Tamsulosin Treatment Research Articles

Effects of diltiazem, a moderate inhibitor of CYP3A4, on the pharmacokinetics of tamsulosin in different CYP2D6 genotypes.

Tamsulosin, a selective antagonist of the α1-adrenoceptor, is primarily metabolized by CYP3A4 and CYP2D6, and tamsulosin exposure is significantly increased according to the genetic polymorphism of CYP2D6. In this study, we investigated the effects of diltiazem, a moderate inhibitor of CYP3A4, on the pharmacokinetics of tamsulosin in subjects with different CYP2D6 genotypes. Twenty-three healthy Korean male subjects with CYP2D6*wt/*wt (*wt = *1 or *2) and CYP2D6*10/*10 were enrolled in the prospective, open-label, two-phase parallel pharmacokinetic study. On the first day of study (day 1), each subject received a single 0.2mg oral dose of tamsulosin. After a washout period of 1week, on day 8, the subjects were given a 60mg oral dose of diltiazem three times daily for four days. On day 10, 1h after the morning dose of diltiazem, they received a single 0.2mg oral dose of tamsulosin. The pharmacokinetic parameters of tamsulosin in those with and without diltiazem treatment were compared in subjects with different CYP2D6 genotypes. After diltiazem treatment, the Cmax and AUCinf of tamsulosin in each CYP2D6 genotype group were significantly increased (p < 0.0001 for all). The CL/F of tamsulosin was also significantly decreased after diltiazem treatment (both p < 0.0001). However, diltiazem did not affect the t1/2 of tamsulosin in each genotype group. In conclusion, diltiazem significantly increases exposure to tamsulosin regardless of the genotype of CYP2D6. Dose adjustment in the daily maintenance dose of tamsulosin may improve tolerability and safety in patients receiving diltiazem.

Effects of combined treatment of tadalafil and tamsulosin on bladder dysfunction via the inhibition of afferent nerve activities in a rat model of bladder outlet obstruction.

To investigate the effects of combined treatment of tadalafil (a phosphodiesterase-5 inhibitor) and tamsulosin (an α1-adrenoceptor antagonist) on bladder dysfunction in a rat model of bladder outlet obstruction (BOO). Cystometry was performed in conscious female BOO rats 6weeks after partially ligation of the urethra. Either tadalafil (0.03, 0.1 and 0.3mg/kg) or tamsulosin (0.001, 0.003 and 0.01mg/kg) was cumulatively applied intravenously at 30-min intervals to examine changes in cystometric parameters and blood pressures. Changes in cystometric parameters and blood pressures were also checked when tadalafil (0.3mg/kg), tamsulosin (0.003mg/kg) or both were intravenously applied. In BOO rats, application of either tadalafil (0.3mg/kg) or tamsulosin (0.003, 0.01mg/kg) alone significantly increased threshold pressures and intercontraction intervals whereas there were no significant changes in other cystometric parameters. In addition, because a significant reduction in blood pressures was detected after the administration of tamsulosin (0.01mg/kg), tamsulosin at a lower dose (0.003mg/kg) was used for the combined treatment. The combination therapy of tadalafil and tamsulosin induced a significantly larger rate of increase in intercontraction intervals (1.7 times) compared with monotherapy of either drug (1.3 times each) although the combined therapy did not affect blood pressures. These results suggest that the combination therapy of tadalafil and tamsulosin can induce the additive inhibitory effects on urinary frequency compared with monotherapy, more likely via inhibition of the afferent limb of micturition reflex rather than the efferent function as evidenced by the increases in threshold pressures and intercontraction intervals without affecting bladder contractile function.

Early Versus Late Trail of Catheter Removal in Patients with Urinary Retention Secondary to Benign Prostatic Hyperplasia under Tamsulosin Treatment

