1
|
Wada N, Mizunaga M, Abe N, Miyauchi K, Kobayashi S, Ohtani M, Tsunekawa R, Nagabuchi M, Morishita S, Ohyama T, Yamaguchi S, Iuchi H, Noda T, Saga Y, Motoya T, Kawakami N, Nishihara M, Numata A, Kakizaki H. Comparison of mirabegron and vibegron for clinical efficacy and safety in female patients with overactive bladder: a multicenter prospective randomized crossover trial. World J Urol 2024; 42:113. [PMID: 38431689 DOI: 10.1007/s00345-024-04799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/16/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE To compare the efficacy and safety of mirabegron and vibegron in female OAB patients. METHODS We conducted a multicenter, prospective, randomized crossover study of female patients with OAB. The patients were assigned to Group MV (mirabegron for 8 weeks, followed by vibegron for 8 weeks) or group VM (vibegron for 8 weeks, followed by mirabegron for 8 weeks). The primary endpoint was the change in OABSS from baseline, and the secondary endpoint was the change in FVC parameters. After completion of the study, each patient was asked which drug was preferable. RESULTS A total of 83 patients were enrolled (40 and 43 in groups MV and VM, respectively). At 8th and 16th week, 33 and 29 in Group MV and 34 and 27 in Group VM continued to receive the treatment. The change in PVR was not significantly different between treatment with mirabegron and vibegron. The changes in OABSS, nighttime frequency, mean, and maximum voided volume were similar between mirabegron and vibegron. The mean change in the daytime frequency was greater in the vibegron than in the mirabegron. Of the 56 patients, 15 (27%) and 30 (53%) preferred mirabegron and vibegron, respectively. The remaining 11 patients (20%) showed no preference. The change in the urgency incontinence score during vibegron was better in patients who preferred vibegron to mirabegron. CONCLUSION The efficacies of mirabegron and vibegron in female patients was similar. The patients' preference for vibegron could depend on the efficacy of vibegron for urgency incontinence.
Collapse
Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
| | | | - Noriyuki Abe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shin Kobayashi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Miyu Ohtani
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Ryoken Tsunekawa
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Masaya Nagabuchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shun Morishita
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Teppei Ohyama
- Department of Urology, Kitasaito Hospital, Asahikawa, Japan
| | | | - Hiromichi Iuchi
- Department of Urology, Hokushinkai Megumino Hospital, Eniwa, Japan
| | - Tsuyoshi Noda
- Department of Urology, Fukagawa City Hospital, Fukagawa, Japan
| | - Yuji Saga
- Department of Urology, Fukagawa City Hospital, Fukagawa, Japan
| | - Tadasu Motoya
- Department of Urology, Asahikawa Rehabilitation Hospital, Asahikawa, Japan
| | - Norihiro Kawakami
- Department of Urology, Asahikawa Rehabilitation Hospital, Asahikawa, Japan
| | | | - Atsushi Numata
- Department of Urology, Furano Kyokai Hospital, Furano, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| |
Collapse
|
2
|
Belkovsky M, Zogaib GV, Passerotti CC, de Almeida Artifon EL, Otoch JP, da Cruz JAS. Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysis. Int Braz J Urol 2023; 49:668-676. [PMID: 37903004 PMCID: PMC10947629 DOI: 10.1590/s1677-5538.ibju.2023.0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/26/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE Medical expulsive therapy (MET) is recommended for distal ureteral stones from 5 to 10 mm. The best drug for MET is still uncertain. In this review, we aim to compare the effectiveness of tadalafil and tamsulosin for distal ureteral stones from 5 to 10 mm in terms of stone expulsion rate (SER), stone expulsion time (SET) and the side effect profile. MATERIALS AND METHODS A comprehensive literature search was conducted on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science, from inception until April 2023. Only randomized controlled trials were included in the analysis. RESULTS Eleven publications with 1,330 patients were included. We observed that tadalafil has a higher SER (OR 0.55, CI 95% 0.38;0.80, p=0.02, I2=52%) and the same efficacy in SET (MD 1.07, CI 95% -0.25; 2.39, p=0.11, I2=84%). No differences were found when comparing side effects as headache, backache, dizziness, and orthostatic hypotension. CONCLUSION Tadalafil has a higher stone expulsion rate than tamsulosin as a medical expulsive therapy for patients with distal stones from 5 to 10 mm without differences in side effects.
Collapse
Affiliation(s)
- Mikhael Belkovsky
- Universidade de São PauloDepartamento de Técnica CirúrgicaSão PauloSPBrasilDepartamento de Técnica Cirúrgica, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - Giulia Veneziani Zogaib
- Universidade Nove de JulhoDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Universidade Nove de Julho, São Paulo, SP, Brasil
| | - Carlo Camargo Passerotti
- Serviço de Urologia Hospital Alemão Oswaldo CruzSão PauloSPBrasilServiço de Urologia Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Everson Luiz de Almeida Artifon
- Universidade de São PauloDepartamento de Técnica CirúrgicaSão PauloSPBrasilDepartamento de Técnica Cirúrgica, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - José Pinhata Otoch
- Universidade de São PauloDepartamento de Técnica CirúrgicaSão PauloSPBrasilDepartamento de Técnica Cirúrgica, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - José Arnaldo Shiomi da Cruz
- Universidade de São PauloDepartamento de Técnica CirúrgicaSão PauloSPBrasilDepartamento de Técnica Cirúrgica, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
- Universidade Nove de JulhoDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Universidade Nove de Julho, São Paulo, SP, Brasil
- Serviço de Urologia Hospital Alemão Oswaldo CruzSão PauloSPBrasilServiço de Urologia Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| |
Collapse
|
3
|
Xue J, Liu N, Su C. Effect of Terazosin Hydrochloride Combined with Interventional Embolisation on Prostate Volume and Quality of Life of Elderly Patients with Prostatic Hyperplasia. ARCH ESP UROL 2023; 76:563-569. [PMID: 37960955 DOI: 10.56434/j.arch.esp.urol.20237608.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVE This study aimed to explore the effect of terazosin hydrochloride combined with interventional embolisation on prostate volume and quality of life (QOL) of elderly patients with prostatic hyperplasia (PH). METHODS The clinical data of 175 elderly patients with PH admitted to Central Hospital Affiliated to Shandong First Medical University from July 2020 to July 2022 were selected for retrospective analysis. Based on different treatment regimens, 89 patients who received interventional embolisation alone were included in the control group (CG), and 86 patients undergoing interventional embolisation combined with terazosin hydrochloride were included in the study group (SG). The prostate volume, serum indicators, adverse reactions and QOL of the two groups before and after treatment were compared between the two groups. RESULTS Before treatment, no significant difference in 36-item short-form health survey (SF-36) scores, serum tumour necrosis factor-α (TNF-α) and prostate-specific antigen (PSA) was observed in both groups (p > 0.05). After treatment, the SF-36 score in the SG was 78.20 ± 6.84 points, which was significantly higher than that in the CG (72.67 ± 5.94 points). In addition, the SG had remarkably lower residual urine volume and prostate volume, higher maximum flow rate and lower TNF-α and PSA levels compared with the CG (p < 0.05). The adverse reaction rate of the SG was only 4.65%, which was significantly lower than that of the CG (14.61%, p < 0.05). CONCLUSIONS Terazosin hydrochloride combined with interventional embolisation overtly reduces the prostate volume and improves the clinical symptoms of patients with fewer side effects, which has a certain clinical application value.
Collapse
Affiliation(s)
- Jianghua Xue
- Interventional Department, Jinan Central Hospital, 250013 Jinan, Shandong, China
| | - Ning Liu
- Medical Imaging Center, Jinan Central Hospital, 250013 Jinan, Shandong, China
| | - Chen Su
- Department of Oncology, Jinan Central Hospital, 250013 Jinan, Shandong, China
| |
Collapse
|
4
|
Abraham DS, Pham Nguyen TP, Newcomb CW, Gray SL, Hennessy S, Leonard CE, Liu Q, Weintraub D, Willis AW. Comparative safety of antimuscarinics versus mirabegron for overactive bladder in Parkinson disease. Parkinsonism Relat Disord 2023; 115:105822. [PMID: 37713748 PMCID: PMC10853986 DOI: 10.1016/j.parkreldis.2023.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Overactive bladder (OAB) is a common non-motor symptom of Parkinson disease (PD), often treated with antimuscarinics or beta-3 agonists. There is lack of evidence to guide OAB management in PD. OBJECTIVES To assess the comparative safety of antimuscarinics versus beta-3 agonists for OAB treatment in PD. METHODS We employed a new-user, active-comparator cohort study design. We included Medicare beneficiaries age ≥65 years with PD who were new users of either antimuscarinic or beta-3 agonist. The primary outcome was any acute care encounter (i.e., non-elective hospitalization or emergency department visit) within 90 days of OAB drug initiation. The main secondary outcome was a composite measure of acute care encounters for anticholinergic related adverse events (AEs). Matching on high-dimensional propensity score (hdPS) was used to address potential confounding. We used Cox proportional hazards models to examine the association between OAB drug category and outcomes. We repeated analyses for 30- and 180-day follow-up periods. RESULTS We identified 27,091 individuals meeting inclusion criteria (mean age: 77.8 years). After hdPS matching, antimuscarinic users had increased risks for any acute care encounter (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.12-1.37) and encounters for anticholinergic related AEs (HR 1.18, 95% CI 1.04-1.34) compared to beta-3 agonist users. Similar associations were observed for sensitivity analyses. CONCLUSIONS Among persons with PD, anticholinergic initiation was associated with a higher risk of acute care encounters compared with beta-3 agonist initiation. The long-term safety of anticholinergic vs. beta-3 agonist therapy in the PD population should be evaluated in a prospective study.
Collapse
Affiliation(s)
- Danielle S Abraham
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Real-world Effectiveness and Safety of Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thanh Phuong Pham Nguyen
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Real-world Effectiveness and Safety of Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, University of Pennsylvania Perelman School of Medicine, Epidemiology and Informatics, Philadelphia, PA, USA
| | - Craig W Newcomb
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, University of Pennsylvania Perelman School of Medicine, Epidemiology and Informatics, Philadelphia, PA, USA
| | - Shelly L Gray
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Sean Hennessy
- Center for Real-world Effectiveness and Safety of Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, University of Pennsylvania Perelman School of Medicine, Epidemiology and Informatics, Philadelphia, PA, USA
| | - Charles E Leonard
- Center for Real-world Effectiveness and Safety of Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, University of Pennsylvania Perelman School of Medicine, Epidemiology and Informatics, Philadelphia, PA, USA
| | - Qing Liu
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, University of Pennsylvania Perelman School of Medicine, Epidemiology and Informatics, Philadelphia, PA, USA
| | - Daniel Weintraub
- Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Allison W Willis
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Real-world Effectiveness and Safety of Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, University of Pennsylvania Perelman School of Medicine, Epidemiology and Informatics, Philadelphia, PA, USA.
| |
Collapse
|
5
|
Ciayadi TA, Palinrungi MA, Kholis K, Hendarto J, Syahrir S, Syarif S, Azis A. A randomized controlled trial study on effectiveness between tadalafil versus combination mirabegron and solifenacin on treatment of ureteral stent-related symptoms. Pan Afr Med J 2023; 46:2. [PMID: 37928219 PMCID: PMC10620325 DOI: 10.11604/pamj.2023.46.2.38100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 08/22/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction ureteral stents have common complications like ureteral stent-related symptoms (SRSs). This study investigated the effectiveness of tadalafil compared to mirabegron and solifenacin combination therapy in patients with ureteral SRSs after double-J (DJ) stent insertion. Methods this double-blind, randomized clinical trial used consecutive random sampling in participants with SRSs after double-J stent insertion. The study was conducted at four different hospitals in Makassar, Indonesia, from July to December 2020. Ureteral stent-related morbidity indices which analyzed include urinary symptoms, pain, general health, quality of work, and sex scores. All of the indices were measured by ureteral symptom score questionnaire for the first, second, third, and fourth weeks after drug consumption, either tadalafil 10 mg/day (group A, n=25) and a combination of mirabegron 25 mg/day and solifenacin 5 mg/day (group B, n=28). Results before the treatment procedure, the groups were comparable in age, gender, body mass index, DJ stent procedures, type, and indication. In general, the score in all parameters declined over the follow-up time for both groups. Group A had a lower urinary symptom score than group B at week III and week IV (all p-value < 0.001). In addition, group A had a lower pain score, general condition, work activity, and other complaints than group B at week II, week III, and week IV (all p-value <0.001). The sexual activity score is comparable between the group, except in week I. Conclusion according to our results, we suggest tadalafil to minimize stent-related urinary symptoms and improve general health in patients with double J stent.
Collapse
Affiliation(s)
- Tjia Adynata Ciayadi
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Asykar Palinrungi
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Khoirul Kholis
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Joko Hendarto
- Department of Public Health, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Syakri Syahrir
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Syarif Syarif
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Abdul Azis
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| |
Collapse
|
6
|
Karin L, Igor M, Chen S, Yariv S, Grotz O, Jack B, Ofer Y, Shachar A. Persistence of overactive bladder pharmacological treatment in women as reflected from large-scale real-world data of prescription claims: A retrospective cohort study. Neurourol Urodyn 2023; 42:1491-1498. [PMID: 37395464 DOI: 10.1002/nau.25238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/09/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Medical treatments for overactive bladder (OAB) have proven efficacy in controlled trials. However, 1-year treatment persistence is reported to be as low as 25% for anticholinergics and 40% for β3 agonists. Real-world data on treatment continuation and treatment sequence is limited. Therefore, we aimed to study treatment persistence trends in women initiated on OAB medications. MATERIALS AND METHODS We used advanced data-mining techniques to query the largest regional provider's medication purchase database, dispensing for patients, for all women initiating OAB pharmacotherapy between 2010 and 2020. Treatment persistence was measured as days in which the patient was in possession of medication and nonpersistence was defined as prescription nonrefilling for 90 days. We employed a Sankey diagram to explore trends in OAB medication acquisition and treatment sequence. We compared treatment persistence using Kaplan-Meier survival curves and pairwise log-rank analysis. RESULTS Here, 46 079 women made 791 681 unique claims of OAB medications. Only 39% of the patients tried more than one OAB formulation, including dose change. The overall persistence rate for all drugs was 55% in 30 days, 46% in 90 days, and 37% per year. The persistence rate for Mirabegron at 30 days was 54%, 42% at 90 days, and 17% at 1 year. Overall, persistence rates were unchanged when stratifying by the time Mirabegron insurance acceptance into coverage (p > 0.05). CONCLUSIONS Real-world OAB pharmacotherapy persistence rates are lower than previously reported. The introduction of Mirabegron did not seem to improve these rates or affect the treatment sequence.
