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Blake-James BT, Chakrabarty B, Fry CH. Adreno-Muscarinic Synergy of Contractile Responses From Human Hyperplastic Prostate. Int Neurourol J 2024; 28:46-54. [PMID: 38461856 DOI: 10.5213/inj.2346144.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/13/2023] [Indexed: 03/12/2024] Open
Abstract
PURPOSE Adreno-muscarinic synergy, a supra-additional contractile response to simultaneous application of α-adrenoreceptor and muscarinic receptor agonists, is a feature of several lower urinary tract regions that have dual sympathetic and parasympathetic innervation. We tested the hypothesis that synergy is also a feature of prostate tissue obtained from men with benign prostatic enlargement. METHODS Isolated tissue strips were dissected from prostate 'chips', collected after transurethral prostate resection procedures for in vitro experiments, to measure isometric tension at 36°C. RESULTS Added separately to the superfusate, phenylephrine and carbachol generated contractions with mean pEC50 (-log10EC50) values of 5.36 and 5.58, respectively, although phenylephrine maximal responses were about six-fold greater. In the presence of carbachol, the mean phenylephrine pEC50 was significantly increased to 5.84 and maximal response increased by 28%; overall, a significant synergistic response was demonstrated. The synergistic response was reduced by muscarinic receptor antagonists, most potently by the M3-selective agent 4-DAMP (1,1-dimethyl-4-diphenylacetoxypiperidinium iodide), and less so by M2 and M1-selective inhibitors gallamine and pirenzepine, but with an overall profile indicating M3/M2 mediation of the synergistic response. The magnitude of the synergistic response was variable between prostate chips that provided isolated preparations suggesting regional heterogenicity, although their zonal origin could not be determined. CONCLUSION These experiments show that adreno-muscarinic contractile synergy is a feature of human hyperplastic prostate tissue. This has implications for the use of a combination therapy of α-blockers and anti-muscarinic agent to relieve secondary symptoms associated with benign prostatic hyperplasia, at least in men who can tolerate antimuscarinics without a risk of retention.
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Affiliation(s)
- Ben T Blake-James
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Basu Chakrabarty
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK
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Sumiya K, Shogenji M, Ikenaga Y, Ogawa Y, Hirako K, Fujita A, Shimada T, Hashimoto M, Masuda A, Nagamoto T, Tamai I, Ogura H, Toyama T, Wada T, Sai Y. Association between switching prescribed drugs for lower urinary tract symptoms and independence of urination in post-stroke patients: A retrospective cohort study. J Stroke Cerebrovasc Dis 2023; 32:107419. [PMID: 37839304 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/24/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES Stroke patients frequently exhibit loss of independence of urination, and their lower urinary tract symptoms change with the phase of stroke. However, it is unclear whether switching prescribed drugs for lower urinary tract symptoms during hospitalization from acute care wards to convalescence rehabilitation wards affects patients' independence of urination at discharge. It is also unclear whether the impact of switching varies by stroke type. This retrospective cohort study aimed to examine these issues. MATERIALS AND METHODS We analyzed 990 patients registered in the Kaga Regional Cooperation Clinical Pathway for Stroke database during 2015-2019. Prescriptions for lower urinary tract symptoms from pre-onset to convalescence rehabilitation were surveyed. Logistic regression analysis was performed to examine the association between switching drugs and independence of urination based on bladder management and voiding location at discharge. Stroke types were also examined in subgroup analyses. RESULTS About 21 % of patients had their lower urinary tract symptoms prescriptions switched during hospitalization. Switching was positively associated with independence of bladder management (odds ratio 1.65, 95 % confidence interval 1.07 to 2.49) and voiding location (odds ratio 2.72, 95 % confidence interval 1.72 to 4.37). Similar associations were observed in different stroke types. CONCLUSIONS Approximately 20 % of patients had their lower urinary tract symptoms medications switched upon transfer from acute to convalescence rehabilitation wards. Switching was significantly associated with improved urinary independence at discharge. Consistent results were observed across different stroke types, suggesting that switching medications contributes to urinary independence after stroke, regardless of the etiology or severity of stroke.
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Affiliation(s)
- Koyomi Sumiya
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Miho Shogenji
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Ishikawa, Japan; Council of Kaga Local Stroke Network, South Ishikawa, Japan
| | - Yoru Ogawa
- Council of Kaga Local Stroke Network, South Ishikawa, Japan; Department of Pharmacy, Komatsu Municipal Hospital, Ishikawa, Japan
| | - Kohei Hirako
- Frontier Science and Social Co-creation Initiative, Kanazawa University, Ishikawa, Japan; The Establishment Preparation Office for The Faculty of Interdisciplinary Economics, Kinjo University, Ishikawa, Japan
| | - Arimi Fujita
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Tsutomu Shimada
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan.
| | | | | | | | - Ikumi Tamai
- Division of Pharmacy, Graduate School of Pharmaceutical Sciences, Kanazawa University, Ishikawa, Japan; AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan
| | - Hisayuki Ogura
- AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan; Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Tadashi Toyama
- AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan; Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Yoshimichi Sai
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan; AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan
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高岡 栄, 藤村 哲. [Voiding dysfunction in geriatric people]. Nihon Ronen Igakkai Zasshi 2023; 60:25-32. [PMID: 36889719 DOI: 10.3143/geriatrics.60.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Bridgeman MB, Brunetti L. Part
II
: Interactive case: Combination therapies in benign prostatic hyperplasia. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ali M, Landeira M, Covernton PJO, Choudhury N, Jaggi A, Fatoye F, van Maanen R. The use of mono- and combination drug therapy in men and women with lower urinary tract symptoms (LUTS) in the UK: a retrospective observational study. BMC Urol 2021; 21:119. [PMID: 34474675 PMCID: PMC8414666 DOI: 10.1186/s12894-021-00881-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combination drug therapy for lower urinary tract symptoms (LUTS) is beneficial to selected patients and recommended by guidelines. Patterns of real-world LUTS drug use, especially combination drug therapy, have not been studied extensively. Moreover, further understanding of the recent landscape is required following the introduction of the beta-3-adrenoceptor agonist mirabegron in the UK in 2013 for overactive bladder (OAB). The objective was to describe mono- and combination drug therapy use for LUTS in patients in UK clinical practice. METHODS This was a retrospective, descriptive, observational database study using UK Clinical Practice Research Datalink GOLD and linked databases. Men and women ≥ 18 years with a first prescription for any LUTS drug from 2014 to 2016 with ≥ 12 months continuous enrollment pre- and post-index date were included. Primary endpoints were mono- or combination drug therapy use for LUTS in male and female cohorts. Secondary endpoints were description of treatment prescribed, treatment persistence and patient demographics. Data were analyzed descriptively. Sub-cohorts were defined by drugs prescribed at index date. RESULTS 79,472 patients (61.3% male) were included, based on index treatments. Of all men, 82.5% received any benign prostatic obstruction (BPO) drug, 25.4% any OAB drug, and 7.9% any BPO drug plus any OAB drug. As either mono- or combination drug therapy, 77.1% received an alpha-blocker, 18.9% a 5-alpha reductase inhibitor, 23.9% an antimuscarinic agent, and 2.1% mirabegron. Of all women, 94.5% received any OAB drug, 6.0% duloxetine, and 0.5% any OAB drug plus duloxetine. As either mono- or combination drug therapy, 87.7% received an antimuscarinic, and 9.7% mirabegron. In men or women receiving OAB treatment, approximately 2.5% received combination drug therapy with an antimuscarinic agent and mirabegron. For OAB drug monotherapies, mirabegron had the highest persistence in both male and female cohorts. CONCLUSIONS This study provides a better understanding of the recent landscape of LUTS drug use in UK clinical practice. It highlights potential undertreatment of storage symptoms in men with LUTS and the low use of combination OAB treatments.