Objective: The main objective of this study is to evaluate the impact of early and late removal of urinary catheter after acute urine retention (AUR) in patients with benign prostatic hyperplasia (BPH) under tamsulosin treatment on the success of trial without catheter (TWOC). Materials and Methods: This is a prospective randomized study, 60 men with AUR secondary to BPH, after fulfilling the inclusion criteria in the absence of the exclusion criteria of the study were catheterized and then were randomly assigned to receive 0.4 mg tamsulosin hydrochloride for 3 days or 7 days, after that the catheter was removed and the ability to void unaided assessed. Results: Eighteen men taking tamsulosin for 3 days and 21 patients taking tamsulosin for 7 days did not require recatheterization on the day of the TWOC (60% and 70%, respectively, P = 0.417). Complication as urinary tract infection, urine leakage, hematuria, or catheter obstruction occurred in five (16.7%) men who received tamsulosin for 3 days and 13 (43.3%) men who received tamsulosin for 7 days (P = 0.024). Conclusions: Men catheterized for AUR can void successfully after catheter removal if treated with alpha-1 blockade, and success rate of TWOC is controversial regarding the duration of catheterization. However, the complications were increased with period of catheterization.

Afferent Pathway-Mediated Effect of α1 Adrenergic Antagonist, Tamsulosin, on the Neurogenic Bladder After Spinal Cord Injury.

PurposeThe functions of the lower urinary tract (LUT), such as voiding and storing urine, are dependent on complex central neural networks located in the brain, spinal cord, and peripheral ganglia. Thus, the functions of the LUT are susceptible to various neurologic disorders including spinal cord injury (SCI). SCI at the cervical or thoracic levels disrupts voluntary control of voiding and the normal reflex pathways coordinating bladder and sphincter functions. In this context, it is noteworthy that α1-adrenoceptor blockers have been reported to relieve voiding symptoms and storage symptoms in elderly men with benign prostatic hyperplasia (BPH). Tamsulosin, an α1-adrenoceptor blocker, is also considered the most effective regimen for patients with LUT symptoms such as BPH and overactive bladder (OAB). MethodsIn the present study, the effects of tamsulosin on the expression of c-Fos, nerve growth factor (NGF), and nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) in the afferent micturition areas, including the pontine micturition center (PMC), the ventrolateral periaqueductal gray matter (vlPAG), and the spinal cord (L5), of rats with an SCI were investigated. ResultsSCI was found to remarkably upregulate the expression of c-Fos, NGF, and NADPH-d in the afferent pathway of micturition, the dorsal horn of L5, the vlPAG, and the PMC, resulting in the symptoms of OAB. In contrast, tamsulosin treatment significantly suppressed these neural activities and the production of nitric oxide in the afferent pathways of micturition, and consequently, attenuated the symptoms of OAB. ConclusionsBased on these results, tamsulosin, an α1-adrenoceptor antagonist, could be used to attenuate bladder dysfunction following SCI. However, further studies are needed to elucidate the exact mechanism and effects of tamsulosin on the afferent pathways of micturition.

MP82-15 THE AMELIORATIVE POTENTIAL OF TAMSULOSIN ON BLADDER FUNCTION IN A RAT MODEL OF CHRONIC PELVIC ISCHEMIA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Basic Research & Pathophysiology II1 Apr 2017MP82-15 THE AMELIORATIVE POTENTIAL OF TAMSULOSIN ON BLADDER FUNCTION IN A RAT MODEL OF CHRONIC PELVIC ISCHEMIA Norifumi Sawada, Satoru Kira, Tatsuya Ihara, Takanori Mochizuki, Yuki Imai, Hiroshi Nakagomi, Takahiko Mitsui, Karl-Erik Andersson, and Masayuki Takeda Norifumi SawadaNorifumi Sawada More articles by this author , Satoru KiraSatoru Kira More articles by this author , Tatsuya IharaTatsuya Ihara More articles by this author , Takanori MochizukiTakanori Mochizuki More articles by this author , Yuki ImaiYuki Imai More articles by this author , Hiroshi NakagomiHiroshi Nakagomi More articles by this author , Takahiko MitsuiTakahiko Mitsui More articles by this author , Karl-Erik AnderssonKarl-Erik Andersson More articles by this author , and Masayuki TakedaMasayuki Takeda More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2562AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The exact etiology of LUTS in human is still poorly understood. Alpha1-blockers are widely used in the treatment of LUTS associated with BPH. Tamsulosin has been reported to possess a potential of increasing blood flow in bladder microcirculation. Using a characterized rat model of chronic pelvic ischemia, we have studied the ameliorating potential of tamsulosin on the changes in bladder function caused by chronic ischemia. METHODS Chronic pelvic ischemia (CPI) was induced by causing bilateral endothelial injury of both iliac arteries and feeding a 2% cholesterol diet. A total of 60 male Sprague Dawley rats (18 weeks old) were divided into three groups: Control, CPI, and CPI-tamsulosin. The Control group received a regular diet and the CPI-tamsulosin group received tamsulosin (10 mg/kg/day) for 8 weeks. Eight weeks after surgery, half of the rats in the Control, CPI and CPI-tamsulosin groups were examined by cystometry and sacrificed for organ bath study. The other half of the rats from each group was examined 16 weeks after surgery (the CPI-tamsulosin group were continued treatment in the latter half of 8 weeks). RESULTS The iliac arteries from the AI showed neo-intimal proliferation and vascular occlusion. This was not prevented by tamsulosin treatment. After 8 weeks, there was no difference between CPI and CPI-tamsulosin groups in micturition interval (MI), bladder capacity (Bcap), and voiding volume (VV). Those parameters in both groups were significantly less than in the Control group (P<0.05). After 16 weeks, those parameters were improved in CPI-tamsulosin group without changing other parameters. CONCLUSIONS Tamsulosin treatment improved voiding function in rats with established chronic pelvic ischemia. The translational impact of this finding would be worth further study for improving the bladder function. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1102-e1103 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Norifumi Sawada More articles by this author Satoru Kira More articles by this author Tatsuya Ihara More articles by this author Takanori Mochizuki More articles by this author Yuki Imai More articles by this author Hiroshi Nakagomi More articles by this author Takahiko Mitsui More articles by this author Karl-Erik Andersson More articles by this author Masayuki Takeda More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