Collapse
Affiliation(s)
- Lifshitz Karin
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Mintz Igor
- Faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shenhar Chen
- Department of Urology, Cleveland Clinic, Cleveland, Ohio, USA
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Stabholtz Yariv
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Osnat Grotz
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baniel Jack
- Faculty of medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Yossepowitch Ofer
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aharony Shachar
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
| |
Collapse
|
7
|
Warli SM, Firsty NN, Natalia D, Velaro AJ, Tala ZZ. Urodynamic parameter improvements after mirabegron vs. antimuscarinics agents in non-neurogenic overactive bladder: a systematic review and meta-analysis of treatment effect. Eur Rev Med Pharmacol Sci 2023; 27:3864-3876. [PMID: 37203811 DOI: 10.26355/eurrev_202305_32292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE: This review aimed to establish the comparison between mirabegron and antimuscarinic agents through the improvement of the urodynamic study (UDS) parameter among overactive bladder (OAB) populations. MATERIALS AND METHODS: The PRISMA checklist and procedure were utilized to standardize our review of studies from scientific databases published between January 2013 and May 2022 in accordance with the applied eligibility criteria. This study mainly focused on UDS parameter improvement; hence, baseline and follow-up completion were mandatory to be included. The quality of each included study was assessed with the Cochrane risk-of-bias tool in RevMan 5.4.1. RESULTS: We included a total of 5 clinical trials encompassing 430 clinically confirmed OAB individuals. Our meta-analysis demonstrated that the improvement of maximum urinary flow rate (Qmax) was more apparent in the mirabegron arm [mean difference (MD), 1.78 (1.31, 2.26); p<0.05] compared to antimuscarinics arm [MD, 0.02 (-2.53, 2.57); p>0.05) as analyzed in random-effect model (REM) analysis within 95% CI. Similar outcomes were also observed on the other UDS parameters related to the bladder's storage function, e.g., post-void residual (PVR) and detrusor overactivity (DO) cases, with most of the MDs favoring mirabegron. CONCLUSIONS: Mirabegron is superior in improving most of the UDS parameter outcomes compared to the antimuscarinics agents though the current guideline should always refer to symptoms improvement. Emphasizing the role of UDS parameter measurements to objectively confirm a therapeutic effect should be considered in the upcoming studies.
Collapse
Affiliation(s)
- S M Warli
- Department of Urology, Universitas Sumatera Utara Hospital - Universitas Sumatera Utara, Medan, Indonesia.
| | | | | | | | | |
Collapse
|
8
|
Halverson T, Mueller ER, Brubaker L, Wolfe AJ. Symptom improvement with mirabegron treatment is associated with urobiome changes in adult women. Int Urogynecol J 2022; 33:1319-1328. [PMID: 35412069 PMCID: PMC9119880 DOI: 10.1007/s00192-022-05190-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
Introduction and hypothesis Mirabegron, a beta-3 agonist, is prescribed for urgency urinary incontinence (UUI). We assessed the correlation of symptom improvement with urobiome characteristics in adult women participants prescribed mirabegron for UUI treatment. Methods We enrolled participants seeking UUI treatment who selected mirabegron and agreed to participate in this 12-week, open label study conducted at the Female Pelvic Medicine and Reconstructive Surgery Center at Loyola University Medical Center. Following eligibility screening and research consent, participants completed the overactive bladder questionnaire (OAB-Q) and provided a catheterized urine sample at baseline, 4, 8, and 12 weeks. The primary outcome, symptom improvement at 12 weeks, was based on the validated Patient Global Symptom Control questionnaire score to dichotomize symptom response (responder vs nonresponder [PGSC score ≤3]). Urine samples were processed by the Expanded Quantitative Urine Culture (EQUC) protocol. Results Eighty-three participants (mean age 68 years) completed baseline assessment. Of the 47 participants with primary outcome data and samples analysis, there were 16 responders and 31 nonresponders; responder groups were similar demographically. Living microbes were detected in most participants. There were no significant differences in alpha diversity (within sample) at baseline between groups. However, at the 12-week follow-up, the responder urobiome became significantly richer, with a larger number of genera (p = 0.027) and was significantly more diverse than the nonresponders. Conclusions Longitudinal urobiome changes are associated with symptom improvement in adult women being treated with mirabegron for UUI. The mechanism for symptoms improvement may relate to the detected changes in the urobiome and warrants further study.
Collapse
Affiliation(s)
- Thomas Halverson
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA
| | - Elizabeth R Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology & Obstetrics/Gynecology, Loyola University Medical Center, Maywood, IL, USA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA.
| |
Collapse
|
9
|
Minh TD, Thanh Ha TN, Duy TN, Hoang NN, PhamTien D, Thai HP, Thi HN, Thi Lan PD, Quoc BP, Ivkin DY, Povydysh MN, Cong BN, Krasnova MV. Linh Phu Khang Tue Tinh inhibited prostate proliferation in rats induced benign prostatic hyperplasia by testosterone propionate. J Ethnopharmacol 2021; 279:114388. [PMID: 34224813 DOI: 10.1016/j.jep.2021.114388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/16/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Benign prostatic hyperplasia (BPH) is the hyperproliferation of the stromal and the epithelial cells within the prostatic transition zone. In recent years, phytotherapy have been studied with the concern for increasing quality of life, improving lower urinary tract symptoms (LUTS) as well as reducing prostate volume and the frequency of adverse events was similar to that of placebo. Linh Phu Khang Tue Tinh (LPKTT) capsules are formulated from 4 herbs widely used in traditional Vietnamese medicine - Panax notoginseng (Burkill) F.H.Chen - Tam thất (radix), Crinum asiaticum L. - Náng hoa trắng or giant crinum lily, Polygonum cuspidatum Willd. ex Spreng. (= Reynoutria japonica Houtt) - Cốt củ khí or Japanese knotweed (radix), Oldenlandia herbacea (L.) Roxb. (formerly known as Hedyotis diffusa Spreng.) - Bạch hoa xà thiẹ^t thảo or slender oldenlandia (herb). The preparation has been used in traditional Vietnamese medicine to treat nocturia, weak urine stream, urinary tract infection. According to modern studies, these herbs have anti-inflammation, antitumor, and antioxidant activities. AIMS OF THE STUDY Evaluating the effects of LPKTT capsules on the development of BPH using a rat model of BPH induced by testosterone propionate (TP). MATERIALS AND METHODS 60 male Wistar rats, 10-12 weeks of age, weight 200-250 g were separated into six groups: (G1) a normal control group that was taken orally phosphate-buffered saline (p.o.; PBS.) with corn oil (subcutaneous injection- Sc); (G2) a BPH model group that received PBS (p.o) with TP (Sc); (G3) a positive control group that received dutasteride (25 μg/kg BW/24 h, p.o.) with TP (Sc); (G4) a positive control group that received alfuzosin HCl (1.8 mg/kg BW/24 h, p.o.) with TP (s.c.) and (G5 and G6) LPKTT groups that received LPKTT at 289.8 or 869.4 mg/kg(p.o.) respectively, with TP (s.c.). BPH model was induced by Sc of TP, 3 mg/kg for 4 weeks. After that, rats were received NaCl/Dutasteride/Alfuzosin/LPKTT for the next 28 days. On the 56th day, assessed the results were through the indicators: micturition frequency, voided volume, total voided volume, the prostate and body weights, the ratio of prostate weight to body weight, prostate histology. RESULTS LPKTT reduced micturition frequency and increased the voided volume when compared to the control group (p < 0.01). The results were equivalent to those of the alfuzosin ones (G4). LPKTT lowered prostate weight and the ratio of prostate weight to body weight when compared to the control group (p < 0.01). These reductions were the same in the dutasteride ones. Histomorphology in G5 and G6 also showed that LPKTT inhibited TP induced prostatic hyperplasia. The results were similar to that in the dutasteride group. Microscopic images of prostate in G5 and G6 were almost similar to that of G1. CONCLUSION LPKTT capsules work to inhibit prostate proliferation in rats induced BPH by TP.
Collapse
Affiliation(s)
- Thuy Doan Minh
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; General Surgery Department, Viet Nam.
| | - Tuan Nguyen Thanh Ha
- Hospital 103, Viet Nam; Vietnam Military Medical University, 160 Phunghung, Hadong district, Hanoi, 100000, Viet Nam
| | - Thuan Nguyen Duy
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; Department of Pharmacology, Viet Nam
| | - Ngan Nguyen Hoang
- Vietnam Military Medical University, 160 Phunghung, Hadong district, Hanoi, 100000, Viet Nam; Department of Pharmacology, Viet Nam
| | - Dung PhamTien
- Department of Traditional Medicine, Haiphong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Hai Phong, 180000, Viet Nam
| | - Hung Pham Thai
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; General Surgery Department, Viet Nam
| | - Hoa Nguyen Thi
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; General Surgery Department, Viet Nam
| | - Phuong Dang Thi Lan
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; General Surgery Department, Viet Nam
| | - Binh Pham Quoc
- Vietnam University of Traditional Medicine, 2 Tranphu Street, Hadong district, Hanoi, 100000, Viet Nam; Department of Theoretical Traditional Medicine, Viet Nam
| | - D Y Ivkin
- Department of Pharmacology and Clinical Pharmacology, Saint Petersburg State Chemical Pharmaceutical University, Saint Petersburg, Russia
| | - M N Povydysh
- Department of Pharmacology and Clinical Pharmacology, Saint Petersburg State Chemical Pharmaceutical University, Saint Petersburg, Russia.
| | - Bang Nguyen Cong
- Vietnam Military Medical University, 160 Phunghung, Hadong district, Hanoi, 100000, Viet Nam
| | - M V Krasnova
- Department of Pharmacology and Clinical Pharmacology, Saint Petersburg State Chemical Pharmaceutical University, Saint Petersburg, Russia
| |
Collapse
|
10
|
Guo J, Tang R. Efficacy and tolerability of doxazosin gastro-intestinal therapeutic system versus tamsulosin in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26955. [PMID: 34414962 PMCID: PMC8376339 DOI: 10.1097/md.0000000000026955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Alpha1-adrenoceptor antagonists (α1-blockers) are first-line drugs for the treatment of lower urinary tract symptoms associated with benign prostate hyperplasia (BPH). Doxazosin gastrointestinal therapeutic system (GITS) and tamsulosin belong to the 2 most frequently prescribed α1-blockers. This systematic review and meta-analysis was performed to compare the efficacy and tolerability of these 2 α1-blockers. METHODS A systematic review of published randomized controlled trials in English or Chinese language was performed using the PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and Vip databases. After data extraction and quality assessment, the meta-analysis was performed to compare clinical parameters (International Prostate Symptom Score [IPSS] total [IPSS-T], storage [IPSS-S], voiding [IPSS-V], maximum urine flow [Qmax], and postvoid residual) and adverse events (AEs) that changed after first drug intake. RESULTS After the screening, 8 eligible randomized controlled trials with 1316 patients were identified. Doxazosin-GITS showed a significantly higher efficacy compared with tamsulosin (IPSS-T P < .001, IPSS-S P < .001, and IPSS-V P < .001). There were no significant differences between the 2 drugs for changes in Qmax (P = .477) or postvoid residual (P = .739). The overall AEs were significantly lower in the doxazosin-GITS group (risk ratio: 0.77; 95% CI: 0.54-1.08; P = .036). However, dizziness (P = .387), headache (P = .745), asthenia (P = .693), postural hypotension (P = .114), and retrograde ejaculation (P = .187) were similar between the 2 groups. CONCLUSIONS This meta-analysis indicates that doxazosin-GITS has significantly higher efficacy and lower AEs than tamsulosin in patients with lower urinary tract symptoms/benign prostate hyperplasia.
Collapse
Affiliation(s)
- Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rong Tang
- Viatris Pharmaceuticals Co., Ltd, Shanghai, China
| |
Collapse
|
11
|
Abstract
This study was to evaluate the impact of the symptoms of overactive bladder (OAB) syndrome on female sexual function. Seventy nine patients with OAB (OAB group) and 79 healthy women (control group) underwent physical examination at our center, and had their sexual function evaluated using the female sexual function index (FSFI). In accordance with the presence or absence of urge incontinence, the OAB group was further divided into the wet and dry groups. The sexual function was evaluated again after 3 months of pharmacotherapy. We investigate the difference of sexual function between OAB and control group. The effect of OAB severity and OAB pharmacotherapy on sexual function was also explored. There were no significant differences between OAB group and control group, including age, body mass index (BMI), education, occupation, fertility, parity, childbirth, and menopause. Compared with the control group, the OAB group had significantly lower FSFI scores. The respective mean ± standard error FSFI scores in the control group and the OAB group were 2.98 ± 1.07 and 2.27 ± 0.96 for desire, 3.48 ± 1.16 and 2.32 ± 1.44 for arousal, 4.60 ± 1.13 and 3.10 ± 1.95 for lubrication, 3.37 ± 0.87 and 2.63 ± 1.04 for orgasm, 3.58 ± 1.02 and 2.41 ± 1.35 for sexual satisfaction, 3.58 ± 1.02 and 2.41 ± 1.35 for sexual pain, and 22.24 ± 5.29 and 15.59 ± 7.47 for the total score (P < .05 for all comparisons). The scores for desire, lubrication, orgasm, sexual satisfaction, pain, and total FSFI between the OAB-dry and OAB-wet subgroup were similar while score of arousal in OAB-wet subgroup was significantly increased compared with that of OAB-dry. OABSS score was commonly used in the assessment of OAB severity. The difference of the FSFI scores among mild OAB group, moderate OAB group, and severe OAB group was statistically significant (P < .05). Female FSFI sexual function scores were significantly improved after OAB pharmacotherapy (P < .05). Women with OAB syndrome have poorer sexual function than healthy women. Patients with more serious OAB experience more disturbing sexual dysfunction. Female sexual function scores were significantly improved after OAB pharmacotherapy.
Collapse
Affiliation(s)
- Xiao-Dan Lin
- Department of Urology, the First Affiliated Hospital of Fujian Medical University
| | - Ning Lin
- Department of Urology, the First Affiliated Hospital of Fujian Medical University
| | - Zhi-Bin Ke
- Department of Urology, the First Affiliated Hospital of Fujian Medical University
| | - Ning Xu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University
| | - Ping Jiang
- Department of Urology, the First Affiliated Hospital of Fujian Medical University
| | - Hong Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| |
Collapse
|
12
|
Sebastianelli A, Spatafora P, Morselli S, Vignozzi L, Serni S, McVary KT, Kaplan S, Gravas S, Chapple C, Gacci M. Tadalafil Alone or in Combination with Tamsulosin for the Management for LUTS/BPH and ED. Curr Urol Rep 2020; 21:56. [PMID: 33108544 PMCID: PMC7591403 DOI: 10.1007/s11934-020-01009-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/18/2022]
Abstract
Purpose of Review Aim of our systematic review is to evaluate and summarize the efficacy and safety of tadalafil alone or in combination with tamsulosin for the management of lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Recent Findings Daily tadalafil, in particular 5 mg, according to retrieved studies, appears to be both safe and effective in treating LUTS/BPH and ED, compared with placebo or tamsulosin. The combination of daily tadalafil 5 mg and tamsulosin 0.4 mg allows a better improvement of LUTS compared with both the monotherapies, even if with an increased, but acceptable and tolerated, adverse events rate. After discontinuation of tamsulosin or tadalafil in patients previously treated with their combination, the improvement of LUTS retains significance compared with baseline. Summary Tadalafil 5 mg should be considered a primary treatment option for patients with LUTS/BPH and ED. Evidence highlight an excellent tolerability, safety, and effectiveness profile, both alone or in combination with tamsulosin 0.4 mg. A better efficacy on LUTS relief has been observed for combination therapy, preserving also sexual function. The further switch to monotherapy allows to preserve LUTS relief, but tadalafil only is able to retain ED improvement. Our results support the evidence for a more and more tailored and modular LUTS treatment.
