were made on the day of DJ stent removal by comparing the mean change in IPSS in both groups. Independent sample t-test and paired t-test were applied. P-value < 0.05 was taken as significant. Result: Mean age was 41.6±13.75 years in Group-A and 38.24±12.24 years in Group-B. Total number of male patients was 25 (50%) in Group-A and 31 (62%) in Group-B. Female patients in Group-A were 25 (50%) and 19 (38%) in Group-B. Mean IPSS was 9.32 ±2.39 in Group-A and 9.52 ±3.39 in Group-B at baseline (p=0.62). After 2 weeks IPSS was 3.98 ±1.74 in Group-A and 2.36 ±1.51 in Group-B (p=0.0001). There was a statistically significant difference between group A and group B in the IPSS score. Trial registration: The study protocol was registered on Clinical Trials Registry- India (ICMR-NIMS) on April 30th, 2020 (registration number: CTRI/2020/04/024945). Conclusions: The mean change in IPSS by combined treatment of Tamsulosin and Solifenacin was significant when compared to Tamsulosin alone in treatment of DJ stents related LUTS.

A Prospective Study on Evaluation of Efficacy of Combination Therapy of Tamsulosin and Deflazacort In Ureteric Stone Expulsion

The patients with ureteric stone are increasing day by day all over the world. A ureteric stone is a mineral mass in the ureter which may or may not originated in the kidney and travelled down to the ureter. The presence of stone in ureter causes inflammation and edema. There are mainly four types of ureteric stone such as Calcium stones, Uric acid stones, Struvite stone, Cystine stone. About 23-53% of spontaneous stone expulsion occurs where the size of stone is 5-10mm diameter. Tamsulosin is an alpha 1 adrenergic blocker which has a spasmolytic action and thus hasten stone expulsion. Deflazacort is a corticosteroid prodrug which acts on the glucocorticoid receptor to show an anti-inflammatory effect. Deflazacort decreases the edema and when prescribed along with alpha 1 adrenergic receptor blocker it facilitate the expulsion of calculi. This study was conducted in 20 patients diagnosed with ureteric calculi. The study was conducted by using suitable proforma for collecting various data’s like site of stones, presence of hydronephrosis, signs and symptoms. Health related quality of life of the patients with ureteric calculi under the treatment of Tamsulosin and Deflazacort combination were assessed by using Wisconsin Stone-QOL questionnaire. As counselling aid patients information leaflet was provided. The patients were asked to review after 10 days of taking the medication. At the end of the study all the parameters and scores were compared with baseline to the end of the study. In our study we analyzed that the data collected from 20 patients diagnosed with ureteric calculi accessed the improvement of quality of life of patients under the treatment of Tamsulosin and Deflazacort combination by using Wisconsin Stone-QOL questionnaire. The observed difference before and after the treatment with Tamsulosin and Deflazacort w

Preventive effects of tamsulosin for postoperative urinary retention after lower limb arthroplasty: A randomized controlled study.

PurposeThis prospective, randomized, controlled study investigated the use of tamsulosin, a selective alpha-blocker, as a prophylactic medication to prevent postoperative urinary retention (POUR) following lower limb arthroplasty.Materials and MethodsThe criterion for diagnosing POUR was used a postoperative bladder volume over 400 mL with incomplete emptying. Patients who underwent primary total hip or knee arthroplasty were randomly assigned at a 1:1 ratio to tamsulosin treatment and non-treatment groups at a single center from September 2018 to November 2018. The treatment group received 0.2 mg of tamsulosin orally once at night for 3 days starting on postoperative day 1. During this 3-day period, an indwelling Foley catheter was maintained. The incidence of POUR according to tamsulosin treatment following lower limb arthroplasty was the primary outcome.ResultsIn total, 100 patients were enrolled, of whom 5 discontinued participation. POUR was diagnosed in 20 of the remaining 95 patients (21.1%). The treatment group contained 48 patients, of whom 6 (12.5%) developed POUR, whereas POUR occurred in the 14 of the 47 patients (29.8%) in the non-treatment group. Tamsulosin treatment reduced the risk of POUR by two-thirds (odds ratio [OR], 0.337; 95% confidence interval [CI], 0.117–0.971; p=0.044). The risk reduction associated with tamsulosin treatment remained robust post-adjustment for potential covariates (OR, 0.250; 95% CI, 0.069–0.905; p=0.038).ConclusionsTamsulosin administration immediately after lower limb arthroplasty reduced the incidence of urinary retention and diminished the need for long-term catheterization.