458 Concomitant tamsulosin and silodosin treatment is not associated with a better clinical outcome or an increased stone free rate in patients treated with ESWL: A randomized-placebo controlled study

458 Concomitant tamsulosin and silodosin treatment is not associated with a better clinical outcome or an increased stone free rate in patients treated with ESWL: A randomized-placebo controlled study

Effect of Tamsulosin in Lower Urinary Tract Symptom Patients With Metabolic Syndrome

To investigate the efficacy of tamsulosin, a selective alpha-1 blocker, in lower urinary tract symptoms (LUTS) patients with metabolic syndrome (MS). This prospective, multicenter clinical trial included men and women (20-75 years old) with LUTS, with or without MS. Patients were categorized as MS+ or MS-, respectively, and all of them were administered tamsulosin 0.2 mg per oral once daily for 24 weeks. Patients were assessed based on the International Prostate Symptom Score, King's Health Questionnaire (KHQ), Overactive Bladder Questionnaire, uroflowmetry with postvoid residuals, and MS factors (blood pressure, waist-to-hip ratio, and serum levels of fasting blood glucose, triglyceride, and high-density lipoprotein cholesterol) at baseline and at 4, 12, and 24 weeks of treatment. Ninety-two patients were enrolled in this study (53/92 were MS- [57.6%]; 39/92 were MS+ [42.4%]). After 24 weeks of tamsulosin treatment, fasting blood glucose (P = .02) and triglyceride (P < .001) levels of changes were significantly greater in the MS+ group than in the MS- group. Total International Prostate Symptom Score, total Overactive Bladder Questionnaire score, and the scores of each question on the KHQ showed significant improvement after treatment without intergroup differences. In KHQ, although improvements in emotional status, sleep quality, fatigue, and personal distress were greater in the MS+ group (P = .05), the difference between the groups did not reach statistical significance. Tamsulosin was effective in both LUTS patients with and without MS. Furthermore, tamsulosin had beneficial effects on some of the factors associated with MS.

Tamsulosin Treatment Affecting Patient-reported Outcomes in Benign Prostatic Hyperplasia-associated Depressive Symptoms