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Affiliation(s)
- Mahmood Ali
- Manchester Metropolitan University, Manchester, UK. .,Astellas Pharma Europe Ltd, Addlestone, UK.
| | | | | | | | - Ashley Jaggi
- Manchester Metropolitan University, Manchester, UK.,Astellas Pharma Europe Ltd, Addlestone, UK
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Pang R, Zhou XY, Wang X, Wang B, Yin XL, Bo H, Jung JH. Anticholinergics combined with alpha-blockers for treating lower urinary tract symptoms related to benign prostatic obstruction. Cochrane Database Syst Rev 2021; 2:CD012336. [PMID: 33567116 PMCID: PMC8094929 DOI: 10.1002/14651858.cd012336.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) represent one of the most common clinical complaints in men. Alpha-blockers are widely used as first-line therapy for men with LUTS secondary to BPO, but up to one third of men report no improvement in their LUTS after taking alpha-blockers. Anticholinergics used in addition to alpha-blockers may help improve symptoms but it is uncertain how effective they are. OBJECTIVES: To assess the effects of combination therapy with anticholinergics and alpha-blockers in men with LUTS related to BPO. SEARCH METHODS We performed a comprehensive search of medical literature, including the Cochrane Library, MEDLINE, Embase, and trials registries, with no restrictions on the language of publication or publication status. The date of the latest search was 7 August 2020. SELECTION CRITERIA We included randomized controlled trials. Inclusion criteria were men with LUTS secondary to BPO, ages 40 years or older, and a total International Prostate Symptom Score of 8 or greater. We excluded trials of men with a known neurogenic bladder due to spinal cord injury, multiple sclerosis, or central nervous system disease, and those examining medical therapy for men who were treated with surgery for BPO. We performed three comparisons: combination therapy versus placebo, combination therapy versus alpha-blockers monotherapy, and combination therapy versus anticholinergics monotherapy. DATA COLLECTION AND ANALYSIS Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted data according to the Cochrane Handbook for Systematic Reviews of Interventions. We used the GRADE approach to rate the certainty of evidence. MAIN RESULTS We included 23 studies with 6285 randomized men across three comparisons. The mean age of participants ranged from 54.4 years to 73.9 years (overall mean age 65.7 years). Of the included studies, 12 were conducted with a single-center setting, while 11 used a multi-center setting. We only found short-term effect (12 weeks to 12 months) of combination therapy based on available evidence. Combination therapy versus placebo: based on five studies with 2369 randomized participants, combination therapy may result in little or no difference in urologic symptom scores (mean difference (MD) -2.73, 95% confidence interval (CI) -5.55 to 0.08; low-certainty evidence). We are very uncertain about the effect of combination therapy on quality of life (QoL) (MD -0.97, 95% CI -2.11 to 0.16; very low-certainty evidence). Combination therapy likely increases adverse events (risk ratio (RR) 1.24, 95% CI 1.04 to 1.47; moderate-certainty evidence); based on 252 adverse events per 1000 participants in the placebo group, this corresponds to 61 more adverse events (95% CI 10 more to 119 more) per 1000 participants treated with combination therapy. Combination therapy versus alpha-blockers alone: based on 22 studies with 4904 randomized participants, we are very uncertain about the effect of combination therapy on urologic symptom scores (MD -2.04, 95% CI -3.56 to -0.52; very low-certainty evidence) and QoL (MD -0.71, 95% CI -1.03 to -0.38; very low-certainty evidence). Combination therapy may result in little or no difference in adverse events rate (RR 1.10, 95% CI 0.90 to 1.34; low-certainty evidence); based on 228 adverse events per 1000 participants in the alpha-blocker group, this corresponds to 23 more adverse events (95% CI 23 fewer to 78 more) per 1000 participants treated with combination therapy. Combination therapy compared to anticholinergics alone: based on three studies with 1218 randomized participants, we are very uncertain about the effect of combination therapy on urologic symptom scores (MD -3.71, 95% CI -9.41 to 1.98; very low-certainty evidence). Combination therapy may result in an improvement in QoL (MD -1.49, 95% CI -1.88 to -1.11; low-certainty evidence). Combination therapy likely results in little to no difference in adverse events (RR 1.26, 95% CI 0.81 to 1.95; moderate-certainty evidence); based on 115 adverse events per 1000 participants in the anticholinergic alone group, this corresponds to 4 fewer adverse events (95% CI 7 fewer to 13 more) per 1000 participants treated with combination therapy. AUTHORS' CONCLUSIONS Based on the findings of the review, combination therapy with anticholinergics and alpha-blockers are associated with little or uncertain effects on urologic symptom scores compared to placebo, alpha-blockers, or anticholinergics monotherapy. However, combination therapy may result in an improvement in quality of life compared to anticholinergics monotherapy, but an uncertain effect compared to placebo, or alpha-blockers. Combination therapy likely increases adverse events compared to placebo, but not compared to alpha-blockers or anticholinergics monotherapy. The findings of this review were limited by study limitations, inconsistency, and imprecision. We were unable to conduct any of the predefined subgroup analyses.