Cost analysis of alpha blocker treatments for benign prostatic hyperplasia in Medicare beneficiaries.

Tamsulosin is the most widely used alpha-1 blocker medication for managing benign prostatic hyperplasia (BPH) as indicated in the current practice guideline. The aim of this study was to compare all-cause medical costs and BPH-specific medical costs in older male adults with BPH treated with tamsulosin vs other alpha-1 blockers (i.e., doxazosin, terazosin, and alfuzosin). This was a retrospective propensity-score matched cohort study based on 2006-2012 Medicare claims data. All-cause medical costs and BPH-specific medical costs were compared between tamsulosin and other alpha-1 blockers treatment groups using baseline-adjusted quantile regression analyses. The comparisons were performed at different percentiles of the cost distributions. 176,793 older male adults with BPH who used alpha-1 blockers were included in the analysis. All-cause medical costs in 75th and 95th percentiles of the cost distribution are substantially higher in tamsulosin treatment group when compared to other alpha-1 blocker medications (p<0.05 for all). Tamsulosin treatment group had substantially higher BPH-specific medical costs in 99th percentile of the cost distribution when compared to doxazosin and terazosin (p<0.001 for all). Overall, the top 5% of the patients with the highest all-cause medical costs accounted for approximately 45% of the overall all-cause medical costs, and the top 1% of the patients with the highest BPH-specific medical costs accounted for 39-51% of those costs. Older adults with BPH who encountered higher medical expenses had substantially higher medical costs when treated with tamsulosin than other common alpha blockers. Cost-related quality of measures should be assessed to improve health outcomes in older adults with BPH.

Periprostatic fat thickness measured on MRI correlates with lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia progression.

This study investigated the correlation between periprostatic fat thickness (PPFT) measured on magnetic resonance imaging and lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia (BPH) progression. A total of 286 treatment-naive men diagnosed with BPH in our department between March 2017 and February 2019 were included. Patients were divided into two groups according to the median value of PPFT: high (PPFT >4.35 mm) PPFT group and low (PPFT <4.35 mm) PPFT group. After the initial evaluation, all patients received a combination drug treatment of tamsulosin and finasteride for 12 months. Of the 286 enrolled patients, 244 completed the drug treatment course. Patients with high PPFT had larger prostate volume (PV; P = 0.013), higher International Prostate Symptom Score (IPSS; P = 0.008), and lower five-item version of the International Index of Erectile Function (IIEF-5) score (P = 0.002) than those with low PPFT. Both high and low PPFT groups showed significant improvements in PV, maximum flow rate, IPSS, and quality of life score and a decrease of IIEF-5 score after the combination drug treatment. The decrease of IIEF-5 score was more obvious in the high PPFT group than that in the low PPFT group. In addition, more patients in the high PPFT group underwent prostate surgery than those in the low PPFT group. Moreover, Pearson's correlation coefficient analysis indicated that PPFT was positively correlated with age, PV, and IPSS and negatively correlated with IIEF-5 score; however, body mass index was only negatively correlated with IIEF-5 score.

P-02-50 Is Tamsulosin Completely Safe in Elderly Patients? Ignored Danger: The Arrhythmogenic Effect

The incidence of Benign Prostate Hyperplasia (BPH) increases with age. Due to advanced age, the drug-related side effects are more critical in those patients. Therefore, we aimed to evaluate the potential adverse effect of Tamsulosin regarding cardiac arrhythmias Between May and June 2017, 835 patients complain about BPH, were evaluated prospectively. Patients, who have cardiovascular or endocrine diseases were excluded. We statted Tamsulosin treatment in 55 patients, who met the study's criteria. After three week of treatment, electrocardiography (ECG) obtained from 37 patients. Control group formed from patients who had not started medication yet. P wave dispersions (PWD) were evaluated in patient´s ECG and, pre/post treatment PWD compared. The PWD calculated by finding the difference between the largest and narrowest P-waves in the ECG. The mean age was 53.6 ± 8 years. Mean PWD before the administration of tamsulosin was 55 ms (30-75), while PWD was 60 ms (45-70) after three weeks of Tamsulosin treatment.

Haemodynamic effects of the flavonoid quercetin in rats revisited.