To investigate the effect of tamsulosin on LUTS and depressive symptoms among depressed and nondepressed individuals previously diagnosed with benign prostatic hyperplasia. The study conducted from July 2013 to June 2014 included outpatient participants with benign prostatic hyperplasia presenting with lower urinary tract symptoms (LUTS). One tablet of tamsulosin (0.2 mg) was administered to patients daily. We divided participants with geriatric depression scale (GDS) scores of 0-17 into the nondepressive symptom group (group 1) and those with GDS scores of 18-30 into the depressive symptom group (group 2). At the first visit (V1), 4th week (V2), and 12th week (V3), the International Prostate Symptom Score (IPSS), quality of life (QoL), patient perception of bladder condition, overactive bladder syndrome symptom score, and GDS questionnaires were administered. IPSS (17.35 ± 7.11 vs 14.61 ± 6.04, P = .10) as well as GDS scores (20.97 ± 3.07 vs 8.84 ± 4.50, P < .01) were higher among those with depressive symptoms than those without, and difference between the two groups was not represented. After taking tamsulosin, on the V2 and V3, both groups had improved overactive bladder syndrome symptom scores, patient perception of bladder condition, IPSS, QoL, and GDS. Comparing the first visit with the V2 and V3, group 2 showed significant changes in GDS, but group 1 did not. Treatment with tamsulosin is associated with improved LUTS and decreased depressive symptoms, which could enhance QoL.

Elucidation of the Pattern of the Onset of Male Lower Urinary Tract Symptoms Using Cluster Analysis: Efficacy of Tamsulosin in Each Symptom Group

To present a new grouping of male patients with lower urinary tract symptoms (LUTS) based on symptom patterns and clarify whether the therapeutic effect of α1-blocker differs among the groups. We performed secondary analysis of anonymous data from 4815 patients enrolled in a postmarketing surveillance study of tamsulosin in Japan. Data on 7 International Prostate Symptom Score (IPSS) items at the initial visit were used in the cluster analysis. IPSS and quality of life (QOL) scores before and after tamsulosin treatment for 12weeks were assessed in each cluster. Partial correlation coefficients were also obtained for IPSS and QOL scores based on changes before and after treatment. Five symptom groups were identified by cluster analysis of IPSS. On their symptom profile, each cluster was labeled as minimal type (cluster 1), multiple severe type (cluster 2), weak stream type (cluster 3), storage type (cluster 4), and voiding type (cluster 5). Prevalence and the mean symptom score were significantly improved in almost all symptoms in all clusters by tamsulosin treatment. Nocturia and weak stream had the strongest effect on QOL in clusters 1, 2, and 4 and clusters 3 and 5, respectively. The study clarified that 5 characteristic symptom patterns exist by cluster analysis of IPSS in male patients with LUTS. Tamsulosin improved various symptoms and QOL in each symptom group. The study reports many male patients with LUTS being satisfied with monotherapy using tamsulosin and suggests the usefulness of α1-blockers as a drug of first choice.

MP41-05 PERINATAL OUTCOMES WITH TAMSULOSIN THERAPY FOR SYMPTOMATIC UROLITHIASIS

You have accessJournal of UrologyStone Disease: Medical Therapy1 Apr 2015MP41-05 PERINATAL OUTCOMES WITH TAMSULOSIN THERAPY FOR SYMPTOMATIC UROLITHIASIS George Bailey, Lisa Vaughan, Eric Bergstralh, Carl Rose, and Amy Krambeck George BaileyGeorge Bailey More articles by this author , Lisa VaughanLisa Vaughan More articles by this author , Eric BergstralhEric Bergstralh More articles by this author , Carl RoseCarl Rose More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1633AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Medical expulsive therapy (MET) has been demonstrated to be safe and effective in the nonpregnant stone former. Tamsulosin is classified by the FDA as a category B medication, with no published data on human pregnancy. Our objective was to explore the safety of tamsulosin as MET for symptomatic urolithiasis during pregnancy. METHODS We retrospectively identified patients with documented tamsulosin treatment for stone disease during pregnancy managed at Mayo Clinic during the 2000-2014 interval through a minimum of 90 days postpartum (MET group). The MET cohort was matched 2:1 with a group of pregnant women with symptomatic urolithiasis during pregnancy who did not receive MET (control group) for maternal age, smoking during pregnancy, requirement for antepartum surgical procedure, and delivery < 37 weeks. Groups were compared using t-tests and Wilcoxon tests for continuous variables and Chi-square and Fisher's exact tests for nominal variables. Additionally, exact conditional logistic regression and linear mixed models were fit in order to account for matching. RESULTS A total of 28 patients receiving MET were identified, of whom 20 (71%) had urolithiasis documented on imaging and 23 (82%) demonstrated hydronephrosis. Median duration of in-utero exposure to tamsulosin was 3 days (range 1, 110), with timing of exposure in the first, second and third trimester in 3 (11%), 10 (36%), and 19 (68%) patients respectively. Surgical intervention was required for refractory renal colic in 13 (46%) patients (6 (21%) ureteral stent, 6 (21%) ureteroscopy, and 1 (4%) nephrostomy tube). Mean maternal age at delivery was 28.4 (SD 4.15) years at a mean gestational age of 38.2 weeks (SD 2.4); 4 infants (14%) were born preterm. The cesarean delivery rate was 43% (11 patients). Mean APGAR scores were 8.5 (1 minute) and 8.9 (5 minutes), and birthweight 3.47 kilograms (SD 0.88). All infants were considered appropriate for gestational age, and no cases of spontaneous abortion, intrauterine demise, and congenital anomalies were encountered. NICU or intermediate care nursery admission after birth was required for 2 infants (7%), and 2 (7%) infants ultimately died of SIDS. Infant outcome data was available for an average of 20.8 months (SD 18.8). Matched cohort comparison between the MET and control groups demonstrated no significant differences in maternal or infant outcomes. CONCLUSIONS Tamsulosin MET during pregnancy does not appear to be associated with adverse maternal or fetal outcomes, and may be considered as adjunctive therapy for symptomatic patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e501 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information George Bailey More articles by this author Lisa Vaughan More articles by this author Eric Bergstralh More articles by this author Carl Rose More articles by this author Amy Krambeck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The preventive effect of tamsulosin on voiding dysfunction after prostate biopsy: a prospective, open-label, observational study.