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Affiliation(s)
- Ran Pang
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xin-Yao Zhou
- Internal Medicine & Outpatients Management Office, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiangling Wang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Bin Wang
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Xue-Lai Yin
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hai Bo
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
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Valladales-Restrepo LF, Machado-Alba JE. Potentially inappropriate prescriptions of anticholinergic drugs in patients with benign prostatic hyperplasia. Aging Male 2020; 23:785-792. [PMID: 30955405 DOI: 10.1080/13685538.2019.1595572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prostatic hyperplasia is frequent in the elderly, and it can be associated with urinary retention in patients who use cholinergic antagonists. The objective was to estimate the anticholinergic burden of drugs prescribed to patients diagnosed with benign prostatic hyperplasia. METHODS A cross-sectional study using a population database to identify prescriptions of cholinergic antagonists drugs used in the management of benign prostatic hyperplasia. The anticholinergic burden was evaluated using the Anticholinergic Drug Scale. RESULTS Three thousand seven hundred and sixty patients with benign prostatic hyperplasia were identified, with a mean age of 68.26 ± 10.46 years. Of these patients, 2961 (78.8%) received pharmacological treatment mainly with tamsulosin monotherapy (34.7%, n = 1026). Overall, 34.7% (n = 1303) of all patients were taking cholinergic antagonists. Patients aged 75-84 years (OR: 1.985, 95%CI: 1.063-3.709) and those 85 or older (OR: 2.52, 95%CI: 1.287-4.948) had a greater probability of having an anticholinergic burden score ≥3 points. Of the patients not receiving pharmacological treatment for benign prostatic hyperplasia, 35% (n = 280) were taking medications with anticholinergic properties. CONCLUSIONS A high proportion of patients with benign prostatic hyperplasia were receiving medical management for the relief of symptoms, mostly via monotherapy. However, one-third of patients received some type of medication with anticholinergic properties, being much more frequent after 75 years.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnologica de Pereira-Audifarma S.A, Pereira, Colombia
- Fundación Universitaria Autónoma de las Américas, Avenida de las Américas Calle, Pereira, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnologica de Pereira-Audifarma S.A, Pereira, Colombia
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Song Y, Chen G, Huang P, Hu C, Liu X. Effects of Tamsulosin Combined With Solifenacin on Lower Urinary Tract Symptoms: Evidence From a Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Front Pharmacol 2020; 11:763. [PMID: 32528291 PMCID: PMC7264120 DOI: 10.3389/fphar.2020.00763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/07/2020] [Indexed: 12/03/2022] Open
Abstract
This study is aimed to systematically evaluate the efficacy of tamsulosin combined with solifenacin and provide clinical evidence for treatment of benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang data information service platform were searched to select randomized controlled trials (RCTs) of tamsulosin combined with solifenacin in the treatment of BPH with LUTS. After extraction of the data, the statistical information was calculated by means of STATA 12.0. The publication bias was calculated using Egger's test and Begg's funnel plot. A total of 17 articles contained 1,870 patients treated with tamsulosin in combination with solifenacin and 1,897 patients treated with tamsulosin only were included in this study. Results show that tamsulosin combined with solifenacin therapy was more effective in reducing the Total International Prostate Symptom Score (TIPSS), Storage International Prostate Symptom Score (SIPSS), Quality of life (QOL), and Overactive bladder symptom score (OABSS) in comparison with tamsulosin monotherapy treatment. However, it was found that the combination therapy may increase levels of prostate-specific antigen (PSA) and the maximal urinary flow rate (QMAX). Differences between the combination therapy and tamsulosin monotherapy were not statistically significant for urgency episodes per 24 h, micturitions per 24 h, Voiding International Prostate Symptom Score (VIPSS), and postvoid residual volume (PVR). Tamsulosin combined with solifenacin therapy is more effective than tamsulosin monotherapy for the treatment of BPH concurrent with LUTS and won't increase the risk of dysuria.
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Affiliation(s)
- Yuxuan Song
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Guangyuan Chen
- The Second Clinical Medical School, Nanchang University, Nanchang, China
| | - Peng Huang
- Center for Evidence-Based Medicine, School of Public Health, Nanchang University, Nanchang, China
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Cong Hu
- The Second Clinical Medical School, Nanchang University, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Xiaoqiang Liu,
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Sung HH, Yu J, Kang SJ, Chae MR, So I, Park JK, Lee SW. Persistent Erectile Dysfunction after Discontinuation of 5-Alpha Reductase Inhibitor Therapy in Rats Depending on the Duration of Treatment. World J Mens Health 2018; 37:240-248. [PMID: 30588787 PMCID: PMC6479083 DOI: 10.5534/wjmh.180082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose The current study is aimed to assess whether a longer duration of 5α-reductase inhibitor (5α-RI) exposure was associated with higher rate of permanent erectile dysfunction (ED) in a rat model. Materials and Methods Male Sprague-Dawley rats (n=76) were assigned to five groups: (i) normal control group; (ii) dutasteride (0.5 mg/rat/d) for 4-weeks group; (iii) dutasteride for 4-weeks plus 2-weeks of resting group; (iv) dutasteride for 8-weeks group; and (v) dutasteride for 8-weeks plus 2-weeks of resting group. In vivo erectile responses to electrical stimulation, and changes of fibrotic factors and smooth muscle/collagen contents in the corpus cavernosum were evaluated in each group. Results Dutasteride administration for 4 and 8 weeks significantly decreased erectile parameters compared with the control group. Reduced erectile responses were recovered during 2 weeks of drug-free time in the 4-week treatment group, but were not in the 8-week group. Protein levels of fibrosis-related factors transforming growth factor (TGF)-β1, TGF-β2, and p-Smad/Smad (Smad 2/3) in the corpus cavernosum showed no significant change after 4 weeks of dutasteride oral administration, but were enhanced after 8 weeks. Dutasteride markedly decreased smooth muscle content and increased collagen after 4 and 8 weeks of use, but no nuclear size changes; however, neither group showed significant improvement in the smooth muscle to collagen ratio after the rest period. Conclusions Our study showed that recovery from ED depended on the duration of medication, and administration of dutasteride for more than 8-weeks in rats could result in irreversible ED even after discontinuation of medication.
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Affiliation(s)
- Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiwoong Yu
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jeong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mee Ree Chae
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Insuk So
- Department of Physiology and Biophysics, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University College of Medicine and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Korea
| | - Sung Won Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Combination treatment for male lower urinary tract symptoms with anticholinergic and alpha-blockers. Curr Opin Urol 2018; 28:277-283. [PMID: 29432226 DOI: 10.1097/mou.0000000000000489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Although alpha-adrenergic antagonists (α-blockers) are effective for relieving voiding lower urinary tract symptoms (LUTS) in men, storage symptoms often persist. The aim of this manuscript is to evaluate the efficacy and safety of combination therapy with α-blockers and muscarinic receptor antagonists (anticholinergics). RECENT FINDINGS High-quality evidence confirms that the addition of an anticholinergic improves micturition diary parameters, such as daytime and nocturnal frequency and urgency incontinence episodes, as well as total and storage subset scores on the International Prostate Symptom Score. Most studies demonstrate a statistically significant improvement over α-blocker monotherapy. Both, incidence of urinary retention and study withdrawal because of treatment-related adverse events with combination therapy, are low. Urodynamic indices, such as maximum flow rate and postvoid residual volume, are also minimally impacted by combination therapy. Outcomes on validated questionnaires and quality-of-life (QoL) indices also indicate a significant improvement. SUMMARY The addition of an anticholinergic to an α-blocker in men with storage and voiding LUTS is an effective practice in reducing both categories of symptoms. The addition of anticholinergic is associated with a low rate of urinary retention and the impact on efficient bladder emptying is minimal. Not unexpectedly, QoL is improved.