Collapse
Affiliation(s)
- A Sebastianelli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - P Spatafora
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - S Morselli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - L Vignozzi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, University of Florence, Florence, Italy
| | - S Serni
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - K T McVary
- Department of Urology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - S Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - S Gravas
- Department of Urology, University of Thessaly, Larissa, Greece
| | - C Chapple
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy.
| |
Collapse
|
13
|
Panken EJ, Fantus RJ, Chang C, Kashanian JA, Helfand BT, Brannigan RE, Bennett NE, Halpern JA. Epidemiology and Diagnosis of Erectile Dysfunction by Urologists Versus Non-Urologists in the United States: An Analysis of the National Ambulatory Medical Care Survey. Urology 2020; 147:167-171. [PMID: 32979379 DOI: 10.1016/j.urology.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/30/2020] [Accepted: 09/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the extent to which erectile dysfunction (ED) is managed by urologists versus non-urologists. We sought to characterize the epidemiology, diagnosis, and outpatient treatment of ED using a nationally representative cohort. METHODS We examined all male patient visits between 2006 and 2016 in the National Ambulatory Medical Care Survey, a survey designed to provide a nationally representative estimate of ambulatory visits in the United States. Distribution of ED diagnoses among physician specialties was determined. Demographic, clinical, and treatment characteristics of men with ED seeing urologists versus non-urologists were compared using chi-squared tests. RESULTS Among the 170,499 patient visits analyzed, 1.2% were associated with a diagnosis of ED, which translated into 3,409,244 weighted visits annually. Visits for ED were predominantly seen by urologists (58.0%) and family practitioners (26.2%). Men visiting non-urologists for ED were more likely to be younger than 65 (77.4% vs 52.9%, P < .05). Men seeing urologists for ED more frequently had an active cancer diagnosis (24.2% vs 2.8%, P < .05). Non-urologists more readily ordered or reordered phosphodiesterase-5 inhibitors for men with ED (66.62% vs 50.77%, P < .05). Advanced therapies such as intracavernosal injections and intra-urethral agents were almost exclusively ordered by urologists compared to non-urologists (2.72% vs 0.25%, P < .05). CONCLUSION Almost half of all ED visits were seen by non-urologist providers, who were much less likely than urologists to order advanced pharmacologic therapies. This difference in prescribing patterns presents an opportunity for interdisciplinary collaboration and education to ensure that all patients seeking treatment for ED are receiving guideline-based care.
Collapse
Affiliation(s)
- Evan J Panken
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Richard J Fantus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Cecilia Chang
- Division of Urology, Department of Surgery, NorthShore University Health System, Evanston, IL
| | | | - Brian T Helfand
- Division of Urology, Department of Surgery, NorthShore University Health System, Evanston, IL
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| |
Collapse
|
14
|
Astroza Eulufi G, Sarrás Jadue M, Bettancourt Guglielmetti C, Lara Hernández B, Neira Soto R, Aguilera Fuenzalida P. Effectiveness of medical expulsive therapy with the ɲ-adrenergic blocker tamsulosin for distal ureterolithiasis in adults attended in an emergency department in Chile. Emergencias 2020; 31:404-406. [PMID: 31777212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess the effectiveness of medical expulsive therapy with tamsulosin. MATERIAL AND METHODS Randomized double-blind controlled trial in an emergency department. We enrolled adults with uncomplicated distal ureterolithiasis and no other complaint. Patients were randomized to take either tamsulosin (0.4 mg/d) plus a nonsteroidal anti-inflammatory drug (NSAID) or placebo plus the NSAID for 21 days. RESULTS The stone expulsion rate did not differ statistically between the 2 groups (P=.29). Time until expulsion was also similar (P=.91). CONCLUSION Medical expulsive therapy with tamsulosin does not improve the rate of distal ureteral stone expulsion.
Collapse
Affiliation(s)
- Gastón Astroza Eulufi
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Miguel Sarrás Jadue
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | | | - Bárbara Lara Hernández
- Servicio de Urgencias, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Rodrigo Neira Soto
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Pablo Aguilera Fuenzalida
- Servicio de Urgencias, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| |
Collapse
|
15
|
Shen YC, Wang HJ, Lee WC, Chen CH, Chuang YC. Intravesical prostatic protrusion does not compromise the therapeutic effects of Mirabegron in male patients with overactive bladder. Int J Clin Pract 2020; 74:e13537. [PMID: 32438481 DOI: 10.1111/ijcp.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022] Open
Abstract
AIMS Intravesical prostatic protrusion (IPP) is associated with the degree of benign prostatic obstruction. We evaluated the effects of Mirabegron, a selective β3 adrenoceptor agonist, on overactive bladder (OAB) in male patients with different degrees of IPP. METHODS About 185 male patients ≥40 years with lower urinary tract symptoms were recruited from a tertiary referral center. OAB was defined by the overactive bladder symptom score (OABSS) urgency score of ≥2 and sum score of ≥3. IPP was measured in the midsagittal section using transrectal ultrasound and patients were divided into IPP ≤5 mm and IPP >5 mm groups. Outcomes were assessed at the baseline, 4, and 12 weeks. RESULTS About 104 patients (56.2%) were diagnosed with OAB and received Mirabegron (50 mg) daily use. Both IPP groups (≤5 and >5 mm) had similar baseline OABSS and International Prostate Symptom Scores (IPSS). Four-week Mirabegron usage was associated with significant decreases in both symptom score measurements, OABSS: IPP ≤5 mm -27.4% and IPP >5 mm -19.7% (P = .419) and IPSS: -32% and -22.5% (P = .202), respectively. Urgency, urge incontinence, and nocturia sub-scores were decreased in both groups, -26.3% and -27.4% (P = .690), 53.3% and 46.2% (P = .916), and 20.8% and 15.4% (P = .958). Effects were maintained at 12 weeks. We found no significant improvement in the frequency sub-score in either group. One patient stopped medication because of intolerable hypertension. Most frequent adverse event was increased residual urine (≥50 mL higher than baseline), IPP ≤5 mm 9.2% and IPP >5 mm 5.1% (P = .707), but no case had acute urinary retention. CONCLUSIONS Mirabegron is an effective drug to treat male OAB regardless of IPP grade.
Collapse
Affiliation(s)
- Yuan C Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung J Wang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei C Lee
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien H Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao C Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
16
|
Aparasu RR, Sura S, Earla JR, Shiozawa A, Ng DB, Schermer CR. Antimuscarinic Discontinuation in Patients with Overactive Bladder in Nursing Homes: A Retrospective Study of Medicare Beneficiaries. Adv Ther 2020; 37:3584-3605. [PMID: 32638205 PMCID: PMC7370971 DOI: 10.1007/s12325-020-01412-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 11/28/2022]
Abstract
Introduction Although antimuscarinics form the first-line therapy in overactive bladder (OAB), little is known regarding antimuscarinic discontinuation among OAB patients in nursing homes. This study examined treatment patterns and predictors of antimuscarinic discontinuation among long-term nursing home (LTNH) residents with OAB. Methods The study cohort included LTNH residents (defined as residents staying ≥ 101 consecutive days) from the Minimum Data Set linked 2013–2015 Medicare claims data. Patients with OAB were defined by OAB-related claims and medication codes. Treatment patterns and discontinuation (medication gap ≥ 30 days) were characterized by examining OAB-specific antimuscarinics prescribed during LTNH stays. The Andersen Behavioral Model was used to identify predisposing, enabling and need factors that predict discontinuation. Kaplan-Meier curves and multivariable Cox proportional hazards regression model were used to assess the unadjusted and adjusted times to discontinuation, respectively, among different antimuscarinics. Results The mean age of the study cohort (n = 11,012) was 81.6 years (± 8.5), 74.6% were female, and 89.8% were non-Hispanic White. The mean duration of nursing home stay was 530.1 (± 268.4) days. The most commonly prescribed OAB-specific antimuscarinic was oxybutynin (69.8%). Overall, 66.5% of the study cohort discontinued the index antimuscarinic. Multivariable Cox PH regression analysis revealed that compared to LTNH residents who initiated treatment with oxybutynin, treatment discontinuation was lower with solifenacin or fesoterodin and discontinuation was more frequent when treatment was initiated with tolterodine, darifenacin or trospium compared with oxybutynin. In addition, several need factors (comorbidities, medication use and anticholinergic burden, etc.) were associated with antimuscarinic discontinuation. Conclusion About two-thirds of LTNH residents with OAB discontinued their index antimuscarinic during their nursing home stay. There was significant variation in discontinuation based on the index antimuscarinic agent with lowest risk of discontiuation with solifenacin and fesoterodin. Concerted efforts to optimize antimuscarinic use are needed to improve the management of OAB in nursing homes. Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01412-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, USA.
| | - Sneha Sura
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, USA
| | - Jagadeswara R Earla
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, USA
| | - Aki Shiozawa
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | - Daniel B Ng
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | |
Collapse
|
17
|
Staskin D, Frankel J, Varano S, Shortino D, Jankowich R, Mudd PN. International Phase III, Randomized, Double-Blind, Placebo and Active Controlled Study to Evaluate the Safety and Efficacy of Vibegron in Patients with Symptoms of Overactive Bladder: EMPOWUR. J Urol 2020; 204:316-324. [PMID: 32068484 DOI: 10.1097/ju.0000000000000807] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE We assessed efficacy, safety and tolerability of vibegron, a novel, potent, highly selective β3-adrenoceptor agonist, administered 12 weeks at 75 mg once daily to patients with overactive bladder in an international phase III trial with placebo and active control. MATERIALS AND METHODS Adult patients with overactive bladder with 8.0 or more micturitions per day were randomized 5:5:4 to 75 mg vibegron, placebo or extended-release 4 mg extended-release tolterodine. Up to 25% of patients could have dry overactive bladder (less than 1.0 urge incontinence episode per day). Patients completed 7-day voiding diaries at baseline and weeks 2, 4, 8 and 12. RESULTS Of 1,518 randomized patients 90.4% completed the trial. At 12 weeks micturitions decreased by an adjusted mean of 1.8 episodes per day for vibegron vs 1.3 for placebo (p <0.001, co-primary end point) and 1.6 for tolterodine. Among incontinent patients urge incontinence episodes decreased by an adjusted mean 2.0 episodes per day for vibegron vs 1.4 for placebo (p <0.0001, co-primary end point) and 1.8 for tolterodine. Moreover, vibegron was statistically significantly superior to placebo for key secondary measures of number of urgency episodes, volume per micturition and proportion of incontinent patients with a 75% or greater reduction in urge incontinence episodes (all p <0.01). Among vibegron treated patients 1.7% discontinued treatment because of adverse events vs 1.1% for placebo and 3.3% for tolterodine. Incidence of hypertension was 1.7% for vibegron and for placebo. CONCLUSIONS Once daily 75 mg vibegron provided statistically significant reductions in micturitions, urgency episodes and urge incontinence, and increased the volume per micturition. Treatment was well tolerated with a favorable safety profile.
Collapse
Affiliation(s)
- David Staskin
- Tufts University School of Medicine, Boston, Massachusetts
| | | | | | | | | | | |
Collapse
|
18
|
Singh I, Tk A, Gupta S. Efficacy and safety of tadalafil vs tamsulosin in lower urinary tract symptoms (LUTS) as a result of benign prostate hyperplasia (BPH)-open label randomised controlled study. Int J Clin Pract 2020; 74:e13530. [PMID: 32542854 DOI: 10.1111/ijcp.13530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION & AIM Several newer medications have emerged for the management of lower urinary tract symptoms secondary to benign prostate hyperplasia (BPH). The efficacy/safety of PDE-5 inhibitors (Tadalafil 5 mg) in BPH-lower urinary tract symptoms (LUTS) has been sparingly assessed in the published English literature as compared with their established role in erectile dysfunction. We aim to assess the efficacy/safety of tadalafil vs tamsulosin in symptomatic patients of BPH in a tertiary care teaching institution. METHODS After obtaining an informed written consent and institutional ethics clearance, 100 patients of BPH with an IPSS score of more than 7, without any complications of the disease were computer randomised to receive therapy with either tamsulosin 0.4 mg or tadalafil 5 mg once daily for a period of 2 months. They were evaluated for its efficacy (IPSS, Peak flow rate, IIEF-5, quality of life index [QOL] and PVR) and safety (side effect profile) with monthly visit assessments for 2 months. Data were analysed statistically using ANOVA and unpaired t-tests.The protocol was registered with the CTRI/2018/03/012825. RESULTS Patients in both groups were comparable on basis of their demographic data, renal function, PSA and baseline efficacy parameters. Significant improvements were visualised amongst/within both groups for IPSS, however the intergroup improvement was not significant (P = .096). Similar trends were seen with peak flow rate and PVR with intergroup improvement differences not being significant (P = .552 and P = .131, respectively).Improvements in QOL index were more significant in the tamsulosin group (mean difference -2.3 vs -3.06 P = .010).The adverse effects were minor and were managed symptomatically without any drug discontinuity. CONCLUSIONS In summary, therefore, we may conclude that that once daily monotherapy with tadalafil 5 mg or tamsulosin 0.4 mg was equally efficacious in the management of moderate to severely bothersome LUTS in majority of patients as a result of BPH. The role of Tadalafil monotherapy in BPH patients with predominant storage LUTS merits further evaluation with larger trials.
