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Tousignant A, Blais M, Tu LM, Morin M, Ismail S. A Scoping Review of the Oral Treatment Options for the Management of Detrusor Sphincter Dyssynergia. Neurourol Urodyn 2025; 44:743-753. [PMID: 39898415 PMCID: PMC12018650 DOI: 10.1002/nau.25642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 12/02/2024] [Accepted: 12/04/2024] [Indexed: 02/04/2025]
Abstract
BACKGROUND Adult neurogenic lower urinary tract dysfunction may be associated with detrusor sphincter dyssynergia (DSD). Given the sparsity of the literature and the absence of official guidelines regarding the use of oral medications in the management of DSD, this scoping review aims to critically assess the available evidence to guide future research and practice. METHODS We conducted a systematic scoping review of articles published from 1950 to July 2023 using PubMed, MedLine, Scopus and CINAHL databases to assess all oral treatment options for DSD. All study designs were included. The search was limited to English and French literature regarding human patients over 18 years of age with DSD. RESULTS Of the 899 records screened, 15 studies were included, involving a total of 257 participants. Alpha-adrenergic blockers, nitric oxyde and muscle relaxants have been used in the treatment of DSD. A decrease of postvoid residual volumes and an improvement of symptom scores as well as urine flow rates were reported in several studies. Regarding the alpha-adrenergic blockers, five of the six studies that detailed postvoid residual volumes and subjective improvement noted benefits in most patients. Additionally, two of the three studies that addressed mean flow rate observed improvements in most patients. All six studies that documented adverse effects found side effects in only a slight minority of patients. CONCLUSIONS Alpha-adrenergic blockers are promising, but there is lacking evidence on the oral treatment of DSD. This study highlights the importance of conducting more studies to draw solid conclusions and stop treating these patients empirically.
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Affiliation(s)
- Angélique Tousignant
- Faculty of Medicine and Health SciencesUniversity of SherbrookeSherbrookeQuebecCanada
| | - Marc‐Antoine Blais
- Faculty of Medicine and Health SciencesUniversity of SherbrookeSherbrookeQuebecCanada
| | - Le Mai Tu
- Faculty of Medicine and Health SciencesUniversity of SherbrookeSherbrookeQuebecCanada
| | - Mélanie Morin
- Faculty of Medicine and Health SciencesUniversity of SherbrookeSherbrookeQuebecCanada
| | - Salima Ismail
- Faculty of Medicine and Health SciencesUniversity of SherbrookeSherbrookeQuebecCanada
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Jeon BJ, Chang HK, Tae BS, Park JY, Yoon DK, Bae JH. Efficacy of Combined Therapy With Silodosin and Solifenacin in Females With Overactive Bladder. Int Neurourol J 2024; 28:264-269. [PMID: 39765338 PMCID: PMC11710955 DOI: 10.5213/inj.2448374.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 10/28/2024] [Indexed: 01/11/2025] Open
Abstract
PURPOSE We aimed to assess the clinical efficacy and safety of combining silodosin and solifenacin for overactive bladder (OAB) in females. METHODS A retrospective analysis of 586 females with OAB was conducted. Patients received either combination therapy (silodosin 8 mg + solifenacin 5 mg) or monotherapy (solifenacin 5 mg) for 12 weeks. Baseline and follow-up assessments included the overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), voided volume (VV), and postvoid residual urine volume (PVR). RESULTS Overall, 287 and 299 patients received combination therapy and monotherapy respectively. Both groups experienced significant improvements in OABSS and total IPSS after 12 weeks. The combination therapy group demonstrated a greater improvement in QoL compared to the monotherapy group (P=0.031). No significant differences were observed in Qmax or VV between the groups. However, the combination therapy group showed a significant reduction in PVR compared to the monotherapy group (P<0.001). CONCLUSION Combining silodosin with solifenacin significantly improved OAB symptoms and QoL in females. This combination therapy was particularly effective in reducing postvoid residual volume compared to solifenacin alone. These findings suggest that adding an alpha-blocker to antimuscarinic therapy can enhance OAB management and patient satisfaction.