To evaluate the association of prostate biopsy with voiding impairment and to investigate whether tamsulosin treatment given before prostate biopsy could improve voiding dysfunction after the procedure. The study included 88 consecutive patients who underwent transrectal ultrasound-guided prostate biopsy without prior BPH medication and were prospectively randomized. Of these 88 patients, 44 patients underwent prostate biopsy only without tamsulosin treatment and served as the control group. The remaining 44 patients were treated with tamsulosin (0.2 mg daily) beginning the day before the biopsy procedure for 7 days. The International Prostate Symptom Score (IPSS) was recorded in all patients before the procedure and on postbiopsy day 7. Maximal flow rate (Q(max)) and postvoid residual urine volume were recorded in all patients before the procedure and on postbiopsy days 1 and 7. No difference was found in baseline characteristics between the two groups. The IPSS (total, storage, and voiding symptom) was not significantly changed after biopsy in both groups. In the control group, the postvoid residual urine volume was increased on postbiopsy days 1 (P < 0.05) and 7, and the Q(max) was significantly decreased on postbiopsy day 7 compared with the baseline value (P < 0.05). In the tamsulosin group, Q(max) was significantly increased on postbiopsy days 1 and 7 (P < 0.01). The postvoid residual urine volume was not increased on postbiopsy days 1 and 7. Acute urinary retention after the biopsy procedure did not develop in any of the patients (0%) in the tamsulosin group, but it developed in two patients (4.5%) of the control group. The results of our study show that prostate biopsy leads to objective voiding impairment. Therefore, the use of alpha-1 blocker tamsulosin before biopsy in patients without prior BPH medication may decrease this morbidity.

Efficacy and safety of a fixed-dose combination of dutasteride and tamsulosin treatment (Duodart(®) ) compared with watchful waiting with initiation of tamsulosin therapy if symptoms do not improve, both provided with lifestyle advice, in the management of treatment-naïve men with moderately symptomatic benign prostatic hyperplasia: 2-year CONDUCT study results.

To investigate whether a fixed-dose combination (FDC) of 0.5 mg dutasteride and 0.4 mg tamsulosin is more effective than watchful waiting with protocol-defined initiation of tamsulosin therapy if symptoms did not improve (WW-All) in treatment-naïve men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression. This was a multicentre, randomised, open-label, parallel-group study (NCT01294592) in 742 men with an International Prostate Symptom Score (IPSS) of 8-19, prostate volume ≥30 mL and total serum PSA level of ≥1.5 ng/mL. Patients were randomised to FDC (369 patients) or WW-All (373) and followed for 24 months. All patients were given lifestyle advice. The primary endpoint was symptomatic improvement from baseline to 24 months, measured by the IPSS. Secondary outcomes included BPH clinical progression, impact on quality of life (QoL), and safety. The change in IPSS at 24 months was significantly greater for FDC than WW-All (-5.4 vs -3.6 points, P < 0.001). With FDC, the risk of BPH progression was reduced by 43.1% (P < 0.001); 29% and 18% of men in the WW-All and FDC groups had clinical progression, respectively, comprising symptomatic progression in most patients. Improvements in QoL (BPH Impact Index and question 8 of the IPSS) were seen in both groups but were significantly greater with FDC (P < 0.001). The safety profile of FDC was consistent with established profiles of dutasteride and tamsulosin. FDC therapy with dutasteride and tamsulosin, plus lifestyle advice, resulted in rapid and sustained improvements in men with moderate BPH symptoms at risk of progression with significantly greater symptom and QoL improvements and a significantly reduced risk of BPH progression compared with WW plus initiation of tamsulosin as per protocol.