Collapse
Affiliation(s)
- Iqbal Singh
- Department of Surgery (Urology), University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi, India
| | - Aravind Tk
- Department of Surgery (Urology), University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi, India
| | - Sanjay Gupta
- Department of Surgery (Urology), University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi, India
| |
Collapse
|
19
|
Fry CH, Chakrabarty B, Hashitani H, Andersson KE, McCloskey K, Jabr RI, Drake MJ. New targets for overactive bladder-ICI-RS 2109. Neurourol Urodyn 2020; 39 Suppl 3:S113-S121. [PMID: 31737931 PMCID: PMC8114459 DOI: 10.1002/nau.24228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 10/31/2019] [Indexed: 12/16/2022]
Abstract
AIM To review evidence for novel drug targets that can manage overactive bladder (OAB) symptoms. METHODS A think tank considered evidence from the literature and their own research experience to propose new drug targets in the urinary bladder to characterize their use to treat OAB. RESULTS Five classes of agents or cellular pathways were considered. (a) Cyclic nucleotide-dependent (cyclic adenosine monophosphate and cyclic guanosine monophosphate) pathways that modulate adenosine triphosphate release from motor nerves and urothelium. (b) Novel targets for β3 agonists, including the bladder wall vasculature and muscularis mucosa. (c) Several TRP channels (TRPV1 , TRPV4 , TRPA1 , and TRPM4 ) and their modulators in affecting detrusor overactivity. (d) Small conductance Ca2+ -activated K+ channels and their influence on spontaneous contractions. (e) Antifibrosis agents that act to modulate directly or indirectly the TGF-β pathway-the canonical fibrosis pathway. CONCLUSIONS The specificity of action remains a consideration if particular classes of agents can be considered for future development as receptors or pathways that mediate actions of the above mentioned potential agents are distributed among most organ systems. The tasks are to determine more detail of the pathological changes that occur in the OAB and how the specificity of potential drugs may be directed to bladder pathological changes. An important conclusion was that the storage, not the voiding, phase in the micturition cycle should be investigated and potential targets lie in the whole range of tissue in the bladder wall and not just detrusor.
Collapse
Affiliation(s)
- Christopher Henry Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Basu Chakrabarty
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Hikaru Hashitani
- Department of Cell Physiology, Nagoya City University, Nagoya, Japan
| | - Karl-Erik Andersson
- Institute of Laboratory Medicine, Lund University, Lund, Sweden
- Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Karen McCloskey
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Rita I. Jabr
- Division of Biochemical Sciences, Faculty of Health and Biomedical Sciences, University of Surrey, Guildford, UK
| | | |
Collapse
|
20
|
Abstract
RATIONALE Herpes zoster (HZ) involving sacral dermatome is very rare, which can sometimes cause voiding dysfunction. PATIENT CONCERNS A 52-year-old man presented with acute pain and voiding dysfunction, following HZ in his right sacral dermatomes. DIAGNOSES Twenty two days before presentation HZ occurred and 9 days after the onset of the HZ, he had trouble with starting urination and weak urine stream which was managed with tamsulosin 0.4 mg orally once a day and intermittent urinary catheterization. He was treated with 150 mg of pregabalin 2 times a day, tramadol 50 mg 2 times, and acetaminophen 600 mg 2 times a day. However, his pain intensity was 5 on the numerical analogue scale (NRS) from 0 (no pain) to 10 (worst pain imaginable). INTERVENTIONS Fluoroscopy guided caudal block was performed with a mixture of 0.5% lidocaine 10 mL and triamcinolone 40 mg. OUTCOMES One day after the procedure, the pain decreased to 1 on the NRS score. In addition, voiding difficulty greatly improved. Three days after the intervention, the patient reported complete resolution of pain and voiding dysfunction. He currently remains symptom free at a 3-month follow-up. LESSONS A caudal block with steroid can be an effective option for treatment of acute voiding dysfunction and pain following sacral HZ.
Collapse
Affiliation(s)
- Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
- Department of Anesthesiology and Pain medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yehun Jin
- Department of Anesthesiology and Pain medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| |
Collapse
|
21
|
Abstract
Pediatric nephrolithiasis is a disease of increasing prevalence and economic burden, with data showing a rising trend among girls and adolescents. Kidney stones in children tend to have a high recurrence rate related to underlying risk factors, and the aim of evaluation should be to understand such causes so that targeted therapy can be provided to decrease recurrence and complications. Metabolic, anatomic, and genetic abnormalities as well as environmental risk factors have all been implicated in the pathogenesis of nephrolithiasis. Recent studies have focused on identifying monogenic causes of nephrolithiasis and/or nephrocalcinosis in young patients that would result in personalization of treatment as well as future diagnostic implications for family members. Treatment aims to decrease stone burden and recurrence as well as minimize complications and is guided by stone size and location as well as surgical expertise. Multidisciplinary care for these patients has been on the rise to provide a more comprehensive medical and surgical support. [Pediatr Ann. 2020;49(6):e262-e267.].
Collapse
|
22
|
Sohn JH, Lee SH, Kwon YS, Kim JH, Kim Y, Lee JJ. The impact of tamsulosin on cognition in Alzheimer disease with benign prostate hyperplasia: A study using the Hallym Smart Clinical Data Warehouse. Medicine (Baltimore) 2020; 99:e20240. [PMID: 32481389 DOI: 10.1097/md.0000000000020240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Studies suggest that the use of alpha-blockers increases the risk of dementia in patients with benign prostate hyperplasia (BPH). Due to study limitations, the relationship between the use of alpha-blockers, such as tamsulosin, and the risk of dementia is still unclear. However, alpha1-adrenoreceptors are also present in the brain, so there is potential for adverse effects on cognitive function. Therefore, we investigated possible associations between the use of alpha-blockers and aggravation of cognitive decline in dementia patients using a clinical data analytic solution called the Smart Clinical Data Warehouse (CDW).We retrospectively investigated clinical data using the Smart CDW of Hallym University Medical Center from 2009 to 2019. We enrolled patients with probable Alzheimer disease (AD) who had completed the Mini-Mental State Examination (MMSE) at least twice during follow-up, and who had BPH. We compared the difference in MMSE scores between patients who took tamsulosin for >1000 days and those who did not take any alpha-blocker. We tested the effect of tamsulosin on cognitive decline in patients with AD, using propensity score-matched logistic regression analysis.Eligible cases were included in the tamsulosin (n = 68) or no-medication (n = 153) groups. After propensity score matching, clinical characteristics such as educational attainment and vascular risk factors were similar in the tamsulosin and no-medication groups. The MMSE scores did not differ significantly between the tamsulosin and no-medication groups (P = .470).The results suggest that tamsulosin for BPH is not associated with worsening of the cognitive decline in patients with AD.
Collapse
Affiliation(s)
| | | | - Young-Suk Kwon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jong-Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Youngmi Kim
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| |
Collapse
|
23
|
Stridh A, Pontén M, Arver S, Kirsch I, Abé C, Jensen KB. Placebo Responses Among Men With Erectile Dysfunction Enrolled in Phosphodiesterase 5 Inhibitor Trials: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e201423. [PMID: 32196105 PMCID: PMC7084170 DOI: 10.1001/jamanetworkopen.2020.1423] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
IMPORTANCE Placebo responses in the treatment of erectile dysfunction (ED) are poorly described in the literature to date. OBJECTIVE To quantify the association of placebo with ED outcomes among men enrolled in placebo-controlled, phosphodiesterase 5 inhibitor (PDE5I) trials. DATA SOURCES For this systematic review and meta-analysis, a database search was conducted to identify double-blind, placebo-controlled studies using PDE5Is for the treatment of ED published from January 1, 1998, to December 31, 2018, within MEDLINE, Embase, Cochrane Library, and Web of Science. Only articles published in the English language were included. STUDY SELECTION Double-blind, placebo-controlled randomized clinical trials of PDE5Is for ED were included. Studies were excluded if they did not provide distribution measures for statistical analysis. Study selection review assessments were conducted by 2 independent investigators. A total of 2215 studies were identified from the database search, and after review, 63 studies that included 12 564 men were analyzed. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in abstracting data and assessing validity. Data were extracted from published reports by 2 independent reviewers. Quality assessment was performed using the Jadad scale. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES The main outcome was improvement in the erectile function domain of the International Index of Erectile Function questionnaire in the placebo arm of the included studies. Effect size was reported as bias-corrected standardized mean difference (Hedges g). The hypothesis was formulated before data extraction. RESULTS A total of 63 studies that included 12 564 men (mean [SD] age, 55 [7] years; age range, 36-68 years) were included. Erectile function was significantly improved among participants in the placebo arm, with a small to moderate effect size (Hedges g [SE], 0.35 [0.03]; P < .001). Placebo effect size was larger among participants with ED associated with posttraumatic stress disorder (Hedges g [SE], 0.78 [0.32]; P = .02) compared with the overall analysis. No significant difference was found between placebo and PDE5Is for ED after prostate surgery or radiotherapy (Hedges g [SE], 0.30 [0.17]; P = .08). CONCLUSIONS AND RELEVANCE In this study, placebo was associated with improvement of ED, especially among men with ED-related posttraumatic stress disorder. No difference was found between placebo and PDE5I among men treated for ED after prostate surgery.
Collapse
Affiliation(s)
- Alexander Stridh
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
| | - Moa Pontén
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
| | - Stefan Arver
- Department of Medicine, Karolinska Institute, Solna, Sweden
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christoph Abé
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
| | - Karin B. Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
| |
Collapse
|
24
|
Sahin A, Yildirim C, Yuksel OH, Urkmez A. Treatment of ureteral catheter related symptoms; mirabegron versus tamsulosin/solifenacin combination: A randomized controlled trial. ARCH ESP UROL 2020; 73:54-59. [PMID: 31950924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES: The double-J (DJ) stents are commonly used to relieve the ureteral obstruction. Besides several known benefits, some of the patients encounter stent-related morbidities with considerable effects on the quality of life, general health situation, sexual matters, and daily work performance. In this study, we evaluated the effectiveness of tamsulosin/solifenacin combination and mirabegron in reducing DJ stent-related symptoms. MATERIALS AND METHODS: A total of 120 patients with 28cm 4.7fr DJ catheter inserted due to ureteral obstruction were included in this study. Patients were randomly divided into three groups of 40 each; group one received only oral hydration for six weeks; group two received 0.4 mg tamsulosin/10 mg solifenacin, and group three received 50 mg mirabegron. Preoperative and after 6 weeks, the VAPS, OAB-q index, and IPSSs forms were filled. RESULTS: The mean age of the patients was 41.60 ± 12.34 years. There was no significant difference between the groups in terms of preoperative and postoperative VAPS values (p>0.05). There was a significant difference in postop IPSSs values (p:0.001). It was higher in the hydration group than tamsulosin/solifenacin and mirabegron groups. Postoperative IPSS value of the hydration group was 21.78 ± 2.54 while the tamsulosin/ solifenacin and mirabegron groups were 15.6 ± 4.37 and 13.65 ± 4.97, respectively. The use of mirabegron and tamsulosin/solifenacin combination alleviates the LUTSs related with DJ stent. There was also a significant difference between groups in terms of postoperative OAB-q values (p:0.001). Postoperative OAB-q values in the tamsulosin/solifenacin group were significantly higher than the mirabegron group. Postoperative OAB-q value of the hydration group was 29.95 ± 5.21, while the tamsulosin/solifenacin and mirabegron groups were 23.68 ± 4.07 and 18.15 ± 4.1, respectively. Our results also showed that, as a beta-3 adrenergic receptor agonist, mirabegron can improve the OAB-q scores. CONCLUSION: Tamsulosin and solifenacin combination is a significantly good treatment option for reducing LUTS associated with DJ stents. Mirabegron single therapy showed good results in treating LUTS and better results in treating OAB symptoms related with DJ stents than other therapies.
Collapse
Affiliation(s)
- Aytac Sahin
- Department of Urology. Health Sciences University. Fatih Sultan Mehmet Training and Research Hospital. Istanbul. Turkey
| | - Caglar Yildirim
- Department of Urology. Health Sciences University. Fatih Sultan Mehmet Training and Research Hospital. Istanbul. Turkey
| | - Ozgur H Yuksel
- Department of Urology. Health Sciences University. Fatih Sultan Mehmet Training and Research Hospital. Istanbul. Turkey
| | - Ahmet Urkmez
- Department of Urology. Health Sciences University. Haydarpasa Numune Training and Research Hospital. Istanbul. Turkey
| |
Collapse
|
25
|
Rosen RC, Roehrborn CG, Manyak MJ, Palacios‐Moreno JM, Wilson TH, Lulic Z, Giuliano F. Evaluation of the impact of dutasteride/tamsulosin combination therapy on libido in sexually active men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH): A post hoc analysis of a prospective randomised placebo-controlled study. Int J Clin Pract 2019; 73:1-9. [PMID: 30317693 PMCID: PMC6767409 DOI: 10.1111/ijcp.13282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/09/2018] [Indexed: 12/17/2022] Open
Abstract
AIMS Five-α reductase inhibitor (5ARI) therapy has been associated with sexual dysfunction in some patients. This study assessed the impact of a fixed-dose combination of the 5ARI dutasteride 0.5 mg and the α1 -adrenoceptor antagonist tamsulosin 0.4 mg (DUT-TAM FDC) on Men's Sexual Health Questionnaire (MSHQ) domain scores in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). METHODS This was a post hoc analysis of a double-blind, randomised, placebo-controlled, parallel-group, multicentre study in sexually active patients, aged ≥50 years, with a confirmed clinical diagnosis of BPH. Sexual activity, sexual desire, and bother domain scores of the MSHQ were assessed at baseline and at Months 1, 3, 6, 9, and 12. Correlation between MSHQ sexual activity/desire scores and ejaculation, erection, and satisfaction domains at baseline was also evaluated. RESULTS In the intent-to-treat population (N = 489), 243 and 246 patients were randomised to DUT-TAM FDC and placebo groups, respectively. Compared with placebo, DUT-TAM FDC therapy resulted in statistically significant reductions (worsening) from baseline in adjusted mean MSHQ sexual activity and bother domain scores at Months 1, 3, 6, 9, and 12 (all P < 0.05) and in adjusted mean MSHQ sexual desire domain scores at Months 6, 9, and 12 (all P < 0.05). Significant moderate correlations in the expected direction were observed at baseline between the sexual activity/desire domains and the ejaculation, erection, and satisfaction domains (P < 0.0001). CONCLUSIONS These findings help clarify the degree and impact of libido changes in sexually active men treated with DUT-TAM FDC and may support clinical decision-making.