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Affiliation(s)
- Byeong Jo Jeon
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyun Kyung Chang
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bum Sik Tae
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Young Park
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Duck Ki Yoon
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Hyun Bae
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Fan YH, Shen YC, Hsu CC, Chow PM, Chang PC, Lin YH, Chang SJ, Jiang YH, Liao CH, Wang CC, Wu CT, Kuo HC. Current Surgical Treatment for Neurogenic Lower Urinary Tract Dysfunction in Patients with Chronic Spinal Cord Injury. J Clin Med 2023; 12:jcm12041400. [PMID: 36835937 PMCID: PMC9963408 DOI: 10.3390/jcm12041400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
This study aimed to present a comprehensive literature review of the efforts of a spinal cord injury workgroup in Taiwan regarding urologic surgery for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI). Surgical procedures should be viewed as a final option for managing patients with SCI who have persistent symptoms and complications that cannot be resolved by other means. Surgeries can be grouped according to their purpose: reducing bladder pressures, reducing urethra resistance, increasing urethra resistance, and urinary diversion. The choice of surgery depends on the type of LUTD based on urodynamic tests. Additionally, cognitive function, hand motility, comorbidities, efficacy of surgery, and related complications should be considered.
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Affiliation(s)
- Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Yuan-Chi Shen
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chih-Chen Hsu
- Department of Urology, Taipei Hospital, Ministry of Health and Welfare, Taipei 24233, Taiwan
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Po-Chih Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Yu-Hua Lin
- Department of Chemistry, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Shang-Jen Chang
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
| | - Chun-Hou Liao
- Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
| | - Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, New Taipei City 23702, Taiwan
| | - Chun-Te Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117)
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Kutzenberger J, Angermund A, Domurath B, Möhr S, Pretzer J, Soljanik I, Kirschner-Hermanns R. [Short version of the S2k guideline on drug therapy of neurogenic lower urinary tract dysfunction (NLUTD)]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:41-52. [PMID: 36271186 DOI: 10.1007/s00120-022-01950-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND In Germany about one million patients suffer from neurogenic lower urinary tract dysfunction (NLUTD). If left untreated, various forms of NLUTD can lead to secondary damage of the lower and upper urinary tract. Thus, the guideline was developed for the drug therapy of patients with NLUTD, who frequently require lifelong care and aftercare. METHODS The guideline was developed in a consensus process with several meetings and online reviews, and final recommendations were decided on in online consensus meetings. Ballots were sent to elected officials of the contributing professional societies. Level of consensus was given for each coordinated recommendation ( https://www.awmf.org/leitlinien/detail/ll/043-053.html ). RESULTS/MOST IMPORTANT RECOMMENDATIONS: (Video)urodynamic classification of the NLUTD should be conducted before the use of antimuscarinic drugs (84.2%). Approved oral antimuscarinics should be used as first choice. Contraindications must be respected (100%). If oral treatment is ineffective or in the case of adverse drug reaction (ADRs) alternatively instillation of oxybutynin solution intravesically (83%) or onabotulinumneurotoxine (OBoNT) injection should be offered (89.5%). In case of failure or ADRs of antimuscarinics, β3 sympathomimetic mirabegron can be used to treat neurogenic detrusor overactivity (NDO) (off-label use) (100%). In case of paraplegia below C8 or multiple sclerosis with an expanded disability status scale (EDSS) of ≤ 6.5, OBoNT injection can be offered as an alternative (89.5%). Drug therapy for NDO should be started early in newborns/young children (84.2%). Conservative, nondrug therapy should be considered in frail elderly (94.7%). No parasympathomimetic therapy should be used to treat neurogenic detrusor underactivity (94.7%). CONCLUSION Precise knowledge of the neurological underlying disease/sequence of trauma and the exact classification of the NLUTD are required for development of individualized therapy.
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Affiliation(s)
- J Kutzenberger
- Departement Neuro-Urologie, Kliniken Hartenstein - UKR, Bad Wildungen, Deutschland.
- , Fontanestr. 16, 34596, Bad Zwesten, Deutschland.