Background and PurposeThe flavonoid quercetin increased the in vitro potency of the α1‐antagonist tamsulosin to reduce phenylephrine‐dependent arterial contractions by 10‐fold. To examine if this supplement–drug interaction luxates hypotensive and orthostatic events in vivo, several set of studies were conducted in spontaneously hypertensive (SHR) and normotensive (Wistar Kyoto [WKY]) rats.Experimental ApproachFirst, in rats pretreated with quercetin or its vehicle, responses to phenylephrine and tamsulosin were examined. Second, tamsulosin‐induced changes in renal, mesenteric, hindquarter and carotid conductance were compared in quercetin‐ and vehicle‐treated rats instrumented with Doppler flow probes. Animals were also placed on a tilt table to record regional haemodynamic changes to orthostatic challenges. Third, adult SHR were instrumented with telemeters to measure 24‐hr patterns of BP. Recordings were made before and during a 5‐week oral treatment of quercetin. Finally, pre‐hypertensive SHR were treated with quercetin from 4 to 8 weeks of age and arterial pressure was measured at 8 and 12 weeks.Key ResultsPretreatment with quercetin did not influence the responses to phenylephrine and tamsulosin, in neither WKY nor SHR. While tamsulosin treatment and tilting lowered BP and increased conductance in all vascular beds, effect size was not influenced by pretreatment with quercetin. Prolonged treatment with quercetin, in either prehypertensive SHR or adult SHR with established hypertension did not lower BP.Conclusions and ImplicationsCumulatively, these data demonstrate that quercetin does not amplify haemodynamic effects of tamsulosin or tilting in vivo in rats and has no effect on BP development in SHR.

Treatment persistence with a fixed-dose combination of tadalafil (5 mg) and tamsulosin (0.4 mg) and reasons for early discontinuation in patients with benign prostatic hyperplasia and erectile dysfunction.

PurposeThe primary aim of this study was to assess treatment persistence with a fixed-dose combination (FDC) of tadalafil (5 mg) and tamsulosin (0.4 mg). This study also evaluated the reasons for early treatment discontinuation.Materials and MethodsThis retrospective observational study included patients with benign prostatic hyperplasia and erectile dysfunction who started an FDC treatment of tadalafil (5 mg) and tamsulosin (0.4 mg) between July 2017 and February 2018. Treatment persistence and reasons for early discontinuation were evaluated during the first 6 months. The cumulative discontinuation rate and differences in various parameters were assessed using Kaplan–Meier analysis and the log-rank test, respectively. Factors related to persistence were analyzed using a Cox proportional hazard model.ResultsOverall, 97 patients were included in the study. The cumulative persistence rate at 30, 90, and 180 days was 88.7%, 66.0%, and 54.6%, respectively. The cumulative persistence over 6 months differed significantly according to the administration of FDC therapy (log-rank p=0.005) and age (log-rank p=0.024). Younger patients (odds ratio, 2.049; p=0.021) and treatment-naive patients (odds ratio, 2.461; p=0.006) were more likely to discontinue therapy within 6 months. The common reasons for discontinuing therapy were side effects (63.6%) and perceived poor efficacy (22.7%).ConclusionsSide effects were reported to be the main reason for treatment discontinuation. Thus, to improve compliance for a once-daily FDC of tadalafil (5 mg) and tamsulosin (0.4 mg), it is recommended to select patients who show adaptation to a combination of α-blockers and phosphodiesterase type 5 inhibitors prior to FDC treatment.

Nutraceutical treatment and prevention of benign prostatic hyperplasia and prostate cancer.