Rate and associated factors of solifenacin add-on after tamsulosin monotherapy in men with voiding and storage lower urinary tract symptoms

To explore the rate of add-on therapy with solifenacin in men with voiding and storage lower urinary tract symptoms (LUTS) after tamsulosin monotherapy and to explore predictive factors for starting solifenacin add-on therapy. Men aged ≥ 45 years with IPSS ≥ 12 and symptoms of OAB (OAB-V8 ≥ 8, micturition ≥ 8/24 h, urgency ≥ 2/24 h) were enrolled to receive tamsulosin 0.2 mg once daily. After 4 weeks, men with residual symptoms of OAB and reported 'dissatisfied' or 'a little satisfied' were received solifenacin 5 mg in combination with tamsulosin monotherapy. Subjects completed an IPSS, a Quality of life (QoL) index, OAB V8, and an International Consultation of Incontinence Questionnaire (ICIQ)-Male LUTS, and patient perception of bladder condition (PPBC) at baseline and week 4. Of a total of 305 patients, 254 patients completed 4 weeks of tamsulosin treatment. For 176 patients, solifenacin was added (69.3%). Significant predictive factors of solifenacin add-on therapy included long LUTS duration, high IPSS, number of micturitions per 24 h, more urgency episodes, high urgency severity score in a voiding diary and high OAB V8 score. Based on multivariable analysis, potential predictive factors of solifenacin add-on therapy included long LUTS duration (OR = 1.008, 95% CI: 1.001-1.014), high serum PSA (OR = 1.543, 95% CI: 1.136-2.095) and small prostate size (OR = 0.970, 95% CI: 0.947-0.994) (p < 0.05). IPSS, daytime micturitions and urgency episodes, OAB V8 scores, ICIQ and PPBC were improved after tamsulosin monotherapy. Two thirds of men with voiding and storage LUTS needed to add anticholinergics after 4 weeks of tamsulosin monotherapy. Patients with longer lasting symptoms and storage symptoms with small prostate volume may require the anticholinergic add-on.

Wound Dehiscence as a Cataract Surgery–Associated Postoperative Complication in Patients Previously Treated With Alpha-1 Blocker Tamsulosin—A Population-Based Study in Taiwan

To compare the cataract surgery-related complications between patients with and without tamsulosin treatment. A nationwide retrospective case-control study. Patients who had undergone cataract surgery were identified using the International Classification of Disease, Ninth Revision, Clinical Modification from a nationally representative dataset of 1 million people selected from the Taiwan National Health Insurance Research Database in 2000. Patients preoperatively treated with α1-blockers before cataract surgery were the treated group, and age-, sex-, and year of surgery-matched patients not preoperatively treated with α1-blockers were the control group. Patients treated with tamsulosin underwent subgroup analysis. A conditional logistic regression model was used to estimate surgery-related complications and interesting variables. The main outcome measures are cataract surgery-related complications. A total of 4474 treated patients and 4474 controls were analyzed. The percentage of cataract surgery-related complications was 8.61% in the treated group and 8% in the control group (not significantly different). However, wound dehiscence was 3.81 times higher (95% confidence interval: 1.24-11.67, P = .0194) in the tamsulosin-treated group. Patients treated with tamsulosin have a higher risk of wound dehiscence after cataract surgery. Carefully taking a history of tamsulosin use before cataract surgery is advised so that some strategies can be used to prevent complications and additional costs.

Prostatic urethral angle might be a predictor of treatment efficacy of α-blockers in men with lower urinary tract symptoms.