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Dogan M, Kutluksaman B, Keles I, Karalar M, Halat AO. The Effects of Systemic Alfuzosin and Tamsulosin Hydrochloride on Choroidal Thickness and Pupil Diameter Sizes in Cases with Benign Prostatic Hyperplasia. Curr Eye Res 2017; 42:1638-1643. [PMID: 28937828 DOI: 10.1080/02713683.2017.1359306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the effects of alfuzosin hydrochloride and tamsulosin hydrochloride on choroidal thickness (CT) and pupil diameter (PD) sizes in patients with benign prostatic hyperplasia. SUBJECTS AND METHODS Sixty-three men patients with newly diagnosis of benign prostatic hyperplasia were randomly assigned to either alfuzosin hydrochloride or to tamsulosin hydrochloride groups in this prospective, randomized, parallel-group clinical trial. Enhanced depth imaging spectral-domain optical coherence tomography, pupillography were obtained at baseline, 1st and 3rd month, and choroidal thicknesses and pupil diameter sizes were compared between the two groups. RESULTS The mean subfoveal choroidal thickness (SCT), nasal choroidal thickness (NCT), and temporal choroidal thickness (TCT) in AH group were 275.70 ± 32.14 μm, 269.7 ± 33.54 μm and 270.71 ± 33.52 μm at baseline, respectively; and they were 275.46 ± 31.6 μm, 268.73 ± 33.08 μm and 270.73 ± 33.05 μm at baseline in TH group, respectively (P = 0.97, P = 0.84, P = 0.99, for SCT, NCT, and TCT, respectively). The mean SCT, NCT, and TCT after 3 months were 278.93 ± 34.58 μm, 272.62 ± 34.17 μm, and 273.6 ± 34.17 μm in AH group, respectively; and they were 274.36 ± 31.91 μm, 264.70 ± 33.59 μm, and 267.72 ± 33.6 μm in TH group, respectively (P = 0.6, P = 0.37, P = 0.43, for SCT, NCT, and TCT, respectively). The mean scotopic pupil diameter (SPD), mesopic pupil diameter (MPD), and photopic pupil diameter (PPD) sizes in AH group were 6.46 ± 0.84 mm, 5.07 ± 0.72 mm and 3.66 ± 0.46 mm at baseline, respectively; and they were 6.44 ± 1.14 mm, 5.01 ± 0.79 mm and 3.62 ± 0.53 mm at baseline in TH group, respectively (P = 0.89, P = 0.74, P = 0.68, for SPD, MPD, and PPD, respectively). The mean SPD, MPD, and PPD sizes after 3 months were 5.96 ± 0.76 mm, 4.67 ± 0.74 mm, and 3.15 ± 0.47 mm in AH group, respectively; and they were 6.42 ± 0.89 mm, 5.05 ± 0.75 mm, and 3.55 ± 0.53 mm in TH group respectively (P = < 0.001, P = < 0.001, P = < 0.001, for SPD, MPD, and PPD, respectively). CONCLUSION The repeated measure of ANOVA for the mean CT values within AH group showed statistically significant increases in baseline CTs, although these differences did not reach statistical significance between 2 groups at follow-ups. We found significant different outcomes for PD sizes during study in the groups. The mean outcome in this study is that using αAR antagonists have potential effects on CT and PD sizes. Abbreviations and Acronyms: AH: alfuzosin hyrdrochloride; ANOVA: analyses of variance; AR: adrenergic receptor; BCVA: best-corrected visual acuity; BPH: benign prostatic hyperplasia; CT: choroidal thickness; EDI-OCT: enhanced depth imaging spectral-domain optical coherence tomography; IFIS: intraoperative floppy iris syndrome; MPD: mesopic pupil diameter; NCT: nasal choroidal thickness; PD: pupil diameter; PPD: photopic pupil diameter; SCT: subfoveal choroidal thickness; SPD: scotopic pupil diameter; TCT: temporal choroidal thickness; TH: tamsulosin hydrochloride.
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Affiliation(s)
- Mustafa Dogan
- a Afyon Kocatepe University , Department of Ophthalmology , Afyonkarahisar , Turkey
| | | | - Ibrahim Keles
- c Afyon Kocatepe University , Department of Urology , Afyonkarahisar , Turkey
| | - Mustafa Karalar
- c Afyon Kocatepe University , Department of Urology , Afyonkarahisar , Turkey
| | - Ahmet Omer Halat
- d Konya Research and Training Hospital , Department of Urology , Konya , Turkey
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12
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Homma Y, Gotoh M, Kawauchi A, Kojima Y, Masumori N, Nagai A, Saitoh T, Sakai H, Takahashi S, Ukimura O, Yamanishi T, Yokoyama O, Yoshida M, Maeda K. Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia. Int J Urol 2017; 24:716-729. [DOI: 10.1111/iju.13401] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/23/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Yukio Homma
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Momokazu Gotoh
- Department of Urology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | | | - Yoshiyuki Kojima
- Department of Urology; Fukushima Prefectural University of Medicine; Fukushima Japan
| | - Naoya Masumori
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Atsushi Nagai
- Department of Urology; Kawasaki Medical School; Kurashiki Japan
| | | | - Hideki Sakai
- Department of Urology; Nagasaki University; Nagasaki Japan
| | | | - Osamu Ukimura
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | | | | | - Masaki Yoshida
- Department of Urology; National Center of Geriatrics and Gerontology; Obu Japan
| | - Kenji Maeda
- Department of Urology; Maeda Clinic of Internal Medicine; Ageo Japan
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13
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Anger JT, Goldman HB, Luo X, Carlsson MO, Chapman D, Zou KH, Russell D, Ntanios F, Esinduy CB, Clemens JQ. Patterns of medical management of overactive bladder (OAB) and benign prostatic hyperplasia (BPH) in the United States. Neurourol Urodyn 2017; 37:213-222. [DOI: 10.1002/nau.23276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/08/2017] [Indexed: 11/06/2022]
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14
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Nunes RV, Manzano J, Truzzi JC, Nardi A, Silvinato A, Bernardo WM. Treatment of benign prostatic hyperplasia. Rev Assoc Med Bras (1992) 2017; 63:95-99. [PMID: 28355368 DOI: 10.1590/1806-9282.63.02.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/21/2022] Open
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15
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Abstract
The etiology of men's lower urinary tract storage and voiding symptoms involves a contribution from both detrusor and outlet. As such, treatment of benign prostatic enlargement (BPE) ± benign prostatic obstruction (BPO) with standard alpha-adrenergic blockade and 5-alpha reductase inhibitor therapy may leave a population of men with persistent and bothersome urinary storage symptoms. An abundance of adequately powered, randomized, placebo-controlled trials indicate that the use of antimuscarinics and beta-3 adrenergic agonists, either alone or in combination with standard BPE/BPO therapy, leads to improvement in storage symptoms. At the same time, metrics associated with urinary emptying, such as maximum flow rate, post-void residual urinary volume, and incidence of treatment-associated urinary retention, appear to be stable and not significantly impacted by the addition of antimuscarinics.