During the last years, pharmaceutical innovations in primary care are dramatically less frequent and will be even more rare in the next future. In this context, preclinical and clinical research oriented their interest toward natural compounds efficacy and safety, supporting the development of a new "nutraceutical" science. Medicinal plants, in the form of plant parts or extracts of them, are commonly used for the treatment of prostate diseases such as benign hypertrophy, prostatitis and chronic pelvic pain syndrome. The pharmacological properties searched for the treatment of prostatic diseases are anti-androgenic, anti-estrogenic, antiproliferative, antioxidant and anti-inflammatory. The most studied and used medicinal plants are Serenoa repens, Pygeum africanum and Urtica dioica. Other promising plants are Cucurbita pepo, Epilobium spp, Lycopersum esculentum, Secale cereale, Roystonea regia, Vaccinium macrocarpon. In parallel, epidemiological studies demonstrated that diet may play an important role on incidence and development of prostatic diseases. The Mediterranean diet is rich of elements with anti-oxidant properties that act as a protective factor for prostatic cancer. Similarly, low intake of animal protein, high intake of fruits and vegetable, lycopene and zinc are a protective factor for benign prostatic hyperplasia (BPH). Serenoa repens in the treatment of symptoms of BPH has been tested either alone or, more frequently, in combination with other medicinal plants, alpha-blockers and inhibitors of 5- alpha reductase (5-ARI). Recent meta-analyses found the effectiveness of Serenoa repens similar or inferior of that of finasteride and tamsulosin but clearly higher than that of placebo in the treatment of mild and moderate low urinary tract symptoms (LUTS), nocturia and discomfort. Clinical trials showed potential synergistic effect of Serenoa repens with other medicinal plants and drugs. In addition to Serenoa repens, there are many other medicinal plants for which clinical evidence is still controversial. Urtica dioica, Pygeum africanum and Curcubita pepo can be considered as an adjunct to the common therapies and their use is supported by studies showing improvement of symptoms and flowmetric indices. Lycopene and selenium are natural products with antioxidant and anti-inflammatory action. The combination of lycopene and selenium with Serenoa repens was able to reduce inflammation in histological prostate sections and to further improve symptom scores and urinary flow in patients with BPH on tamsulosin treatment. Similar effects could be obtained with the use of other carotenoids, such as astaxanthin, and/or zinc. Efficacy on symptoms of patients with BPH of some polyphenols such as quercitin, equol and curcumin have been demonstrated by clinical studies. Pollen extract is a mixture of natural components able to inhibit several cytokines and prostaglandin and leukotriene synthesis resulting in a potent anti-inflammatory effect. Pollen extracts significantly improve symptoms, pain, and quality of life in patients affected by chronic pelvic pain syndrome and chronic prostatitis. Beta-sitosterol is a sterol able to improve urinary symptoms and flow measures, but not to reduce the size of the prostate gland. Palmitoylethanolamide (PEA) is an endogenous fatty acid amide-signaling molecule with anti-inflammatory and neuroprotective effects that can have an interesting role in the management of chronic pelvic pain syndrome and chronic urological pain. Finally, several plant-based products have been subjected to preclinical, in vitro and in vivo, investigations for their potential pharmacological activity against prostate cancer. Some epidemiological studies or clinical trials evaluated the effects of beverages, extracts or food preparations on the risk of prostate cancer. Some plant species deserved more intense investigation, such as Camelia sinensis (green or black tea), Solanum lycopersicum (common tomato), Punica granatum (pomegranate), Glycine max (common soy) and Linum usitatissimum (linen).

Modified Corneal Incisions for Cataract Surgery in Patients Treated with Tamsulosin: A Prospective Study

ABSTRACTPurpose: To evaluate modified anterior elongated corneal incisions as a simple technique to reduce the incidence and severity of intraoperative floppy iris syndrome (IFIS), in patients taking tamsulosin (a selective α1a-adrenergic receptor antagonist).Methods: This prospective case series was conducted at Meir Medical Center, a tertiary care facility in Israel. Included were 45 eyes of 39 male patients taking tamsulosin, and thus prone to IFIS. Patients underwent phacoemulsification cataract surgery with anterior elongated corneal incisions. The primary outcomes were the incidence and severity of IFIS, the complication rate and the need for additional IFIS management techniques. The secondary outcome was to quantify the surgically induced astigmatism, using Alpin’s vector analysis. The tamsulosin treatment period and pupil diameter during five stages of the surgery were also noted.Results: The overall rate of IFIS was 33.33% (n = 15). The IFIS severity was rated as mild in 22.22% and moderate in 11.11% of the study eyes. No IFIS was noted in 66.67% of the eyes. There were no cases of severe IFIS, and no need for other IFIS management strategies. The complications rate was 2.22% (n = 1). Patients who developed IFIS had a significantly smaller pupil at the beginning of surgery (p < 0.05). There was no significant difference in tamsulosin treatment period between patients with and without IFIS (p = 0.19). The centroid – the mean SIA vector was 0.51 D @ 18° ±1.5 D (SD).Conclusions: In tamsulosin treated patients, using modified corneal incisions may be feasible in order to reduce the incidence and severity of IFIS during cataract surgery. Future randomized studies are warranted.