PurposeWe investigated the association of the prostatic urethral angle (PUA) with peak urinary flow rate (Qmax) and the severity of lower urinary tract symptoms (LUTS) on the aging male. We also evaluated the effect of the PUA on the treatment efficacy of tamsulosin on men with LUTS.Materials and methodsThe records were obtained from a prospective database for first-visit male patients with LUTS in the outpatient department of our institution. These patients underwent a detailed physical examination and taking of medical history. A transrectal ultrasound was performed on these patients. The prostate size, length of intravesical prostatic protrusion (IPP), PUA, and International Prostate Symptom Score (IPSS) of the patients were evaluated. Uroflowmetry and a bladder scan for residual urine were also performed on every patient. Tamsulosin 0.2 mg per day was prescribed. The IPSS and uroflowmetry were reevaluated after they had received treatment for 3 months.ResultsA total of 178 patients were included, and 149 of them completed this cohort study. The mean PUA was 48.32°±13.74°. The mean prostate volume was 39.19±20.87 mL, and the mean IPP was 5.67±7.85 mm. On multivariate linear regression analysis, the PUA was independently associated with the IPSS (P<0.001), Qmax (P=0.004), post-treatment IPSS change (P=0.032), and post-treatment Qmax change (P<0.001). However, the prostate volume and IPP were not associated with these clinical items.ConclusionThe PUA is significantly associated with Qmax and IPSS in men with LUTS. The PUA is also inversely correlated with changes in Qmax and IPSS after tamsulosin treatment. Namely, the PUA might be a predictor for the treatment efficacy of α-blockers in aging men with LUTS.

A comparison of nifedipine and tamsulosin as medical expulsive therapy for the management of lower ureteral stones without ESWL.

Administration of nifedipine or tamsulosin has been suggested to augment stone expulsion rates. We aimed to compare the stone expulsion rates and adverse effects associated with the use of nifedipine or tamsulosin as medical expulsive therapy (MET) for the management of lower ureteral stones (LUS) without extracorporeal shock wave lithotripsy (ESWL) via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from the Medline, EMBASE, Cochrane CENTRAL, and Google Scholar databases. Finally, a total of 7 RCTs with 3897 patients were included. Our meta-analysis showed that tamsulosin could significantly increase the stone expulsion rate relative to nifedipine in patients with LUS (random-effects model; risk ratio [RR] = 0.81; 95% confidence interval [CI] = 0.75–0.88; P < 0.00001). The subgroup analysis indicated no statistically significant difference between the drugs with regard to minor or major adverse effects (fixed-effect model; RR = 1.19, 95% CI = 0.91–1.54, P = 0.20; and RR = 1.63, 95% CI = 0.22–11.82, P = 0.63, respectively). This meta-analysis demonstrated that tamsulosin was more effective than nifedipine in patients with LUS, as evidenced by the higher stone expulsion rate. Tamsulosin treatment should therefore be considered for patients with LUS.

MP4-15 THE EFFICACY DIFFERENCE OF A-BLOCKERS ON OVERACTIVE BLADDER SYMPTOM ACCORDING TO PERMEABILITY TO BLOOD BRAIN BARRIER

MP4-15 THE EFFICACY DIFFERENCE OF A-BLOCKERS ON OVERACTIVE BLADDER SYMPTOM ACCORDING TO PERMEABILITY TO BLOOD BRAIN BARRIER

Tamsulosinin Ön Segment Parametreleri ve Santral Kornea Kalınlığına Etkisi

Objective: To investigate the effects of tamsulosin (α-1 adrenergic receptor antagonist) on the main numerical parameters of anterior segment using Pentacam rotating Scheimmpflug camera, and on biomechanical parameters using Reichert Ocular Response Analyser (ORA) in patients with benign prostate hyperplasia. Material and Methods: In addition to full eye examination [best corrected visual acuity, keratometry, intraocular pressure (IOP) measured with Goldmann applanation tonometry], Pentacam [central corneal thickness (CCT), anterior chamber depth, anterior chamber volume, anterior chamber angle, pupil diameter] and ORA (corneal hysteresis, corneal resistance factor, corneal compensated IOP, Goldmann correlated IOP) measurements of 30 eyes of 15 male patients were performed before and one month after tamsulosin therapy. Paired t-test and non-parametric Wilcoxon test were used for comparisons. Results: Mean age in the study group was 61.50±6.10 (range 47-69) years. After tamsulosin treatment, CCT increased and this increment was statistically significant (p=0.002). None of the other parameters that were evaluated showed statistically significant difference after tamsulosin use. Conclusion: Tamsulosin leads to significant increment in CCT. The effects of tamsulosin on CCT should be taken into consideration for proper clinical interpretation in patients using tamsulosin.