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Affiliation(s)
- Matthew C Moss
- Department of Urology, Louisiana State University Health - Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - Tameem Rezan
- Department of Urology, Louisiana State University Health - Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - Umar R Karaman
- Department of Urology, Louisiana State University Health - Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - Alex Gomelsky
- Department of Urology, Louisiana State University Health - Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA.
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16
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Kim HJ, Sun HY, Choi H, Park JY, Bae JH, Doo SW, Yang WJ, Song YS, Ko YM, Kim JH. Efficacy and Safety of Initial Combination Treatment of an Alpha Blocker with an Anticholinergic Medication in Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptoms: Updated Meta-Analysis. PLoS One 2017; 12:e0169248. [PMID: 28072862 PMCID: PMC5224810 DOI: 10.1371/journal.pone.0169248] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/14/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS). OBJECTIVE The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis. METHODS We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL). RESULTS In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14-0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 - -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 - -0.07), 0.00 (95% CI: -0.08-0.08), and 0.56 (95% CI: 0.23-0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR. CONCLUSIONS Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/ LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function.
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Affiliation(s)
- Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hwa Yeon Sun
- Department of Urology, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Korea
| | - Hoon Choi
- Department of Urology, Korea University Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Young Park
- Department of Urology, Korea University Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Hyun Bae
- Department of Urology, Korea University Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Whan Doo
- Department of Urology, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Korea
| | - Yun Seob Song
- Department of Urology, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Korea
| | - Young Myoung Ko
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Korea
- * E-mail:
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17
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Han JL, Gandhi S, Bockoven CG, Narayan VM, Dahm P. The landscape of systematic reviews in urology (1998 to 2015): an assessment of methodological quality. BJU Int 2016; 119:638-649. [DOI: 10.1111/bju.13653] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Julia L. Han
- Department of Urology; University of Florida; Gainesville FL USA
| | | | | | - Vikram M. Narayan
- Department of Urology; University of Minnesota and Minneapolis VA Health Care System; Minneapolis MN USA
| | - Philipp Dahm
- Department of Urology; University of Minnesota and Minneapolis VA Health Care System; Minneapolis MN USA
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18
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Pang R, Zhou XY, Wang XL, Wang B, Yin XL, Bo H. Anticholinergics combined with alpha-blockers for treating lower urinary tract symptoms related to benign prostatic obstruction. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ran Pang
- Guang An Men Hospital, China Academy of Chinese Medical Sciences; Department of Urology; No.5 Bei Xian Ge Street, Xicheng District Beijing China 100053
| | - Xin-Yao Zhou
- Guang An Men Hospital, China Academy of Chinese Medical Sciences; Internal Medicine & Outpatients Management Office; No. 5 Bei Xian Ge Street, Xicheng District Beijing China 100053
| | - Xiang-ling Wang
- Mayo Clinic; Division of Nephrology and Hypertension; 200 First Street SW Rochester Minnesota USA 55905
| | - Bin Wang
- China Academy of Chinese Medical Sciences; No.16 Dong Zhi Men Nei Nan Xiao Street, Dongcheng District Beijing China 100700
| | - Xue-Lai Yin
- Guang An Men Hospital, China Academy of Chinese Medical Sciences; Department of Urology; No.5 Bei Xian Ge Street, Xicheng District Beijing China 100053
| | - Hai Bo
- Guang An Men Hospital, China Academy of Chinese Medical Sciences; Department of Urology; No.5 Bei Xian Ge Street, Xicheng District Beijing China 100053
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19
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Li MC, Wang ZY, Yang J, Guo XL, Wang T, Wang SG, Liu JH, Ye ZQ. Efficacy and safety of solifenacin plus tamsulosin oral controlled absorption system in men with lower urinary tract symptoms: a meta-analysis. Asian J Androl 2016; 17:124-34. [PMID: 25337836 PMCID: PMC4291856 DOI: 10.4103/1008-682x.137685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We performed a meta-analysis to compare treatment with a combination of solifenacin plus tamsulosin oral controlled absorption system (TOCAS) with placebo or TOCAS monotherapy. The aim of the meta-analysis was to clarify the efficacy and safety of the combination treatments method for lower urinary tract symptoms (LUTS). We searched for trials of men with LUTS that were randomized to combination treatment compared with TOCAS monotherapy or placebo. We pooled data from three placebo-controlled trials meeting inclusion criteria. Primary outcomes of interest included changes in International Prostate Symptom Score (IPSS) and urinary frequency. We also assessed postvoid residual, maximum urinary flow rate, incidence of urinary retention (UR), adverse events. Data were pooled using random or fixed effect models for continuous outcomes and the Mantel–Haenszel method to generate risk ratio. Reductions in IPSS storage subscore and total urgency and frequency score (TUFS) were observed with solifenacin 6 mg plus TOCAS compared with placebo (P < 0.0001 and P < 0.0001, respectively). Reductions in IPSS storage subscore and TUFS were observed with solifenacin 9 mg plus TOCAS compared with placebo (P = 0.003 and P = 0.0006, respectively). Reductions in TUFS was observed with solifenacin 6 mg plus TOCAS compared with TOCAS (P = 0.01). Both combination treatments were well tolerated, with low incidence of UR. Solifenacin 6 mg plus TOCAS significantly improved total IPSS, storage and voiding symptoms compared with placebo. Solifenacin 6 mg plus TOCAS also improved storage symptoms compared with TOCAS alone. There was no additional benefit of solifenacin 9 mg compared with 6 mg when used in combination with TOCAS.