| | - A Angermund
- Neuro-Urologie, Schön Klinik Vogtareuth, Vogtareuth, Deutschland
| | - B Domurath
- Zentrum für Neuro-Urologie, Kliniken Beelitz, Beelitz-Heilstätten, Deutschland
| | - S Möhr
- Neuro-Urologie, REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Basel, Schweiz
| | - J Pretzer
- Klinik für Urologie und Neuro-Urologie, Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - I Soljanik
- Klinik für Paraplegiologie, Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Universität Heidelberg, Heidelberg, Deutschland
| | - R Kirschner-Hermanns
- Universitätsklinikum Bonn, Sektion Neuro-Urologie/, Klinik für Urologie und Kinderurologie und Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshöhe e. V., Bonn, Deutschland
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Wu SY, Jhang JF, Liu HH, Chen JT, Li JR, Chiu B, Chen SL, Kuo HC. Long-Term Surveillance and Management of Urological Complications in Chronic Spinal Cord-Injured Patients. J Clin Med 2022; 11:7307. [PMID: 36555924 PMCID: PMC9785560 DOI: 10.3390/jcm11247307] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Bladder dysfunction is a common complication after chronic spinal cord injury (SCI). Patients may experience renal function loss, urinary tract infection (UTI), urolithiasis, bladder cancer, and even life-threatening events such as severe sepsis or renal failure. Suitable patient care may prevent UTI and urinary incontinence, decrease medication use, and preserve renal function. As the primary goal is to preserve renal function, management should be focused on facilitating bladder drainage, the avoidance of UTI, and the maintenance of a low intravesical pressure for continence and complete bladder emptying. Currently, several bladder management options are available to SCI patients: (1) reflex voiding; (2) clean intermittent catheterization; (3) indwelling catheterization. The target organ may be the bladder or the bladder outlet. The purposes of intervention include the following: (1) increasing bladder capacity and/or decreasing intravesical pressure; (2) increasing bladder outlet resistance; (3) decreasing bladder outlet resistance; (4) producing detrusor contractility; (5) urinary diversion. Different bladder management methods and interventions may have different results depending on the patient's lower urinary tract dysfunction. This review aims to report the current management options for long-term bladder dysfunction in chronic SCI patients. Furthermore, we summarize the most suitable care plans for improving the clinical outcome of SCI patients.
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Affiliation(s)
- Shu-Yu Wu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
| | - Hsin-Ho Liu
- Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan
| | - Jian-Ting Chen
- Division of Urology, Department of Surgery, Yuanlin Christian Hospital, Changhua 51053, Taiwan
| | - Jian-Ri Li
- Department of Urology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Bin Chiu
- Department of Urology, Far Eastern Memorial Hospital, New Taipei City 22000, Taiwan
| | - Sung-Lang Chen
- Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Urology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
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Place des alphabloquants chez la femme : revue de la littérature. Prog Urol 2020; 30:1078-1095. [DOI: 10.1016/j.purol.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
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Abstract
PURPOSE OF REVIEW Multiple sclerosis (MS) is the most frequent neuroinflammatory disease of the central nervous system and is commonly associated with lower urinary tract (LUT) dysfunction. As a consequence, health-related quality of life is often impaired and the upper urinary tract might be at risk for damage. The aim of this review is to give an overview of current treatment options for LUT dysfunction in patients with MS. RECENT FINDINGS The treatment is tailored to the type of dysfunction-storage or voiding dysfunction-beginning with conservative treatment options and ending with invasive therapies and surgery. Additionally, alternative options, e.g., different intravesical therapies or cannabinoids, have been evaluated in recent years with promising results. Current available therapies offer different possible treatments for LUT dysfunction in patients with MS. They address either voiding or storage dysfunction and therefore ameliorate LUT symptoms improve quality of life and protect the upper urinary tract.
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Affiliation(s)
- Jure Tornic
- Department of Uro-Neurology, The National Hospital For Neurology and Neurosurgery and UCL Institute for Neurology, Queen Square, London, WC1N 3BG, UK.