Collapse
Affiliation(s)
- Raymond C. Rosen
- HealthCore/New England Research InstitutesWatertownMassachusetts
| | | | | | | | | | | | - Francois Giuliano
- Neuro‐Urology R. Poincare Hospital AP‐HP, GarchesUMR1179 Inserm‐UVSQ‐Paris Saclay UniversityParisFrance
| |
Collapse
|
26
|
Moussa AS, Ragheb AM, Abdelbary AM, Ibrahim RM, El Adawy MS, Aref A, Assem A, Elfayoumy H, Elzawy F. Outcome of Botulinum Toxin-A intraprostatic injection for benign prostatic hyperplasia induced lower urinary tract symptoms: A prospective multicenter study. Prostate 2019; 79:1221-1225. [PMID: 31189024 DOI: 10.1002/pros.23805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 03/15/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Our aim was to determine the factors predicting the outcome of intraprostatic injection of Botulinum Toxin-A (BTX-A) in the treatment of benign prostatic hyperplasia (BPH)-induced lower urinary tract symptoms (LUTS) and to evaluate its efficacy and safety. METHODS Between September 2016 and May 2018, 45 Egyptian patients, with BPH-induced LUTS were included; the indication was a failure of medical treatment, unfit, or refusing surgical intervention. Measurements of prostate size by TRUS, total PSA level before and 12 weeks after injection. IPSS, uroflow, and postvoiding residual urine (PVR) were measured before injection, 2, 4, 8 and 12 weeks postinjection. 100 U BTX-A vial was diluted with 10 mL of saline then injected into the transition zone at base and midzone of the prostate by TRUS. RESULTS The mean patients' age was 64.4 ± 6.6 years. Mean baseline IPSS 24.06 decreased to 18.75 at 2 weeks and progressively decreased to 16.37 at 12 weeks (P < 0.001), Q max of 9.08 mL/s. increased to 10.44 at 2 weeks and 11.44 at 12 weeks (P < 0.001), mean prostate volume was 67.44cc; decreased to 66.06cc (P < 0.001) at 12 weeks and mean residual urine was 82.62 mL and decreased to 57.66 mL at 12 weeks. DISCUSSION Intraprostatic injection of BTX-A as modality treatment of LUTS/BPH significantly improve IPSS, Q max , PVR, and decrease prostate volume. We can suspect better results with this line of treatment in patients with IPSS ≤ 22 and Q max ≤ 10 mL/min and prostate volume ≤ 56.5cc.
Collapse
Affiliation(s)
- Ayman S Moussa
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed M Ragheb
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed M Abdelbary
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Rabie M Ibrahim
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mahmoud S El Adawy
- Urology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Ahmad Aref
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Assem
- Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany Elfayoumy
- Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Faysal Elzawy
- Urology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| |
Collapse
|
27
|
Fiev DN, Vinarov AZ, Tsarichenko DG, Kopylov PY, Demidko YL, Syrkin AL, Rapoport LM, Alyaev YG, Glybochko PV. Holter Monitoring (24-Hour ECG) Parameter Dynamics in Patients with Ischemic Heart Disease and Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Adv Ther 2019; 36:2072-2085. [PMID: 31148056 PMCID: PMC6822867 DOI: 10.1007/s12325-019-00977-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study examined the dynamics of 24-h electrocardiogram (ECG) monitoring parameters (Holter monitoring) in patients with ischemic heart disease (IHD) before and after conservative or surgical treatment of patients with voiding and storage lower urinary tract symptoms (LTS) due to benign prostatic hyperplasia (BPH). METHODS A total of eighty-three 57 to 81-year-old (mean age 70.4 ± 5.75 years) patients with LUTS/BPH and accompanying IHD were examined and treated at the Institute of Urology and Human Reproductive Health and Clinic of Cardiology of Sechenov University. All patients received recommended cardiac therapy at least 6 months before inclusion in the study. RESULTS Our study demonstrated that there is correlation between voiding and storage LUTS/BPH and Holter-detected cardiac impairments in patients with IHD/BPH. These data make it possible to consider LUTS/BPH (voiding and storage) as a factor in the additional functional and psychological load on the activity of patients with ischemic heart disease. Improvement of voiding and storage LUTS due to BPH and objective parameters of urination (Qmax) in patients treated with alpha-1 adrenoceptor blocker tamsulosin correlated with improvement of 24-h ECG monitoring parameters (Holter monitoring) in 72% of patients. Improvement of 24-h ECG monitoring parameters (Holter monitoring) 1 month after transurethral resection of the prostate (TURP) in IHD/BPH patients and indications for surgical treatment was observed in 65.7%. Negative dynamics of the Holter-based ECG was not registered in patients who were operated on. CONCLUSION Holter monitoring helps to identify groups of patients in whom urinary impairments caused by prostatic hyperplasia negatively affect the course of IHD. Restored urination (either conservatively or operatively) in patients with BPH in 72% of cases decreased the number of fits of angina, thus influencing favourably the course of IHD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03856242.
Collapse
Affiliation(s)
- Dmitrii N Fiev
- Institute for Urology and Human Reproductive Health, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Andrey Z Vinarov
- Institute for Urology and Human Reproductive Health, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Dmitrii G Tsarichenko
- Institute for Urology and Human Reproductive Health, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Yuri L Demidko
- Institute for Urology and Human Reproductive Health, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Abram L Syrkin
- Department of Preventive and Emergency Cardiology, Sechenov University, Moscow, Russia
| | - Leonid M Rapoport
- Institute for Urology and Human Reproductive Health, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yuri G Alyaev
- Institute for Urology and Human Reproductive Health, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Pyotr V Glybochko
- Institute for Urology and Human Reproductive Health, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| |
Collapse
|
28
|
Rezaee ME, Ward CE, Brandes ER, Munarriz RM, Gross MS. A Review of Economic Evaluations of Erectile Dysfunction Therapies. Sex Med Rev 2019; 8:497-503. [PMID: 31326359 DOI: 10.1016/j.sxmr.2019.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a common and costly urologic condition with increasing prevalence as men age. Cost-effectiveness of ED therapies and whether cost-effectiveness varies for different populations of men remains underexplored. AIM To review and summarize available published data on the economic evaluation of ED therapies and to identify gaps in the literature that still need to be addressed. METHODS All relevant peer-reviewed publications and conference abstracts were reviewed and incorporated. RESULTS There are a number of medical and surgical treatment options available for ED. The economic evaluation of phosphodiesterase-5 inhibitors, particularly sildenafil, has been well described. However, minimal research has been conducted to assess the cost-effectiveness of intracavernosal injections, intraurethral suppositories, penile prosthesis surgery, vacuum erection devices, and other emerging therapies in men with different causes of ED. CONCLUSION Available economic evaluations of ED therapies are dated, do not reflect present-day physician, pharmaceutical, and device costs, fail to account for patient comorbidities, and may not be generalizable to today's ED patients. Substantial research is needed to evaluate the cost-effectiveness of ED treatments across different patient populations, countries, and reimbursement systems. Rezaee ME, Ward CE, Brandes ER, et al. A Review of Economic Evaluations of Erectile Dysfunction Therapies. Sex Med Rev 2019;8:497-503.
Collapse
Affiliation(s)
- Michael E Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Charlotte E Ward
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - Eileen R Brandes
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Ricardo M Munarriz
- Department of Urology, Boston University Medical Center, Boston, MA, USA
| | - Martin S Gross
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| |
Collapse
|
29
|
Krivoborodov GG, Tur EI. [Efficiency and safety of silodosin for treatment of lower urinary tract symptoms, associated of benign prostatic hyperplasia]. Urologiia 2019:67-72. [PMID: 31162905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Benign prostatic hyperplasia commonly is the most common cause of bladder outlet obstruction and can result in storage and micturition symptoms in men older than 40 years. Nowadays the 1-adrenoreceptor antagonists are the first-line drug for treatment of the lower urinary tract symptoms (LUTS). However, 1-adrenoreceptors are known to be present in other tissues and this fact could be a reason of potential risk of adverse events, associated with changes in peripheral vascular tone, such as orthostatic hypotension, syncopal states, dizziness, etc., especially in patients of advanced age, and those affected by cardiovascular diseases and taking essential drugs. A highly selective -adrenergic blocker silodosin is characterized by a lower rate of mentioned adverse events, comparable with placebo. Silodosin is also highly effective in treating of both types of LUTS in these patients, both as monotherapy and in combination with other drugs. A detailed analysis of clinical data confirming the high efficacy and safety of silodosin is presented in this review of the literature.
Collapse
Affiliation(s)
- G G Krivoborodov
- ) Department of Urology and Andrology in N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- ) University Clinic Mater Domini Catanzaro, Italy
| | - E I Tur
- ) Department of Urology and Andrology in N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia
- ) University Clinic Mater Domini Catanzaro, Italy
| |
Collapse
|
30
|
Liao XH, Chen JQ, Wu JT, Cheng JL, Wang F. [Medication versus health education for patients with type Ⅲ prostatitis-like symptoms: A prospective randomized control study]. Zhonghua Nan Ke Xue 2019; 25:420-423. [PMID: 32216227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the necessity of medication for patients with type Ⅲ prostatitis-like symptoms for less than 3 months. METHODS We enrolled in this study 171 outpatients with type Ⅲ prostatitis-like symptoms for less than 3 months in our hospital from November 2016 to October 2017, and randomly divided them into groups A (n = 57), B (n = 57) and C (n = 57). The patients of group A received tamsulosin, levofloxacin and health education, those of group B tamsulosin and health education, and those of group C health education only. Three months later, we evaluated the therapeutic effects according to the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores of the patients, 4-point reduction in the total score indicating effectiveness. RESULTS After 3 months of treatment, the total NIH-CPSI scores of the patients in groups A, B and C were decreased by (9.0 ± 2.9), (8.2 ± 3.4) and (8.6 ± 3.2) points respectively, all indicating effectiveness, the pain scores (4.2 ± 1.8), (4.0 ± 1.9) and (4.2 ± 1.6) points, the urinary symptom scores decreased by decreased by (2.4 ± 1.2), (2.4 ± 1.4) and (2.2 ± 1.2) points, and quality of life scores decreased by (2.4 ± 1.4), (1.9 ± 1.4) and (2.2 ± 1.3) points, none with statistically significant difference among the three groups (P > 0.05). CONCLUSIONS Health education is proved to have a therapeutic effect on type Ⅲ prostatitis-like symptoms similar to that of alpha receptor blockers.
Collapse
Affiliation(s)
- Xin-Hui Liao
- Department of Urology, Shenzhen Second People's Hospital / The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| | - Jie-Qing Chen
- Department of Urology, Shenzhen Second People's Hospital / The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| | - Jian-Ting Wu
- Department of Urology, Shenzhen Second People's Hospital / The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| | - Jian-Li Cheng
- Department of Urology, Shenzhen Second People's Hospital / The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| | - Feng Wang
- Department of Urology, Shenzhen Second People's Hospital / The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
| |
Collapse
|
31
|
Kuzmenko AV, Kuzmenko VV, Gyaurgiev TA. [The efficacy of fesoterodine in patients after transurethral resection of the prostate]. Urologiia 2019:52-55. [PMID: 31184018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM For a long time, benign prostatic hyperplasia (BPH) was considered as only cause of lower urinary tract symptoms (LUTS) in elderly men. More than 30% of patients underwent surgery by the age of 80. Unsatisfactory outcome of surgical treatment of BPH are observed in 9-27% of cases. Various irritative symptoms, which are typical for detrusor overactivity, persist especially often. Currently, anticholinergic drug therapy (m-cholinoblockers) is the main treatment for detrusor overactivity. The aim of our study was to assess the effectiveness of m-cholinoblockers for the treatment of persisted LUTS in men with BPH who had undergone transurethral resection of prostate (TURP). MATERIALS AND METHODS The study included 60 patients with BPH who underwent TURP. All patients were divided into two groups. In Group 1, anti-inflammatory therapy for 10 days with 1-month follow-up was prescribed. In Group 2, anti-inflammatory therapy was combined with the drug Toviaz for 1 month. Evaluation of the treatment effectiveness was carried out 3-5 days, 14-15 days and 1 month after TURP, respectively and included voiding diary, IPSS score, QOL, uroflowmetry, adverse events and acute urinary retention. RESULTS At baseline, in the Group 1 and 2, average urination frequency was 12.6 and 12.7 times per day, the number of urgency episodes was 9.2 and 9.0 times and number of nocturnal voiding episodes was 5,2 and 5.3 times, respectively. The average IPSS score was 19.8 and 19.7 points and Qmax was 6.5 and 6.7 ml/sec, respectively. By the 14th-15th day of therapy, in both groups positive changes were found. There was a significant decrease (p<0.05) in the urination frequency and nocturnal voiding episodes according to voiding diaries, an increase in Qmax and average IPSS and QOL score. The adverse events rate in group 2 was 16.7%. By the 30th day of therapy in the group 1 there were no significant changes. However, in group 2, urination frequency, number of urgency episodes, average IPSS and QOL score decreased to an average of 5.7 times a day, 0.4 times, 1.2 times, 9.3 points and 1.6 points, respectively. Average Qmax increased to 15.5 ml/sec. No adverse events were detected. CONCLUSION According to the results of our study, the use of m-cholinoblockers, in particular Fesoterodine (Toviaz), in combination with standard therapy in patients with detrusor overactivity after TURP is reasonable and allows to effectively and safely alleviate irritative symptoms.
Collapse
Affiliation(s)
- A V Kuzmenko
- FGBOU VO Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia
| | - V V Kuzmenko
- FGBOU VO Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia
| | - T A Gyaurgiev
- FGBOU VO Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia
| |
Collapse
|
32
|
Abstract
BACKGROUND Some trials have stated that there is no benefit to tamsulosin administration for clearing ureteral stones, which is contrary to previous studies. To confirm the efficacy of tamsulosin for treating symptomatic ureteral stones, we performed this review. METHODS We searched the PubMed, Embase, and Cochrane Library databases to identify all studied variables, including tamsulosin, urinary stones, expulsion, and side effects. In addition, for all patients and different stone sizes, the treatment efficacy, expulsion rate, and expulsion time were also recorded for this treatment. RESULTS Forty-nine studies involving 6436 patients met the inclusion criteria. The data synthesized from these studies indicated that tamsulosin improved the renal stone clearance rate (80.5% vs 70.5%; mean difference (MD), 1.16; 95% confidence interval (CI), 1.13-1.19; P <.00001) and reduced the expulsion time (MD, -3.61; 95% CI, -3.77 to -3.46; P ≤.00001). Regarding complications, no significant difference was found between the 2 groups in terms of the total side effects (MD, 1.15; 95% CI, 0.97-1.35; P = .10) or divided complications, including retrograde ejaculation (P = .01), hypotension (P = .52), dizziness (P = .07), diarrhea (P = .58), vomiting (P = .88), headache (P = .84), nausea (P = .91), and fatigue (P = .10). CONCLUSIONS Tamsulosin should be strongly recommended for patients with ureteral stones to increase treatment efficacy. The side effects were not significantly different between the tamsulosin and control treatments.