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Affiliation(s)
| | | | | | | | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Ji-Hong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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20
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Benign prostatic hyperplasia and lower urinary tract symptoms. A review of current evidence. Actas Urol Esp 2016; 40:288-94. [PMID: 26823069 DOI: 10.1016/j.acuro.2015.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 02/07/2023]
Abstract
CONTEXT The treatment of benign prostatic hyperplasia (BPH) is changing due to a greater understanding of the disease and the development of the functional concept of lower urinary tract symptoms (LUTS). OBJECTIVES To describe the current state of BPH and the diagnosis and treatment of LUTS. ACQUISITION OF EVIDENCE We summarise the issues presented and debated by a group of expert urologists during the First UROVI Congress, sponsored by the Spanish Urological Association. SUMMARY OF THE EVIDENCE LUTS encompasses filling, voiding and postvoiding symptoms that affect patients' quality of life. The aetiological diagnosis is an important element in starting the most ideal treatment. For this reason, new alternative therapies (both pharmacological and surgical) are needed to help individually address the symptoms in the various patient profiles. There is now a new combination of drugs (6mg of solifenacin and 0.4mg of the tamsulosin oral controlled absorption system) for treating moderate to severe filling symptoms and emptying symptoms associated with BPH in patients who do not respond to monotherapy. Furthermore, new surgical techniques that are increasingly less invasive help provide surgical options for older patients and those with high comorbidity. CONCLUSIONS The availability of drugs that can act on the various LUTS helps integrate the pathophysiological paradigm into the functional one, providing more appropriate treatment for our patients.
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21
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Chughtai B, Forde JC, Thomas DDM, Laor L, Hossack T, Woo HH, Te AE, Kaplan SA. Benign prostatic hyperplasia. Nat Rev Dis Primers 2016; 2:16031. [PMID: 27147135 DOI: 10.1038/nrdp.2016.31] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Benign prostatic hyperplasia (BPH), which causes lower urinary tract symptoms (LUTS), is a common diagnosis among the ageing male population with increasing prevalence. Many risks factors, both modifiable and non-modifiable, can increase the risk of development and progression of BPH and LUTS. The symptoms can be obstructive (resulting in urinary hesitancy, weak stream, straining or prolonged voiding) or irritative (resulting in increased urinary frequency and urgency, nocturia, urge incontinence and reduced voiding volumes), or can affect the patient after micturition (for example, postvoid dribble or incomplete emptying). BPH occurs when both stromal and epithelial cells of the prostate in the transitional zone proliferate by processes that are thought to be influenced by inflammation and sex hormones, causing prostate enlargement. Patients with LUTS undergo several key diagnostic investigations before being diagnosed with BPH. Treatment options for men with BPH start at watchful waiting and progress through medical to surgical interventions. For the majority of patients, the starting point on the treatment pathway will be dictated by their symptoms and degree of bother.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - James C Forde
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Dominique Dana Marie Thomas
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Leanna Laor
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Tania Hossack
- Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Henry H Woo
- Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Alexis E Te
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 625 Madison Avenue, New York, New York 10022, USA
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22
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Griebling TL. Re: The Risk of Fall and Fracture with the Initiation of a Prostate-Selective α Antagonist: A Population Based Cohort Study. J Urol 2016; 195:1544-1545. [DOI: 10.1016/j.juro.2016.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Benign Prostat Hiperplazisi ve Antimuskarinik Tedavi. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2016. [DOI: 10.21673/anadoluklin.180743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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24
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Abstract
This is a review of the most current literature on medical management of the neurogenic bladder (NGB) to treat detrusor overactivity (DO), improve bladder compliance and treat urinary incontinence. The use of antimuscarinics, alpha blockers, tricyclic antidepressants, desmopressin and mirabegron will be discussed along with combination therapy to improve efficacy. These medical therapies will be the focus of this review with surgical therapy and botulinum toxin injections being the subject of other articles in this series.
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Affiliation(s)
- Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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25
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Actualización en el tratamiento médico de los síntomas del tracto urinario inferior en el varón. Semergen 2016; 42:31-7. [DOI: 10.1016/j.semerg.2015.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 11/21/2022]
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26
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Angulo JC. Combination therapy with tamsulosin and solifenacin for male lower urinary tract symptoms with predominant filling symptoms: a new approach to an old problem. Curr Med Res Opin 2015; 31:1963-5. [PMID: 26368336 DOI: 10.1185/03007995.2015.1080156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Benign prostatic enlargement is the main cause of male lower urinary tract symptoms (LUTS). The distinction and quantification of voiding, storage and postmicturition symptoms help clinicians decide on a modern pharmacological therapeutic approach for male LUTS. Muscarinic receptors antagonists are now considered safe therapy in males and a fixed-dose combination of oral controlled absorbed system solifenacin and tamsulosin is advantageous compared to tamsulosin monotherapy in males with predominant storage symptoms when validated instruments such as International Prostatic Score Symptoms (IPSS) or Total Urgency Frequency Score (TUFS) are used. This combination therapy is well tolerated and maintains symptomatic improvement in the long term. Different options of managing male LUTS with predominant storage symptoms include a combination of tamsulosin and solifenacin, antimuscarinics alone - some with flexible dosing, and the beta-3 agonist mirabegron. Tailored pharmacological therapy for the particular patient is not a reality yet, but judicious use of the different alternatives could bring varied new therapeutic solutions for male LUTS including benign prostatic enlargement and benign prostatic obstruction.
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Affiliation(s)
- Javier C Angulo
- a a Servicio de Urologia, Hospital Universitario de Getafe , Madrid , Spain
- b b Universidad Europea de Madrid, Laureate Universities , Madrid , Spain
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27
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Welk B, McArthur E, Fraser LA, Hayward J, Dixon S, Hwang YJ, Ordon M. The risk of fall and fracture with the initiation of a prostate-selective α antagonist: a population based cohort study. BMJ 2015; 351:h5398. [PMID: 26502947 PMCID: PMC4620650 DOI: 10.1136/bmj.h5398] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
STUDY QUESTION Do men starting treatment with prostate-specific α antagonists have increased risk of fall and fracture? METHODS Administrative datasets from the province of Ontario, Canada, that contain patient level data were used to generate a cohort of 147,084 men aged ≥ 66 years who filled their first outpatient prescription for prostate-specific α antagonists tamsulosin, alfuzosin, or silodosin between June 2003 and December 2013 (exposed men) plus an equal sized cohort matched 1:1 (using a propensity score model) who did not initiate α antagonist therapy. The primary outcome was a hospital emergency room visit or inpatient admission for a fall or fracture in the 90 days after exposure. STUDY ANSWER AND LIMITATIONS The men exposed to prostate-specific α antagonist had significantly increased risks of falling (odds ratio 1.14 (95% CI 1.07 to 1.21), absolute risk increase 0.17% (0.08 to 0.25%)) and of sustaining a fracture (odds ratio 1.16 (1.04 to 1.29), absolute risk increase 0.06% (0.02 to 0.11%)) compared with the unexposed cohort. This increased risk was not observed in the period before α antagonist use. Secondary outcomes of hypotension and head trauma were also significantly increased in the exposed cohort (odds ratios 1.80 (1.59 to 2.03) and 1.15 (1.04 to 1.27) respectively). The two cohorts were similar across 98 different covariates including demographics, comorbid conditions, medication use, healthcare use, and prior medical investigation. Potential unmeasured confounders, such as physical deconditioning, mobility impairment, and situational risk factors, may exist. The data used to identify the primary outcomes had limited sensitivity, so the absolute risks of the outcomes are probably underestimates. The study only included men ≥ 66 years old, and 84% of exposed men were prescribed tamsulosin, so results may not be generalizable to younger men, and there may not be statistical power to show small differences in outcomes between the drugs. WHAT THIS STUDY ADDS Prostate-specific α antagonists are associated with a small but significant increased risk of fall, fracture, and head trauma, probably as a result of induced hypotension. FUNDING, COMPETING INTERESTS, DATA SHARING This project was conducted at the Institute for Clinical Evaluative Sciences (ICES) Western Site through the Kidney, Dialysis, and Transplantation (KDT) research program. BW has received a research grant from Astellas, and L-AF does consultancy for Amgen.