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital For Neurology and Neurosurgery and UCL Institute for Neurology, Queen Square, London, WC1N 3BG, UK
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Demir M, Akin Y, Terim KAK, Gulum M, Buyukfirat E, Ciftci H, Yeni E. Evaluation of apoptosis indexes in currently used oral alpha-blockers in prostate: a pilot study. Int Braz J Urol 2018; 44:600-607. [PMID: 29617082 PMCID: PMC5996798 DOI: 10.1590/s1677-5538.ibju.2017.0668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 02/22/2018] [Indexed: 11/24/2022] Open
Abstract
Objectives: Apoptosis effect of oral alpha-blockers is known in the prostate. Apoptosis index of silodosin has not been proved, yet. Aims are to present apoptosis index of silodosin in prostate and to compare this with other currently used alpha-blocker's apoptosis indexes together with their clinical effects. Materials and Methods: Benign prostatic hyperplasia (BPH) patients were enrolled among those admitted to urology outpatient clinic between June 2014 and June 2015. Study groups were created according to randomly prescribed oral alpha-blocker drugs as silodosin 8mg (Group 1; n=24), tamsulosin 0.4mg (Group 2; n=30), alfuzosin 10mg (Group 3; n=25), doxazosin 8mg (Group 4; n=22), terazosin 5mg (Group 5; n=15). Pa- tients who refused to use any alpha-blocker drug were included into Group 6 as control group (n=16). We investigated apoptosis indexes of the drugs in prostatic tissues that were taken from patient's surgery (transurethral resection of prostate) and/or prostate biopsies. Immunochemical dyeing, light microscope, and Image Processing and Analy- sis in Java were used for evaluations. Statistical significant p was p<0.05. Results: There were 132 patients with mean follow-up of 4.2±2.1 months. Pathologist researched randomly selected 10 areas in each microscope set. Group 1 showed statisti- cal significant difference apoptosis index in immunochemical TUNEL dyeing and im- age software (p<0.001). Moreover, we determined superior significant development in parameters as uroflowmetry, quality of life scores, and international prostate symptom score in Group 1. Conclusions: Silodosin has higher apoptosis effect than other alpha-blockers in prostate. Thus, clinic improvement with silodosin was proved by histologic studies. Besides, static factor of BPH may be overcome with creating apoptosis.
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Affiliation(s)
- Mehmet Demir
- Department of Urology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Yigit Akin
- Department of Urology, Harran University School of Medicine, Sanliurfa, Turkey.,Department of Urology, Izmir Katip Celebi University School of Medicine, Izmir, Turkey
| | | | - Mehmet Gulum
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Evren Buyukfirat
- Department of Anaesthesiology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Halil Ciftci
- Department of Urology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Ercan Yeni
- Department of Urology, Harran University School of Medicine, Sanliurfa, Turkey
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Kim DK. Current pharmacological and surgical treatment of underactive bladder. Investig Clin Urol 2017; 58:S90-S98. [PMID: 29279881 PMCID: PMC5740035 DOI: 10.4111/icu.2017.58.s2.s90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
Generally accepted guidelines are not yet available on the management of underactive bladder (UAB). Although the natural history of UAB is still not fully understood, observation may be an acceptable management option in patients with tolerable lower urinary tract symptoms and little risk of upper urinary tract damage. If needed, scheduled and double voiding may be recommended as an effective and safe add-on therapy. Parasympathomimetics have been widely used for the management of UAB, but the evidence does not support clinical benefit. The efficacy of alpha-blockers has also not yet been clearly demonstrated. However, selective alpha-blockers may help to enhance voiding efficiency and to decrease possible upper tract damage. Sacral neuromodulation is a surgical option for nonobstructive UAB approved by the Food and Drug Administration. However, the response rate of test stimulation is not high and the efficacy of permanent implants does not always coincide with that of test stimulation. Although surgery to reduce outlet resistance may be a viable option in UAB with presumed obstruction, surgery seems to have little role in those without obstruction. Latissimus dorsi detrusor myoplasty has shown promising results in restoring voluntary voiding in selected patients. The procedure requires a multidisciplinary team approach of urologists and plastic reconstructive experts. In summary, current treatments of UAB remain unsatisfactory. The multifactorial nature of UAB pathogenesis complicates the appropriate management for each patient. Future research to establish a more clinically relevant definition of UAB will be required to open new era of UAB management.
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Affiliation(s)
- Dae Kyung Kim
- Department of Urology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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Yamanishi T, Kaga K, Fuse M, Shibata C, Kamai T, Uchiyama T. Six-year follow up of silodosin monotherapy for the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: What are the factors for continuation or withdrawal? Int J Urol 2015; 22:1143-8. [DOI: 10.1111/iju.12915] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Tomonori Yamanishi
- Department of Urology; Continence Center; Dokkyo Medical University; Tochigi Japan
| | - Kanya Kaga
- Department of Urology; Continence Center; Dokkyo Medical University; Tochigi Japan
| | - Miki Fuse
- Department of Urology; Continence Center; Dokkyo Medical University; Tochigi Japan
| | - Chiharu Shibata
- Department of Urology; Continence Center; Dokkyo Medical University; Tochigi Japan
| | - Takao Kamai
- Department of Urology; Dokkyo Medical University; Tochigi Japan
| | - Tomoyuki Uchiyama
- Department of Neurology; Continence Center; Dokkyo Medical University; Tochigi Japan
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