Effects of Bladder Function by Early Tamsulosin Treatment in a Spinal Cord Injury Rat Model

ObjectiveTo investigate the effects of early tamsulosin treatment on changes in bladder characteristics after a spinal cord injury.MethodsWe divided 45 rats into three groups: the control (CON) group, the spinal cord injury (SCI) group, and the SCI+tamsulosin treatment (SCI+TAM) group. Spinal cord transection was performed in the SCI and SCI+TAM groups. Tamsulosin was injected for 7 days in the SCI+TAM group. Intravesical and intra-abdominal catheters were implanted before cord injury. Basal pressure (BP), maximal vesical pressure (MVP), micturition volume (MV), and voiding interval time (VIT) were measured at 7 days after SCI. The bladder was then removed and used for an in vitro organ bath study and Western blot analysis. The percentage changes in contractility from baseline after acetylcholine alone, pretreatment with a muscarinic 2 (M2) receptor blocker (AQ-RA741), and pretreatment with a M3 receptor blocker (4-DAMP) were compared among the groups. Western blot analyses were performed to determine expression levels of pERK1/2 and rho-kinase.ResultsIn cystometry, MVP, BP, MV, and VIT showed changes in the SCI and SCI+TAM groups versus the CON group (p<0.05). In the organ bath study, acetylcholine-induced contractility in the three groups differed significantly (p<0.05). Additionally, acetylcholine-induced contractility with 4-DAMP pretreatment was reduced significantly in the SCI+TAM group versus the SCI group. In Western blotting, pERK1/2 expression was stronger (p<0.05) and rho-kinase expression was weaker in the SCI+TAM group than the SCI group (p<0.05).ConclusionThese results suggest that the bladder contraction due to acetylcholine after SCI can be decreased by tamsulosin in the acute stage and this involves changes in pERK1/2 and rho-kinase.

Effect of tamsulosin on stone expulsion in proximal ureteral calculi: an open-label randomized controlled trial

Medical expulsive therapy (MET) using alpha-blockers is effective for distal ureteral calculi (UC). We aimed to evaluate the efficacy of tamsulosin for proximal UC expulsion. An open-label randomized controlled trial was conducted with 108 patients who agreed to conservative management for single, radiopaque, proximal UC ≤ 6 mm and were randomized into group A (n = 54, conservative managements only) or B (n = 54, 0.2 mg tamsulosin once a day). The primary end-point was stone passage rates (SPR) in the intention-to-treat population in 4 treatment weeks. The secondary end-points were estimated in per-protocol population and were time to stone passage, post-trial Euro-quality-of-life (EuroQOL) score, oral analgesic requirements, and willingness to undergo conservative treatment again. The two groups were well balanced in terms of baseline patient and stone characteristics. Seventy nine patients (73.2%; 35 of group A and 44 of group B) completed the study protocol. The overall SPR was 60.2% (65/108). Group B had a higher SPR (74.1%; 40/54) than group A (46.3%; 25/54; p = 0.003) and a significantly shorter time to stone passage (mean days, A: 19.6 vs. B: 14.3, p = 0.005). The groups did not differ in post-trial EuroQOL score or oral analgesic requirements, whereas 74.3% (26/35) of group A and 90.9% (40/44) of group B were willing to undergo conservative treatment again (p = 0.048). Univariate logistic regression analysis showed that stone size (OR = 1.447, p = 0.045) and tamsulosin treatment (OR = 3.314, p = 0.004) significantly predicted stone expulsion. On multivariate analysis, only tamsulosin was statistically significant (OR=3.198, p = 0.021). Tamsulosin was associated with significantly higher stone expulsion rate and shorter expulsion time in proximal UC ≤ 6 mm compared with conservative managements only. Our results indicate that similar to patients with distal UC, MET using tamsulosin is a reasonable treatment option for patients with proximal UC.