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Affiliation(s)
- Blayne Welk
- Department of Surgery, Western University, London ON N6A 4V2, Ontario, Canada Institute for Clinical Evaluative Sciences, London, Ontario Department of Epidemiology and Biostatistics, Western University, London, Ontario
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, London, Ontario
| | | | - Jade Hayward
- Institute for Clinical Evaluative Sciences, London, Ontario
| | - Stephanie Dixon
- Institute for Clinical Evaluative Sciences, London, Ontario Department of Epidemiology and Biostatistics, Western University, London, Ontario
| | - Y Joseph Hwang
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario
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Seehra J, Pandis N, Koletsi D, Fleming PS. Use of quality assessment tools in systematic reviews was varied and inconsistent. J Clin Epidemiol 2015; 69:179-84.e5. [PMID: 26151664 DOI: 10.1016/j.jclinepi.2015.06.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/21/2015] [Accepted: 06/26/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the use of quality assessment tools among a cross-section of systematic reviews (SRs) and to further evaluate whether quality was used as a parameter in the decision to include primary studies within subsequent meta-analysis. STUDY DESIGN AND SETTING We searched PubMed for SRs (interventional, observational, and diagnostic) published in Core Clinical Journals between January 1 and March 31, 2014. RESULTS Three hundred nine SRs were identified. Quality assessment was undertaken in 222 (71.8%) with isolated use of the Cochrane risk of bias tool (26.1%, n = 58) and the Newcastle-Ottawa Scale (15.3%, n = 34) most common. A threshold level of primary study quality for subsequent meta-analysis was used in 12.9% (40 of 309) of reviews. Overall, fifty-four combinations of quality assessment tools were identified with a similar preponderance of tools used among observational and interventional reviews. Multiple tools were used in 11.7% (n = 36) of SRs overall. CONCLUSION We found that quality assessment tools were used in a majority of SRs; however, a threshold level of quality for meta-analysis was stipulated in just 12.9% (n = 40). This cross-sectional analysis provides further evidence of the need for more active or intuitive editorial processes to enhance the reporting of SRs.
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Affiliation(s)
- Jadbinder Seehra
- Dental Institute Kings College London, Department of Orthodontics, Denmark Hill, London, SE5 9RS, United Kingdom.
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Freiburgstrasse 7 CH-3010, Bern, Switzerland
| | - Despina Koletsi
- Department of Orthodontics, Dental School, University of Athens and Private Practice, 2 Thivon str, 11527 Goudi, Athens, Greece
| | - Padhraig S Fleming
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner St., London E1 2 AD, United Kingdom
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Zhang YM, Lu Y, Tang Y, Yang D, Wu HF, Bian ZP, Xu JD, Gu CR, Wang LS, Chen XJ. The effects of different initiation time of exercise training on left ventricular remodeling and cardiopulmonary rehabilitation in patients with left ventricular dysfunction after myocardial infarction. Disabil Rehabil 2015; 38:268-76. [PMID: 25885667 DOI: 10.3109/09638288.2015.1036174] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to determine whether different initiation of exercise training (ET) produces different effect sizes for left ventricular (LV) remodeling and cardiopulmonary rehabilitation in patients with LV dysfunction after myocardial infarction (MI). METHOD Trials evaluating ET outcomes identified by searches in OVID MEDLINE, EMBASE, PubMed and WEB OF SCIENCE were used. Meta-analysis was conducted with the use of the software STATA 11.0. The results were expressed as the standardized mean difference (SMD), with corresponding 95% CI and p value. RESULTS The largest changes in LV remodeling and cardiopulmonary capacity rehabilitation were obtained when programs began the acute phase after MI. With the healing of MI, the beneficial effects of ET on LV ejection fraction (LVEF), LV end-systolic diameter (LVDs) and peak VO2 were gradually weakened even worse. The incidence of major adverse cardiac events was not significantly increased in acute phase post-MI. Sensitivity analyses show that ET still had significant effect in reducing LVDs and increasing peak VO2, while ET no longer had statistical effect in increasing LVEF but showed favorable trends when the same research institution's works were excluded. CONCLUSIONS ET has favorable effects on LV remodeling and cardiopulmonary rehabilitation in LV dysfunction post-MI patients. The greatest benefits are obtained when ET starts at the acute phase following MI. IMPLICATIONS FOR REHABILITATION Early exercise training is safe and feasible in acute and healing phase after myocardial infarction. Early exercise training could attenuate LV remodeling and improve cardiopulmonary capacity in patients with myocardial infarction after hospital discharge (around one week post-MI). Exercise training has favorable effects on LV remodeling and cardiopulmonary capacity rehabilitation. Exercise training should be treated to have the same roles with drugs in secondary prevention of myocardial infarction.
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Affiliation(s)
- You-Ming Zhang
- a Department of Cardiology and.,b Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing , China , and
| | - Yao Lu
- a Department of Cardiology and.,b Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing , China , and
| | - Yun Tang
- c Department of Neonatology , Huai'an First People's Hospital, Nanjing Medical University , Huai'an , Jiangsu , China
| | - Di Yang
- a Department of Cardiology and
| | | | - Zhi-Ping Bian
- b Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing , China , and
| | | | - Chun-Rong Gu
- b Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing , China , and
| | | | - Xiang-Jian Chen
- b Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing , China , and
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Abstract
Lower urinary tract symptoms (LUTS) are common and can affect up to 30% of men over the age of 65 years. The term LUTS encompasses storage, voiding and post-micturition symptoms; all of which can produce a significant impact on quality of life. There are many causes of LUTS. In addition to pathology within the urinary tract, LUTS can also be caused by medication, diabetes, heart failure, obstructive sleep apnoea and high levels of fluid intake. A common urological cause for symptoms is benign prostatic hyperplasia (BPH); a benign enlargement of the prostate gland that affects 30% of men between 50 and 60 years in age and up to 90% of men over the age of 85 years. This article aims to assist GPs to identify and understand the patient presenting with prostatic symptoms, and effectively manage BPH in a primary care setting.