Collapse
Affiliation(s)
- Yi Sun
- Department of Urology, West China Hospital, Sichuan University, Xiang, Chengdu
| | - Guo-Lin Lei
- Department of Urology, Jianyang People Hospital, Jianyang, China
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, Xiang, Chengdu
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Xiang, Chengdu
| | - Xin Wei
- Department of Urology, West China Hospital, Sichuan University, Xiang, Chengdu
| |
Collapse
|
33
|
Liu B, Liu Y, Qin Z, Zhou K, Xu H, He L, Li N, Su T, Sun J, Yue Z, Zang Z, Zhang W, Zhao J, Zhou Z, Liu L, Wu D, Wu J, Zhou J, Pang R, Wang Y, Liu J, Yu J, Liu Z. Electroacupuncture Versus Pelvic Floor Muscle Training Plus Solifenacin for Women With Mixed Urinary Incontinence: A Randomized Noninferiority Trial. Mayo Clin Proc 2019; 94:54-65. [PMID: 30611454 DOI: 10.1016/j.mayocp.2018.07.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/19/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of electroacupuncture vs pelvic floor muscle training (PFMT) plus solifenacin for women with mixed urinary incontinence (MUI). PATIENTS AND METHODS This randomized controlled noninferiority trial was conducted at 10 hospitals in China between March 1, 2014, and October 10, 2016. Participants were randomized 1:1 to receive electroacupuncture (36 sessions) over 12 weeks with 24 weeks of follow-up or PFMT-solifenacin (5 mg/d) over 36 weeks. The primary outcome was percentage change from baseline to week 12 in mean 72-hour incontinence episode frequency (IEF) measured by the 72-hour bladder diary. It was analyzed in the per-protocol set with a prespecified noninferiority margin of 15%. RESULTS Of 500 women with MUI who were randomized, 467 (239 in the electroacupuncture group and 228 in the PFMT-solifenacin group) completed treatment per protocol and were included in the primary outcome analysis. At weeks 1 through 12, the percentage of reduction from baseline in mean 72-hour IEF was 37.83% in the electroacupuncture group and 36.49% in the PFMT-solifenacin group (between-group difference, -1.34% [95% CI, -9.78% to 7.10%]; P<.001 for noninferiority), which demonstrates noninferiority; the treatment effect persisted throughout follow-up. Statistically significant improvements were found for secondary outcomes in both groups, with no meaningful difference between treatments. CONCLUSION In women with moderate to severe MUI, electroacupuncture was not inferior to PFMT-solifenacin in decreasing the 72-hour IEF and shows promise as an effective alternative for the treatment of MUI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02047032.
Collapse
Affiliation(s)
- Baoyan Liu
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zongshi Qin
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kehua Zhou
- Catholic Health System Internal Medicine Training Program, University at Buffalo, Buffalo, NY
| | - Huangfang Xu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liyun He
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ning Li
- West China Hospital of Sichuan University, Chengdu, China
| | - Tongsheng Su
- Shaanxi Province Hospital of Traditional Chinese Medicine, Xi'an, China
| | - Jianhua Sun
- Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Zenghui Yue
- Hengyang Hospital Affiliated to Hunan University of Chinese Medicine, Hengyang, China
| | - Zhiwei Zang
- Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Wei Zhang
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Jiping Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Zhongyu Zhou
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Lian Liu
- Qingdao Haici Medical Center, Qingdao, China
| | - Dongning Wu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiani Wu
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jing Zhou
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ran Pang
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yang Wang
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jia Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinna Yu
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| |
Collapse
|
34
|
Rao KL, Menon P, Samujh R, Mahajan JK, Bawa M, Malik MA, Mittal BR. Endoscopic Management of Vesicoureteral Reflux and Long-term Follow-up. Indian Pediatr 2018; 55:1046-1049. [PMID: 30745475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To report our experience with endoscopic management of vesicoureteral reflux (VUR) by injection of a tissue bulking substance - Dextranomer/ hyaluronic acid co-polymer at vesicoureteric junction. DESIGN Retrospective analyses of case records. SETTING Pediatric Surgery department in a tertiary care government Institute. PARTICIPANTS 500 children (767 renal units) consecutively referred to the out-patient department with vesicoureteral reflux noted on micturating cysto-urethrogram (MCU) over a period of 13 years (2004-2016). INTERVENTION Preoperative VUR grading and renal scars on radionuclide scans were documented. Dextranomer hyaluronic acid copolymer was injected through a cystoscope at the vesicoureteral junction as a day care procedure under short anesthesia. Patients were followed (average duration 27.3 mo) with clinical assessment, periodic urine cultures and renal scans. MAIN OUTCOME MEASURE Cessation of VUR and symptomatic relief / clinical success postoperatively at 3 months. RESULTS Complete symptomatic relief was obtained in 482 (96.4%) patients. In 681 units where MCU was available, 614 (90%) units showed resolution of VUR. CONCLUSIONS Endoscopic injection of tissue bulking substances at vesicoureteric junction to stop VUR seems to be an effective intervention.
Collapse
Affiliation(s)
- K Ln Rao
- Department of Pediatric Surgery, PGIMER, Chandigarh, India
| | - Prema Menon
- Department of Pediatric Surgery, PGIMER, Chandigarh, India. Correspondence to: Dr Prema Menon, Department of Pediatric Surgery, Advanced Pediatrics Centre, PGIMER, Chandigarh 160012, India,
| | - R Samujh
- Department of Pediatric Surgery, PGIMER, Chandigarh, India
| | - J K Mahajan
- Department of Pediatric Surgery, PGIMER, Chandigarh, India
| | - M Bawa
- Department of Pediatric Surgery, PGIMER, Chandigarh, India
| | - M A Malik
- Department of Pediatric Surgery, PGIMER, Chandigarh, India
| | - B R Mittal
- Department of Nuclear Medicine, PGIMER, Chandigarh, India
| |
Collapse
|
35
|
Deng ZX, Ji LX, Zhang YR, Li CD, Cai J, Jiang HH. [Ningmitai Capsules relieve lower urinary tract symptoms in patients with benign prostatic hyperplasia : A short-term clinical observation]. Zhonghua Nan Ke Xue 2018; 24:72-77. [PMID: 30157365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To observe the clinical effect and safety of the Chinese patent medicine Ningmitai Capsules (NMT) in relieving lower urinary tract symptoms (LUTS) in the patient with benign prostatic hyperplasia (BPH). METHODS We randomly assigned 40 BPH patients to an experimental and a control group of equal number to receive oral administration of NMT at 4 capsules tid and terazosin hydrochloride tablets at 2 mg qd, respectively, both for 14 days. At 7 and 14 days after medication, we recorded and compared the International Prostate Symptoms Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL) scores, results of urinalysis and blood routine examination, and indexes of hepatic and renal function. RESULTS Both NMT and terazosin significantly improved the total IPSS score, the IPSS scores in the storage and voiding phases, increased Qmax and urine output, reduced post-void residual urine (PVR), and improved the QoL of the patients. The patients of the NMT group showed a better relief of incomplete bladder emptying, more improved QoL and fewer adverse reactions, while those treated with terazosin achieved a better attenuation of weak urine stream and PVR. CONCLUSIONS NMT is safe and effective in relieving LUTS in BPH patients. Each of NMT and terazosin has its own advantages in attenuating urinary tract irritation and obstruction, but whether their combination may produce a better effect on LUTS and the specific mechanisms of NMT improving acute symptoms of BPH are yet to be further studied.
Collapse
Affiliation(s)
- Zhe-Xian Deng
- Department of Urology, The First Hospital Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Ling-Xiao Ji
- Department of Urology, The First Hospital Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Yi-Rong Zhang
- Department of Urology, The First Hospital Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Cheng-di Li
- Department of Andrology, The First Hospital Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jian Cai
- Department of Andrology, The First Hospital Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Hai-Hong Jiang
- Department of Urology, The First Hospital Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| |
Collapse
|
36
|
Vonesh E, Gooch KL, Khangulov V, Schermer CR, Johnston KM, Szabo SM, Rumsfeld JS. Cardiovascular risk profile in individuals initiating treatment for overactive bladder - Challenges and learnings for comparative analysis using linked claims and electronic medical record databases. PLoS One 2018; 13:e0205640. [PMID: 30325968 PMCID: PMC6191128 DOI: 10.1371/journal.pone.0205640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/28/2018] [Indexed: 11/19/2022] Open
Abstract
For managing overactive bladder (OAB), mirabegron, a β3 adrenergic receptor agonist, is typically used as second-line pharmacotherapy after antimuscarinics. Therefore, patients initiating treatment with mirabegron and antimuscarinics may differ, potentially impacting associated clinical outcomes. When using observational data to evaluate real-world safety and effectiveness of OAB treatments, residual bias due to unmeasured confounding and/or confounding by indication are important considerations. Falsification analysis, in which clinically irrelevant endpoints are tested as a reference, can be used to assess residual bias. The objective in this study was to compare baseline cardiovascular risk among OAB patients by treatment, and assess the presence of residual bias via falsification analysis of OAB patients treated with mirabegron or antimuscarinics, to determine whether clinically relevant comparisons across groups would be feasible. Linked electronic health record and claims data (Optum/Humedica) for OAB patients in the United States from 2011-2015 were available, with index defined as first date of OAB treatment during this period. Unadjusted characteristics were compared across groups at index and propensity-matching conducted. Falsification endpoints (hepatitis C, shingles, community-acquired pneumonia) were compared between groups using odds ratios (ORs) and 95% confidence intervals (CI). The study identified 10,311 antimuscarinic- and 408 mirabegron-treated patients. Mirabegron patients were predominantly older males, with more comorbidities. The analytic sample included 1,188 antimuscarinic patients propensity-matched to 396 mirabegron patients; after matching, no significant baseline differences remained. Estimates of falsification ORs were 0.7 (CI:0.3-1.7) for shingles, 1.5 (CI:0.3-8.2) for hepatitis C, 0.8 (CI:0.4-1.8) and 0.9 (CI:0.6-1.4) for pneumonia. While propensity matching successfully balanced observed covariates, wide CIs prevented definitive conclusions regarding residual bias. Accordingly, further observational comparisons by treatment group were not pursued. In real-world analysis, bias-detection methods could not confirm that differences in cardiovascular risk in patients receiving mirabegron versus antimuscarinics were fully adjusted for, precluding clinically relevant comparisons across treatment groups.
Collapse
Affiliation(s)
- E. Vonesh
- Department of Biostatistics, Northwestern Medicine, Chicago, IL, United States of America
| | - K. L. Gooch
- Medical Affairs, Astellas Pharma USA, Northbrook, IL, United States of America
| | - V. Khangulov
- Boston Strategic Partners, Boston, MA, United States of America
| | - C. R. Schermer
- Medical Affairs, Astellas Pharma USA, Northbrook, IL, United States of America
| | | | | | - J. S. Rumsfeld
- Faculty of Medicine, University of Colorado, Denver, CO, United States of America
| |
Collapse
|
37
|
Hwang EC, Gandhi S, Jung JH, Imamura M, Kim MH, Pang R, Dahm P. Naftopidil for the treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia. Cochrane Database Syst Rev 2018; 10:CD007360. [PMID: 30306544 PMCID: PMC6516835 DOI: 10.1002/14651858.cd007360.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a common condition in ageing men that may cause lower urinary tract symptoms (LUTS). Treatment aims are to relieve symptoms and prevent disease-related complications. Naftopidil is an alpha-blocker (AB) that has a high affinity for the A1d receptor that may have advantages in treating LUTS in this setting. This is an update of a Cochrane Review first published in 2009. Since that time, several large randomised controlled trials (RCTs) have been reported, making this update relevant. OBJECTIVES To evaluate the effects of naftopidil for the treatment of LUTS associated with BPH. SEARCH METHODS We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, LILAC, and Web of Science), trials registries, other sources of grey literature, and conference proceedings with no restrictions on the language of publication or publication status up to 31 May 2018 SELECTION CRITERIA: We included all parallel RCTs. We also included cross-over design trials. DATA COLLECTION AND ANALYSIS Two review authors independently classified and abstracted data from the included studies. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. Primary outcomes were urological symptom scores, quality of life (QoL) and treatment withdrawals for any reason; secondary outcomes were treatment withdrawals due to adverse events, acute urinary retention, surgical intervention for BPH, and cardiovascular and sexual adverse events. We considered outcomes measured up to 12 months after randomisation as short term, and later than 12 months as long term. We rated the certainty of the evidence according to the GRADE approach. MAIN RESULTS We included 22 RCTs with 2223 randomised participants across four comparisons for short-term follow-up. This abstract focuses on only two of four comparisons for which we found data since two comparators (i.e. propiverine and Eviprostat (phytotherapy)) are rarely used. One study comparing naftopidil to placebo did not report any relevant outcomes and was therefore excluded. There were no trials that compared to combination therapy with naftopidil or any 5-alpha reductase inhibitors (5-ARIs) to combination therapy with other ABs and any 5-ARIs.All included studies were conducted in Asian countries. Study duration ranged from four to 12 weeks. Mean age was 67.8 years, prostate volume was 35.4 mL, and International Prostate Symptom Score was 18.3. We were unable to perform any of the preplanned subgroup analyses based on age and baseline symptom score.Naftopidil versus tamsulosinBased on 12 studies with 965 randomised participants, naftopidil may have resulted in little or no difference in urological symptom score (mean difference (MD) 0.47, 95% confidence interval (CI) -0.09 to 1.04 measured on a scale from 0 to 35 with higher score representing increased symptoms), QoL (MD 0.11, 95% CI -0.09 to 0.30; measured on a scale from 0 to 6 with higher scores representing worse QoL), and treatment withdrawals for any reason (risk ratio (RR) 0.92, 95% CI 0.64 to 1.34; corresponding to 7 fewer per 1000 participants, 95% CI 32 fewer to 31 more). Naftopidil may have resulted in little to no difference in sexual adverse events (RR 0.54, 95% CI 0.24 to 1.22); this would result in 26 fewer sexual adverse events per 1000 participants (95% CI 43 fewer to 13 more). We rated the certainty of evidence as moderate for urological symptom score and low for the other outcomes.Naftopidil versus silodosinBased on five studies with 652 randomised participants, naftopidil may have resulted in little or no difference in the urological symptom scores (MD 1.04, 95% CI -0.78 to 2.85), QoL (MD 0.21, 95% CI -0.23 to 0.66), and treatment withdrawals for any reason (RR 0.80, 95% CI 0.52 to 1.23; corresponding to 26 fewer per 1000 participants, 95% CI 62 fewer to 32 more). We rated the certainty of evidence as low for all these outcomes. Naftopidil likely reduced sexual adverse events (RR 0.15, 95% CI 0.06 to 0.42; corresponding to 126 fewer sexual adverse events per 1000 participants, 95% CI 139 fewer to 86 fewer). We rated the certainty of evidence as moderate for sexual adverse events. AUTHORS' CONCLUSIONS Naftopidil appears to have similar effects in the urological symptom scores and QoL compared to tamsulosin and silodosin. Naftopidil has similar sexual adverse events compared to tamsulosin but has fewer compared to silodosin.
