Pre-treatment serum testosterone level can be a useful factor to predict the improvement in bladder outlet obstruction by tadalafil for male patients with lower urinary tract symptoms induced by benign prostatic obstruction

Development and validation of a clinical prediction model of fertilization failure during routine IVF cycles

Purpose

This study aims to create and validate a clinical model that predict the probability of fertilization failure in routine in-vitro fertilization (IVF) cycles.

Methods

This study employed a retrospective methodology, gathering data from 1770 couples that used reproductive center's of the Fourth Hospital of Hebei Medical University standard IVF fertilization between June 2015 and June 2023. 1062 were in the training set and 708 were in the validation set when it was randomly split into the training set and validation set in a 6:4 ratio. The study employed both univariate and multivariate logistic regression analysis to determine the factors those influence the failure of traditional in vitro fertilization. Based on the multiple regression model, a predictive model of traditional IVF fertilization failure was created. The calibration and decision curves were used to assess the effectiveness and therapeutic usefulness of this model.

Results

The following factors independently predicted the probability of an unsuccessful fertilization: infertility years, basal oestrogen, the rate of mature oocytes, oligoasthenozoospermia, sperm concentration, sperm vitality, percentage of abnormal morphological sperm, and percentage of progressive motility (PR%).The receiver operating characteristic curve's area under the curve (AUC) in the training set is 0.776 (95% CI: 0.740,0.812), while the validation set's AUC is 0.756 (95% CI: 0.708,0.805), indicating a rather high clinical prediction capacity.

Conclusion

Our generated nomogram has the ability to forecast the probability of fertilization failure in couples undergoing IVF, hence can assist clinical staff in making informed decisions.

Dutasteride add-on treatment to tadalafil for patients with benign prostatic enlargement is similarly effective as dutasteride add-on treatment to alpha blocker: a propensity-score matching analysis

PURPOSE

To investigate the efficacy of dutasteride add-on treatment to tadalafil in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic enlargement (BPE).

METHODS

A prospective study was conducted in patients with BPE who had not been satisfied with tadalafil monotherapy for more than 3 months. Inclusion criteria were prostate volume (PV) ≥ 30 ml and IPSS ≥ 8 or QOL index ≥ 3 under administration of tadalafil without anticholinergic agent. Before and 24 weeks after dutasteride add-on treatment to tadalafil, we assessed IPSS, overactive bladder symptom score (OABSS), serum PSA and testosterone, and uroflowmetry (UFM) to compare these parameters before and after dutasteride add-on treatment. Using a propensity-score matching analysis, the efficacy of dutasteride add-on treatment to tadalafil was compared with the previous study of dutasteride add-on treatment to alpha blocker.

RESULTS

Of 52 patients who were enrolled in this study, 48 patients completed the study (mean age: 72 ± 5 years old). Dutasteride add-on treatment to tadalafil significantly improved IPSS (from 16.4 ± 5.2 to 13.3 ± 6.4) and IPSS-QOL (from 4.0 ± 1.2 to 3.3 ± 1.1), and reduced PV from 55 ± 26 to 39 ± 22 ml. Propensity-score matching identified 42 matched pairs of patients. The improvement rate of IPSS and reduction rate of PV were similar between patients treated with dutasteride add-on treatment to tadalafil and dutasteride add-on treatment to alpha blocker. The logistic regression analysis showed that PV at baseline and reduction rate of PV after treatment were associated with the effective symptomatic outcome.

CONCLUSIONS

The dutasteride add-on is a reasonable treatment option for male patients with LUTS who are not satisfied with tadalafil monotherapy.

Discontinuation Rates of Tadalafil Alone and in Combination with a-Blockers in the Treatment of Male Lower Urinary Tract Symptoms with or without Coexisting Erectile Dysfunction: A Systematic Review and Meta-Analysis

PURPOSE

We examined the discontinuation rates of tadalafil alone and in combination with a-blockers (ABs) for the treatment of male lower urinary tract symptoms (LUTS), with or without erectile dysfunction (ED).

MATERIALS AND METHODS

We searched the EMBASE, PubMed, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov databases for studies published until May 15, 2022. The discontinuation rates associated with LUTS medications were subsequently analyzed by meta-analysis.

RESULTS

Forty-four studies, including 1724 discontinued patients, were included. The combined discontinuation rate was 12.78% (95% confidence interval (CI) 9.89-15.98%), and the discontinuation rates because of adverse events and lack of efficacy were 4.56% (95% CI 3.39-5.90%) and 3.30% (95% CI 1.53-5.72%), respectively.

CONCLUSIONS

The discontinuation rate of tadalafil alone or in combination with ABs for LUTS with or without ED was relatively low and varied according to the study type. Patients receiving monotherapy or combination therapy were similarly likely to abandon treatment. Treatment with a fixed-dose combination was associated with better persistence than with a free-dose combination. These data may help guide clinicians in selecting drug regimens when making decisions. Factors associated with treatment withdrawal need to be determined through high-quality clinical studies to reduce the drug discontinuation rate, which will ultimately reduce healthcare costs and improve patient outcomes.