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32
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Gong M, Dong W, Huang G, Gong Z, Deng D, Qiu S, Yuan R. Tamsulosin combined with solifenacin versus tamsulosin monotherapy for male lower urinary tract symptoms: a meta-analysis. Curr Med Res Opin 2015. [PMID: 26211817 DOI: 10.1185/03007995.2015.1074067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of tamsulosin and solifenacin combination therapy compared with tamsulosin monotherapy for male lower urinary tract symptoms (LUTS). METHODS We identified all eligible studies that compared tamsulosin and solifenacin combination therapy with tamsulosin monotherapy for male LUTS (up to January 2015). The fixed- or random-effects model was selected depending on the proportion of heterogeneity. RESULTS Seven articles were identified as eligible for this meta-analysis, with a total of 3063 participants. Synthetic data showed combination therapy had significant improvements in Storage International Prostate Symptom Score (WMD = -0.60; 95% CI: -0.81 to -0.38, P < 0.0001), quality of life (WMD = -0.23; 95% CI: -0.34 to -0.11, P < 0.0001), micturitions per 24 hours (WMD = -0.70; 95% CI: -0.86 to -0.55, P < 0.0001) and urgency episodes per 24 hours (WMD = -0.26; 95% CI: -0.48 to -0.05, P = 0.018). The incidence of adverse effects in the tamsulosin and solifenacin combined therapy group (30.82%) was similar to the tamsulosin monotherapy group (25.75%). Acute urinary retention was seldom reported in the studies and no clinically significant changes regarding Qmax were showed in our meta-analysis. CONCLUSIONS Tamsulosin and solifenacin combination therapy may be a reasonable option for male LUTS patients, especially for those who have significant storage symptoms. However, PVR should be measured during treatment to assess the increase in PVR or the incidence of AUR.
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Affiliation(s)
- Mancheng Gong
- a a Department of Urology , Zhongshan Affiliated Hospital of Sun Yat-sen University , Zhongshan , Guangdong , China
| | - Wenjing Dong
- b b Department of Oncology , Zhongshan Affiliated Hospital of Sun Yat-sen University , Zhongshan , Guangdong , China
| | - Guiying Huang
- c c The Second General Department , Zhongshan Affiliated Hospital of Sun Yat-sen University , Zhongshan , Guangdong , China
| | - Zhaoyang Gong
- a a Department of Urology , Zhongshan Affiliated Hospital of Sun Yat-sen University , Zhongshan , Guangdong , China
| | - Decheng Deng
- a a Department of Urology , Zhongshan Affiliated Hospital of Sun Yat-sen University , Zhongshan , Guangdong , China
| | - Shaopeng Qiu
- d d Department of Urology , The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , Guangdong , China
| | - Runqiang Yuan
- a a Department of Urology , Zhongshan Affiliated Hospital of Sun Yat-sen University , Zhongshan , Guangdong , China
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Reges R, Regadas RP, Cerqueira JBG, Gonzaga-Silva LF. Phosphodiesterase inhibitors for treatment of voiding dysfunction: An overview of experimental and clinical evidence. World J Clin Urol 2014; 3:249-257. [DOI: 10.5410/wjcu.v3.i3.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/14/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
Recently, the focus of the origin of lower urinary tract symptoms (LUTS) has change from the prostate to the bladder. Regardless of the underlying mechanism associated with the origin of LUTS, alpha-blockers continue to be the most common medicine prescribed to treat LUTS due to benign prostatic obstruction (BPO). The newest class of drug introduced to treat LUTS/BPO is phosphodiesterase inhibitors (PDEi) and the aim of this study was to review the role of PDEi in the treatment of LUTS/BPO. In this review, the first evidence was evaluated based on epidemiological studies followed by randomized clinical trials which provide evidence on the administration of PDEi in patients with LUTS/BPO. Experimental studies were also assessed to tentatively elucidate the association between LUTS and erectile dysfunction, and to elucidate the underlying mechanism. There is still controversy regarding the administration of PDEi due to the fear of detrusor impairment, response to acute administration, and the effects of PDEi combined with alpha-blockers. Following this review, we conclude that treatment of BPO/LUTS with PDEi is beneficial, based on experimental studies, strong evidence and the large number of randomized clinical trials confirming their efficiency.
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Abstract
Benign prostatic hyperplasia (BPH) is a highly prevalent and costly condition that affects older men worldwide. Many affected men develop lower urinary tract symptoms, which can have a negative impact on their quality of life. In the past, transurethral resection of the prostate (TURP) was the mainstay of treatment. However, several efficacious drug treatments have been developed, which have transformed BPH from an acute surgical entity to a chronic medical condition. Specifically, multiple clinical trials have shown that α adrenoceptor antagonists can significantly ameliorate lower urinary tract symptoms. Moreover, 5α reductase inhibitors, alone or combined with an α adrenoceptor antagonist, can reverse the natural course of BPH, reducing the risk of urinary retention and the need for surgical intervention. Newer medical regimens including the use of antimuscarinic agents or phosphodiesterase type 5 inhibitors, have shown promise in men with predominantly storage symptoms and concomitant erectile dysfunction, respectively. For men who do not adequately respond to conservative measures or pharmacotherapy, minimally invasive surgical techniques (such as transurethral needle ablation, microwave thermotherapy, and prostatic urethral lift) may be of benefit, although they lack the durability of TURP. A variety of laser procedures have also been introduced, whose improved hemostatic properties abrogate many of the complications associated with traditional surgery.
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Affiliation(s)
- John M Hollingsworth
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Timothy J Wilt
- Minneapolis VA Center for Chronic Diseases Outcomes Research, Minneapolis, MN 55417, USA University of Minnesota School of Medicine, Minneapolis, MN, USA
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New Medical and Injectable Treatments for LUTS/BPH – Anticholinergics, PDE-5, and Botox. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0227-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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37
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Miller NL. Benign prostatic hyperplasia and lower urinary tract symptoms--when to pull the trigger on surgery? J Urol 2013; 190:1976-7. [PMID: 24055265 DOI: 10.1016/j.juro.2013.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Nicole L Miller
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
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