Collapse
Affiliation(s)
- Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun HospitalDepartment of UrologyHwasunKorea, South
| | | | - Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
- Yonsei University Wonju College of MedicineInstitute of Evidence Based Medicine20 Ilsan‐roWonjuGangwonKorea, South26426
| | - Mari Imamura
- University of AberdeenAcademic UrologyHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Myung Ha Kim
- Yonsei University Wonju College of MedicineYonsei Wonju Medical LibraryWonjuKorea, South
| | - Ran Pang
- Guang An Men Hospital, China Academy of Chinese Medical SciencesDepartment of UrologyNo.5 Bei Xian Ge Street, Xicheng DistrictBeijingChina100053
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
| | | |
Collapse
|
38
|
Palmisano F, Spinelli MG, Luzzago S, Boeri L, De Lorenzis E, Albo G, Gadda F, Gelosa M, Longo F, Dell'Orto PG, Montanari E. Medical Expulsive Therapy for Symptomatic Distal Ureter Stones: Is the Combination of Bromelain and Tamsulosin More Effective than Tamsulosin Alone? Preliminary Results of a Single-Center Study. Urol Int 2018; 102:145-152. [PMID: 30227429 DOI: 10.1159/000493158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/21/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the safety and efficacy of bromelain plus tamsulosin versus tamsulosin alone as medical expulsive therapy (MET) for promoting spontaneous stone passage (SSP) of symptomatic distal ureter stones. PATIENTS AND METHODS One-hundred-fourteen patients with a 4-10 mm distal ureteral stone were enrolled (Group A). Patients self-administered daily bromelain with tamsulosin for 30 days or until SSP or intervention was mandatory. Patients were compared to those from a control group taking tamsulosin as MET (Group B) and matched for the following factors: sex, age ±10%, stone diameter. A logistic regression model evaluated bromelain and the ureteral stone diameter as explanatory variables. RESULTS SSP rates were 87.7 vs. 75.4% for group A vs. group B respectively (p = 0.016); with no difference observed for the time to self-reported stone expulsion (11.68 vs. 11.57 days; p = 0.91). Considering larger stones (> 5 mm), the SSP rate was 83.3% in group A and 61% in group B (p < 0.01). With each millimeter increment of stone diameter, the probability of SSP decreased by 59.1% (p < 0.0001), while it increased of 3.3 when bromelain was present. Only 3 cases of tamsulosin-related adverse events were recorded. CONCLUSION The association of bromelain and tamsulosin as MET increases the probability of SSP of symptomatic distal ureteral stones, with no bromelain-related side effects recorded.
Collapse
|
39
|
Ivchenko A, Bödeker RH, Neumeister C, Wiedemann A. Anticholinergic burden and comorbidities in patients attending treatment with trospium chloride for overactive bladder in a real-life setting: results of a prospective non-interventional study. BMC Urol 2018; 18:80. [PMID: 30217174 PMCID: PMC6137886 DOI: 10.1186/s12894-018-0394-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Elderly people are representative for the patients most likely to be treated with anticholinergics for overactive bladder (OAB). They often receive further drugs with anticholinergic properties for concomitant conditions. This increases the risk for side effects, including central nervous system disorders. Data on comorbidities and baseline anticholinergic burden of OAB patients seen in urological practice is scarce. Therefore, we included an epidemiological survey on these issues in our study which assessed the effectiveness and tolerability of trospium chloride (TC) in established dosages under routine conditions. METHODS Outpatients (≥ 65 years of age), for whom treatment with TC was indicated, were eligible to participate in this non-interventional, prospective study performed in 162 urological practices in Germany. Epidemiological questions were evaluated by the Anticholinergic Burden (ACB) scale and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) at baseline. Efficacy was assessed by changes in symptom-related variables of OAB after treatment. Dosage regimen, duration of treatment, adverse events, withdrawals, and ease of subdivision of the prescribed SNAP-TAB tablet were documented. Patients and physicians rated efficacy and tolerability of treatment. Statistics were descriptive. RESULTS Four hundred fourty-five out of 986 (47.54%) patients in the epidemiological population had a baseline ACB scale score > 0, 100 (24.72%) of whom a score ≥ 3. The median CIRS-G comorbidity index score for all patients was 5. 78.55% (608/774) of patients in the efficacy population received a daily dose of 45 mg TC. 60.03% (365/608) of them took this dose by dividing the SNAP-TAB tablet in three equal parts. Before-after-comparisons of the core symptoms of OAB showed clear improvements. An influence of the dosage scheme (1 × 45 mg TC/d vs 3 × 15 mg TC/d) on clinical outcome could not be observed. Most urologists and patients rated TC treatment as effective and well tolerated. 44 (4.37%) out of 1007 patients in the safety collective ended their treatment prematurely, while 75 patients (7.45%) experienced adverse events. CONCLUSIONS Anticholinergic burden and comorbidities in elderly OAB patients are frequent. The acceptance of the SNAP-TAB tablet, which facilitates flexible dosing with TC, was high, which is supportive in ensuring adherence in therapy. TRIAL REGISTRATION This non-interventional study was registered on October 29, 2014 with the number DRKS00007109 at the German Register of Clinical Studies (DRKS).
Collapse
Affiliation(s)
- A. Ivchenko
- Department of Urology, Evangelisches KrankenhausWitten gGmbH, UniversityWitten/Herdecke, Pferdebachstrasse 27, 58455 Witten, Germany
| | - R.-H. Bödeker
- Department of Statistics, Institute of Medical Informatics, University Clinic Giessen, Rudolf-Buchheim-Strasse 6, 35392 Gießen, Germany
| | - C. Neumeister
- Department of Medical Science/Clinical Research, Dr. R. Pfleger GmbH, Dr.-Robert-Pfleger-Strasse 12, 96052 Bamberg, Germany
| | - A. Wiedemann
- Department of Urology, Evangelisches KrankenhausWitten gGmbH, UniversityWitten/Herdecke, Pferdebachstrasse 27, 58455 Witten, Germany
| |
Collapse
|
40
|
Krhut J, Borovička V, Bílková K, Sýkora R, Míka D, Mokriš J, Zachoval R. Efficacy and safety of mirabegron for the treatment of neurogenic detrusor overactivity-Prospective, randomized, double-blind, placebo-controlled study. Neurourol Urodyn 2018; 37:2226-2233. [PMID: 29603781 DOI: 10.1002/nau.23566] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/05/2018] [Indexed: 11/11/2022]
Abstract
AIMS To assess the efficacy and safety of mirabegron in the treatment of neurogenic detrusor overactivity. METHODS This prospective, multicenter, randomized, double-blind, placebo-controlled study was conducted in three tertiary centers, and included 78 patients suffering from spinal cord injury or multiple sclerosis. Patients were randomized for Mirabegron 50 mg (Group A) or placebo (Group B). Urodynamic parameters, the 24 h pad-weight test, and patient-reported outcomes were assessed. Safety assessments included monitoring the incidence and severity of adverse events. Changes in time and differences between groups were assessed with nonparametric Kruskal-Wallis one-way analysis of variance; P ≤ 0.05 was considered statistically significant. RESULTS In total, 66 patients were eligible for inclusion in the final analysis. There was a significant increase of volume at the first detrusor contraction (P = 0.00047) and an improvement in bladder compliance (P = 0.0041) in the mirabegron group compared with the placebo-treated group, whereas the increase in cystometric capacity did not reach statistical significance (P = 0.061). There was a clear tendency to reduced urine leakage (P = 0.056) in Group A. There were significant changes in all the patient-reported outcomes, favoring the mirabegron group. The incidence of drug-related adverse events was 3.13%. CONCLUSIONS Mirabegron (50 mg) improved both urodynamic variables and patient-reported outcomes in patients with NDO. The treatment was tolerated well.
Collapse
Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | | | - Karolína Bílková
- Spinal Cord Rehabilitation Unit, Rehabilitation Center, Kladruby, Czech Republic
| | - Radek Sýkora
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - David Míka
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - Jan Mokriš
- Department of Urology, Thomayer Hospital, Prague, Czech Republic
| | - Roman Zachoval
- Department of Urology, Thomayer Hospital, Prague, Czech Republic
| |
Collapse
|
41
|
Hsu YP, Hsu CW, Bai CH, Cheng SW, Chen KC, Chen C. Silodosin versus tamsulosin for medical expulsive treatment of ureteral stones: A systematic review and meta-analysis. PLoS One 2018; 13:e0203035. [PMID: 30153301 PMCID: PMC6112672 DOI: 10.1371/journal.pone.0203035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/14/2018] [Indexed: 02/03/2023] Open
Abstract
Silodosin, a recently introduced selective α-blocker, has a much higher selectivity for the α-1A receptor. The efficacy and safety of silodosin compared to tamsulosin in medical expulsive therapy (MET) are controversial. The objective of this study was to assess the efficacy and safety of silodosin compared to tamsulosin for treating ureteral stones <10 mm in diameter. We systematically searched the PubMed, EMBASE, Cochrane library, and Scopus databases from their inception to May 2018. We included randomized controlled studies (RCTs) and observational studies, which investigated stone expulsion rates using silodosin compared to tamsulosin. Data were synthesized using a random-effects model. Sixteen studies with 1824 patients were eligible for inclusion. Silodosin achieved significantly higher expulsion rates than tamsulosin (pooled risk difference (RD): 0.13, 95% confidence interval (CI): 0.09 to 0.18, GRADE: high). A subgroup analyses showed that silodosin has a significantly higher expulsion rate on stone sizes of 5-10 mm than tamsulosin (pooled RD: 0.14, 95% CI: 0.06 to 0.22, I2 = 0%). The superior effect was not observed on stone sizes <5 mm. A multivariate regression showed that the RD was negatively associated with the control expulsion rate after adjusting for age and gender (coefficient -0.658, p = 0.01). A sensitivity analysis showed that our findings were robust. Patients receiving silodosin also probably had a significantly shorter expulsion time (pooled mean difference (MD): -2.55 days, 95% CI: -4.06 to -1.04, I2 = 85%, GRADE: moderate) and may have fewer pain episodes (pooled MD: -0.3, 95% CI: -0.51 to -0.09, GRADE: low) but a higher incidence of retrograde ejaculation by 5% compared to those receiving tamsulosin. In conclusion, compared to tamsulosin, silodosin provided significantly better stone passage for patients with ureteral stones (particularly for sizes of 5~10 mm), shorter expulsion times, and fewer pain episodes but caused a higher incidence of retrograde ejaculation.
Collapse
Affiliation(s)
- Yuan-Pin Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chin-Wang Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Wei Cheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Chou Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Urology, Taipei Medical University Shuang-Ho Hospital, Taipei, Taiwan
| | - Chiehfeng Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Evidence-based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
42
|
Li R, Jia DY, Li Z, Xu DR, Luo SY. [Efficacy of Kangshuailing Gao on benign prostatic hyperplasia in rats]. Zhonghua Nan Ke Xue 2018; 24:729-734. [PMID: 30173434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the effect of Kangshuailing Gao (KG) on benign prostatic hyperplasia (BPH) in rats and its action mechanisms. METHODS Fifty BPH model rats were randomized into five groups of equal number, BPH model control, finasteride control, and high-, medium- and low-dose KG, to be treated intragastrically with distilled water, finasteride solution at 0.52 mg/kg, and KG solution at 4.16, 2.08 and 1.04 g/kg respectively once a day for 30 days consecutively. Another 10 normal healthy rats were taken as blank controls. The rats were weighed once a week during the treatment. The wet weight and index of the prostate were obtained after treatment, followed by measurement of the contents of serum estradiol (E2) and dihydrotestosterone (DHT), testosterone (T) and hypoxia-inducible factor-1α (HIF-1α) in the prostatic tissue, and observation of histomorphological changes in the prostate under the light microscope. RESULTS Compared with the BPH model control group, high- and medium-dose KG significantly reduced the prostate wet weight ([0.84 ± 0.08] vs [0.69 ± 0.04] and [0.71 ± 0.07] g, P < 0.01), the prostatic index ([0.28 ± 0.03]% vs [0.20 ± 0.02]% and [0.22 ± 0.03]%, P < 0.01), and the levels of T ([4.63 ± 1.25] vs [2.44 ± 0.47] and [2.91 ± 0.69] ng/L, P < 0.01) and DHT ([154.44 ± 20.25] vs [88.23 ± 13.63] and [90.52 ± 16.44] nmol/L, P < 0.01), but increased the level of E2 ([0.95 ± 0.24] vs [1.19 ± 0.14] and [1.20 ± 0.22] nmol/L, P < 0.01) in the serum. High-dose KG remarkably reduced the overexpression of HIF-1α in the prostate tissue of the BPH model rats (P < 0.01) and alleviated such BPH-related symptoms as epithelium thinning, intraglandular secretion reduction, and interstitial substance decrease. CONCLUSIONS Kangshuailing Gao acted effectively on BPH in the model rats by reducing the androgen level, balancing the estrogen/androgen ratio, and downregulating the expression of HIF-1α in the prostate tissue.
Collapse
Affiliation(s)
- Rui Li
- Department of Pharmaceutical Toxicology, Anhui Research Institute of Medical Sciences, Hefei, Anhui 230061, China
| | - De-Yun Jia
- Department of Pharmaceutical Toxicology, Anhui Research Institute of Medical Sciences, Hefei, Anhui 230061, China
| | - Zeng Li
- Department of Pharmaceutical Chemistry, School of Pharmacy, Anhui Medical University, Hefei, Anhui 230061, China
| | - Dong-Rui Xu
- School of International Education, Anhui Xinhua College, Hefei, Anhui 230061, China
| | - Sheng-Yong Luo
- Department of Pharmaceutical Toxicology, Anhui Research Institute of Medical Sciences, Hefei, Anhui 230061, China
| |
Collapse
|
43
|
Gharib T, Mohey A, Fathi A, Alhefnawy M, Alazaby H, Eldakhakhny A. Comparative Study between Silodosin and Tamsulosin in Expectant Therapy of Distal Ureteral Stones. Urol Int 2018; 101:161-166. [PMID: 30025399 DOI: 10.1159/000490623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/02/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of silodosin against tamsulosin as medical expulsion therapeutic agent in stone lower 1/3rd ureter. PATIENTS AND METHODS One hundred fifty patients divided equally into 2 groups I and II received silodosin 8 mg and tamsulosin 0.4 mg respectively. Patients aged 18 years or older having single unilateral stone 10 mm or less were included in the study. Patients with bilateral or multiple stones, marked hydronephrosis, previous open or endoscopic surgery and having urinary infection were excluded. Patients were followed weekly for 4 weeks by ultrasonography, plain radiography of the urinary tract and CT of the urinary tract when indicated. RESULTS Silodosin showed better results against tamsulosin as stone expulsion rate in silodosin and tamsulosin groups was 82.4 and 61.5% respectively with significant difference (p = 0.007). Also, the stone expulsion time was significantly lower in silodosin against tamsulosin groups as it was 9.4 ± 3.8 vs. 12.7 ± 5.1 days in group I and II respectively (p = 0.001). The adverse effects were comparable with non-significant more retrograde ejaculation in the silodosin group. CONCLUSION Silodosin showed better efficacy in the stone expulsion rate and time with comparable safety of both drugs, with nonsignificant more retrograde ejaculation in silodosin.