Efficacy of tadalafil against lower urinary tract symptoms after low-dose-rate brachytherapy in prostate cancer patients

Objectives: This study was performed to evaluate the effects of addition of tadalafil to tamsulosin in the treatment of brachytherapy patients with lower urinary tract symptoms (LUTS). Methods: Localized prostate cancer patients who developed LUTS after low-dose-rate brachytherapy (LDR-BT) were first treated with alpha-1 blockers (tamsulosin, 0.2 mg per day). Those still suffering from LUTS were additionally treated with phosphodiesterase type 5 inhibitor (tadalafil, 5 mg/day). LUTS was evaluated by the International Prostate Symptom Score (IPSS), IPSS Quality of Life (QOL) score, Overactive Bladder Symptom Score (OABSS), and the International Index of Erectile Function 5 (IIEF5) score before brachytherapy, before treatment with tadalafil, and after three months of treatment with tadalafil. Results: Twenty-three patients were enrolled in the study. Each subscore of the IPSS (storage symptom, voiding symptom, and postvoiding symptom) and the QOL score improved, but OABSS and IIEF5 did not show significant recovery after addition of tadalafil treatment. When patient characteristics and each question score were surveyed, time from seed implantation until treatment with tadalafil showed the strongest correlation with recovery. Conclusions: Addition of tadalafil to tamsulosin treatment was effective against LUTS in localised prostate cancer patients after brachytherapy. Evidence level: 2b

Male patients with a higher frequency of nocturnal urinary episodes are more likely to benefit from alpha-blocker therapy for bothersome nocturia.

This retrospective study investigated the therapeutic effects of alpha-blockers on men with lower urinary tract symptoms (LUTS) to identify baseline variables that may predict therapeutic response in terms of nocturia improvement. The study included 348 men with LUTS, including bothersome nocturia, treated with tamsulosin 0.4 mg at bedtime (h.s.) for 3 months. Responders were defined as patients with a decrease of ≥1 nocturia episodes/night after alpha-blocker therapy. Nocturnal urinary frequency, International Prostate Symptom Score (IPSS) voiding and storage scores, as well as the voiding to storage (V/S) ratio, prostate measurements, uroflowmetry, and post-void residual were determined at baseline and 1 and 3 months after alpha-blocker therapy. The overall response rate was 44.8% (156/348). Nocturia improved in 60 patients (17.2%) reporting a reduction of ≥2 episodes/night and in 96 patients (27.6%) reporting a reduction of 1 episode/night. Total and storage IPSS scores, the IPSS V/S ratio and the number nocturia episodes were higher in responders than non-responders. IPSS storage subscores and nocturia episodes were significantly greater, whereas IPSS V/S ratio and maximum flow rate (Qmax ) were lower, in those with a reduction of ≥2 versus 1 episode/night. Multivariate analysis revealed that nocturia episodes and a lower V/S ratio were predictors of responders with an improvement of ≥2 episodes/night. The quality of life index improved significantly more in responders than non-responders. Tamsulosin treatment (0.4 mg, h.s.) for 3 months not only improved voiding and storage symptoms, but also reduced nocturia episodes. Patients with more nocturia episodes may benefit more from alpha-blocker treatment in terms of reducing the number of nocturia episodes.

Study of the Effect of Tamsulosin HCl (an Alpha-1 Receptor Antagonist) as a Medical Expelling Agent on Subsequent Ureteroscopic Procedure for Treatment of Lower Ureteric Stones

AbstractBackground: Tamsulosin is an a-1A-specific blocker which induces selective relaxation of ureteral smooth muscle with subsequent inhibition of ureteral spasms and dilatation of the ureteral lumen and facilitates stone expulsion.Aim of the Study: In this prospective randomized study we aimed to assess the efficacy of use of alpha blocker (tamsulosin Hcl 0.4mg) on the outecome of ureteroscopic lithotripsy for distal ureteric stone.Patients and Methods: In a prospective study by a rand-omized controlled clinical trial, which was performed from September 2016 to March 2017, about 50 patients underwent ureteroscopic lithotripsy with the pneumatic wolf lithotripsy. The patients were randomly divided into 2 groups: The study group including 25 patients, received tamsulosin with our traditional treatment (hydration and analgesic when required), and the control group with 25 patients who received placebo with traditional treatment. Patients prospectively will be evaluated for stone clearing rate by imaging at morning of URSL and at the end of 2nd week including: (KUB and pelvi abdominal ultrasound)and they will be evaluated for number of colic episodes, analgesic consumption and post-operative complications (haematuria and UTI).Results: The results showed that tamsulosin treatment group had short time of the procedure, easy extraction of the stone fragments, had low expulsion time, low urinary tract symptoms, least analgesic needs and low adverse effects.Conclusions: Administration of a-1A-specific antagon istmade the procedure of short time, easy extraction of the stone fragments reduced analgesic dosage and colic episodes, rate of adverse effects after ureteroscopic lithotripsy of lower ureteral stones and decreased gravel expulsion time after URSL.