Collapse
|
44
|
Okamoto K, Kurita M, Yamaguchi H, Numakura Y, Oka M. Effect of tadalafil on chronic pelvic pain and prostatic inflammation in a rat model of experimental autoimmune prostatitis. Prostate 2018; 78:707-713. [PMID: 29577372 DOI: 10.1002/pros.23514] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 03/07/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Experimental autoimmune prostatitis (EAP) shares important clinical features with clinical chronic prostatitis/chronic pelvic pain. We investigated the effect of tadalafil on pelvic pain and prostatic inflammation in a rat EAP model. METHODS EAP was induced in rats by intradermal injection of rat prostate antigen and complete Freund's adjuvant on days 0 and 28. Rats were treated with tadalafil (2 mg/kg, p.o.; EAP-tadalafil) or vehicle (EAP-vehicle) once daily from day 0, while sham-operated animals were treated with vehicle only (Sham). Tactile allodynia was measured on days 28, 35, and 42 by applying von Frey filaments to the lower abdomen as an index of pelvic pain. On day 42, the plasma immunoglobulin G (IgG) concentration and the testosterone/estradiol ratio were measured and histopathological analysis of the prostate was performed. RESULTS Tactile allodynia in the pelvic region was observed on days 28, 35, and 42 after EAP induction. The tactile allodynia observed on day 42 was significantly reduced by repeated treatment with tadalafil. Plasma IgG concentrations increased after EAP induction but the increase was not changed by tadalafil treatment. Prostate tissues were characterized by epithelial necrosis, infiltration of neutrophils and/or lymphocytes to acini and stroma, and fibrosis, in addition to a high stroma-to-epithelium ratio. Tadalafil treatment significantly suppressed the severity of the lesions. CONCLUSIONS EAP rats developed pelvic pain, prostatic inflammation and increased plasma IgG concentrations. Tadalafil inhibited the chronic pelvic pain and prostatic inflammation, suggesting that its anti-inflammatory action may contribute to its blocking of pain development in the EAP model.
Collapse
Affiliation(s)
- Ken Okamoto
- Research Laboratories, Nippon Shinyaku Co., Ltd., Minami-ku, Kyoto, Japan
| | - Maki Kurita
- Research Laboratories, Nippon Shinyaku Co., Ltd., Minami-ku, Kyoto, Japan
| | - Hiroshi Yamaguchi
- Research Laboratories, Nippon Shinyaku Co., Ltd., Minami-ku, Kyoto, Japan
| | - Yuki Numakura
- Research Laboratories, Nippon Shinyaku Co., Ltd., Minami-ku, Kyoto, Japan
| | - Michiko Oka
- Research Laboratories, Nippon Shinyaku Co., Ltd., Minami-ku, Kyoto, Japan
| |
Collapse
|
45
|
Modi PK, Wang Y, Kirk PS, Dupree JM, Singer EA, Chang SL. The Receipt of Industry Payments is Associated With Prescribing Promoted Alpha-blockers and Overactive Bladder Medications. Urology 2018; 117:50-56. [PMID: 29680480 PMCID: PMC6005747 DOI: 10.1016/j.urology.2018.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/20/2018] [Accepted: 04/05/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the impact of physicians' financial relationships with the pharmaceutical industry on prescribing marketed alpha-blockers and overactive bladder (OAB) medications. We also aim to examine if the number or total value of transactions is influential. MATERIALS AND METHODS We linked the Open Payments Program database of industry payments to prescribers with Medicare Part D prescription data. We used binomial logistic regression to identify the association between receipt of industry payment and prescribing of marketed alpha-blockers (silodosin) and OAB medications (fesoterodine, solifenacin, and mirabegron). We also evaluated the impact of increasing total value and number of payments on prescribing of marketed drugs. RESULTS The receipt of industry payment was associated with increased odds of prescribing the marketed drug for all included drugs: silodosin (odds ratio [OR] 34.1), fesoterodine (OR 5.9), solifenacin (OR 2.7), and mirabegron (OR 6.8) (all P <.001). We also found that increasing value of total payment and increasing frequency of payments were both independently associated with increased odds of prescribing with a dose-response effect. CONCLUSION There is a consistent association between receipt of industry payment and prescribing marketed alpha-blockers and OAB medications. Both the total value and number of transactions were associated with prescribing.
Collapse
Affiliation(s)
- Parth K Modi
- Department of Urology, Dow Division of Health Services Research, Michigan Medicine, Ann Arbor, MI.
| | - Ye Wang
- Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Peter S Kirk
- Department of Urology, Dow Division of Health Services Research, Michigan Medicine, Ann Arbor, MI
| | - James M Dupree
- Department of Urology, Dow Division of Health Services Research, Michigan Medicine, Ann Arbor, MI
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Steven L Chang
- Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| |
Collapse
|
46
|
Zachariou A, Mamoulakis C, Filiponi M, Dimitriadis F, Giannakis J, Skouros S, Tsounapi P, Takenaka A, Sofikitis N. The effect of mirabegron, used for overactive bladder treatment, on female sexual function: a prospective controlled study. BMC Urol 2018; 18:61. [PMID: 29940933 PMCID: PMC6020185 DOI: 10.1186/s12894-018-0377-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 06/20/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Αim of the study was to determine the effect of mirabegron, used for overactive bladder (OAB) treatment, on female sexual function. METHODS Eighty five sexually active women suffering from overactive bladder were prospectively enrolled in this study. Females were divided into two groups. In Group A (control), 48 patients received no treatment and in Group B, 37 patients received mirabegron 50 mg/daily for 3 months. Patients were evaluated with FSFI-Gr at the beginning of the study and again after a period of 3 months. RESULTS In Group B, there was a significant increase post-treatment compared to baseline (p < 0.001) in total FSFI (20.3 (3.8) to 26.6 (4.2)) and all domains (desire: 3.0 (1.2) to 4.8 (1.2)), arousal: 3.0 (0.8) to 4.8 (0.9), lubrication: 3.9 (1.1) to 4.8 (1.2), orgasm: 3.6 (0.8) to 4.8 (1.0), satisfaction: 3.2 (0.4) to 4.0 (0.8) and pain: 3.2 (0.8) to 4.4 (1.2)). In Group A, there were no statistically significant changes in pre- and post-observation values. CONCLUSIONS This study is one of the few demonstrating that management of OAB with mirabegron improves female sexual function. TRIAL REGISTRATION TRN ISRCTN17199301 , 20/10/2017, retrospectively registered.
Collapse
Affiliation(s)
- A. Zachariou
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
- 3 Spyridi Street, 38221 Volos, Greece
| | - C. Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
| | - M. Filiponi
- Department of Urology, ELPIS Hospital, Volos, Greece
| | - F. Dimitriadis
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
| | - J. Giannakis
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
| | - S. Skouros
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
| | - P. Tsounapi
- Department of Urology, School of Medicine, Tottori University, Yonago, Japan
| | - A. Takenaka
- Department of Urology, School of Medicine, Tottori University, Yonago, Japan
| | - N. Sofikitis
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
| |
Collapse
|
47
|
Ergakov DV, Martov AG. [Combination therapy in the management of urinary disorders after transurethral resection of the prostate]. Urologiia 2018:62-70. [PMID: 29634136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Surgery in patients with large prostates due to benign prostatic hyperplasia (BPH) results in severe dysuria manifesting as frequent or urgent need to urinate and urinary incontinence. Traditionally, these conditions are treated with alpha blockers. Recently, alpha-blockers and the anticholinergic combination have been used showing additional advantages. This study aimed to investigate the comparative effectiveness of monotherapy versus combination therapy in the treatment of postoperative dysuria in BPH patients with large prostates undergoing transurethral surgery. MATERIALS AND METHODS From September 2016 to March 2017, 94 BPH patients with prostates greater than 100 cc underwent transurethral surgery at the Department of Urology of D.D. Pletnev Clinical Hospital; 22 patients had exclusion criteria. In the postoperative period, 36 patients received 0.4 mg of modified release tamsulosin (Omnik) for a month, and 36 patients were administered controlled release tablets tamsulosin 0.4 mg + solifenacin 6 mg (Vezomni) as fixed-dose combination therapy. At one month postoperatively, patients were asked to rate their symptoms on a visual analogue scale and fill out I-PSS and QoL questionnaires. Preoperative parameters of the groups were: visual analogue scale scores were 5.1 and 5.2, I-PSS scores were 24 and 24.2, QoL scores were 4.5 in both groups. Prostate volumes were 114 and 118 cc; maximum urinary flow rates were 7.7 vs. 7.5 ml/sec, residual urine volumes were 110 vs. 105 ml, respectively. RESULTS Visual analogue scale scores were 6.5 versus 9.2 points, I-PSS scores were 16.3 versus 12.1. The patients of the second group had greater mean micturition volume (150 versus 240 ml); other variables did not differ statistically significantly between the groups. Adverse reactions were mild, and drugs were not discontinued in any case. CONCLUSION In BPH patients with dysuria after transurethral resection of large prostates, Vezomni administration results in a better quality of life due to an improvement in urgency and nocturia.
Collapse
Affiliation(s)
- D V Ergakov
- D.D. Pletnev City Clinical Hospital,, Moscow Health Department, Moscow, Russia
- Department of Urology, IPPE of A.I. Burnazyan SSC Federal Medical Biophysical Center of FMBA of Russia, Moscow, Russia
| | - A G Martov
- D.D. Pletnev City Clinical Hospital,, Moscow Health Department, Moscow, Russia
- Department of Urology, IPPE of A.I. Burnazyan SSC Federal Medical Biophysical Center of FMBA of Russia, Moscow, Russia
| |
Collapse
|
48
|
Hou CP, Lin YH, Chen TH, Chang PL, Juang HH, Chen CL, Yang PS, Tsui KH. Transurethral resection of the prostate achieves favorable outcomes in stroke patients with symptomatic benign prostate hyperplasia. Aging Male 2018; 21:9-16. [PMID: 28763255 DOI: 10.1080/13685538.2017.1358260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To evaluate the surgical outcomes of stroke patients with symptomatic benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP) and compare the clinical outcomes between patients with stroke and those without stroke receiving this procedure. METHODS This retrospective cohort study analyzed claims data collected during the period of 1997-2012 from Taiwan National Health Insurance Research Database. We enrolled 6625 patients who had persistent lower urinary tract symptoms and underwent TURP for BPH. They were categorized into a stroke (n = 577) and nonstroke (n = 6048) group. Patient characteristics, postoperative clinical outcomes, medication records, and medical expenses were compared. RESULTS Compared with the stroke group patients, those in the nonstroke group were younger, had fewer comorbidities, and more favorable postoperative clinical outcomes. Nevertheless, TURP achieved favorable outcomes in stroke patients with symptomatic BPH. In the stroke group, the rate of urinary tract infection (UTI) decreased from 34.7% during 1 year preoperatively to 29.8% during 1 year postoperatively (p = .05). The rate of urinary retention (UR) also decreased from 55.5% during 1 year preoperatively to 22.5% during 1 year postoperatively (p = .05). TURP reduced the overall medical expenses of patients with stroke. Annual patient medical expense during 1 year preoperatively, 1 year postoperatively, 2 years postoperatively, and 3 years postoperatively was NT$659,000, NT$646,000, NT$560,000, and NT$599,000, respectively. CONCLUSIONS In patients with stroke, TURP reduces the risks of UTI and UR and annual total medical expense.
Collapse
Affiliation(s)
- Chen-Pang Hou
- a Department of Urology , Chang Gung Memorial Hospital at Linkou , Tao-Yuan , Taiwan, Republic of China
- b School of Medicine , Chang Gung University , Tao-Yuan , Taiwan, Republic of China
| | - Yu-Hsiang Lin
- a Department of Urology , Chang Gung Memorial Hospital at Linkou , Tao-Yuan , Taiwan, Republic of China
- b School of Medicine , Chang Gung University , Tao-Yuan , Taiwan, Republic of China
- c Graduate Institute of Clinical Medical Sciences, College of Medicine , Chang Gung University , Tao-Yuan , Taiwan, Republic of China
| | - Tien-Hsing Chen
- b School of Medicine , Chang Gung University , Tao-Yuan , Taiwan, Republic of China
- d Division of Cardiology, Department of Internal medicine , Chang Gung Memorial Hospital , Keelung , Taiwan, Republic of China
| | - Phei-Lang Chang
- a Department of Urology , Chang Gung Memorial Hospital at Linkou , Tao-Yuan , Taiwan, Republic of China
- b School of Medicine , Chang Gung University , Tao-Yuan , Taiwan, Republic of China
| | - Horng-Heng Juang
- e Department of Anatomy, School of Medicine , Chang Gung University , Tao-Yuan , Taiwan, Republic of China
| | - Chien-Lun Chen
- a Department of Urology , Chang Gung Memorial Hospital at Linkou , Tao-Yuan , Taiwan, Republic of China
- b School of Medicine , Chang Gung University , Tao-Yuan , Taiwan, Republic of China
| | - Pei-Shan Yang
- a Department of Urology , Chang Gung Memorial Hospital at Linkou , Tao-Yuan , Taiwan, Republic of China
- b School of Medicine , Chang Gung University , Tao-Yuan , Taiwan, Republic of China
| | - Ke-Hung Tsui
- a Department of Urology , Chang Gung Memorial Hospital at Linkou , Tao-Yuan , Taiwan, Republic of China
- b School of Medicine , Chang Gung University , Tao-Yuan , Taiwan, Republic of China
| |
Collapse
|
49
|
Kinlaw AC, Funk MJ, Conover MM, Pate V, Markland AD, Wu JM. Impact of New Medications and $4 Generic Programs on Overactive Bladder Treatment Among Older Adults in the United States, 2000-2015. Med Care 2018; 56:162-170. [PMID: 29287033 PMCID: PMC5766403 DOI: 10.1097/mlr.0000000000000858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite several new medications being Food and Drug Administration-approved for overactive bladder (OAB) and new prescription drug payment programs, there are limited population-based data regarding OAB medication use among older adults. OBJECTIVES To examine: (1) impacts of new medications and $4 generic programs on time trends for OAB-related medication dispensing for older adults in the United States; (2) differences by age and sex; and (3) temporal changes in OAB-related medication payments. METHODS Using Truven Health Analytics' Medicare Supplemental Database (2000-2015), we analyzed OAB-related medication claims for 9,477,061 Medigap beneficiaries age 65-104. We estimated dispensing rates (per 1000 person-months), assessed dispensing trends using interrupted time-series methods, compared dispensing rates by age and sex, and summarized payment trends. RESULTS From 2000 to 2015, 771,609 individuals filled 13,863,998 OAB-related prescriptions. During 2000-2007, 3 new extended-release medications became available (tolterodine, darifenacin, solifenacin), leading to increases in overall OAB-related dispensing rates by 19.1 (99% confidence interval, 17.0-21.2), a 92% increase since 2000; overall rates remained stable during 2008-2015. By 2015, the most common medications were oxybutynin (38%), solifenacin (20%), tolterodine (19%), and mirabegron (12%). Dispensing rates peaked at age 90 (rate, 53.4; 99% confidence interval, 53.1-53.7). Women had higher rates than men at all ages (average ratewomen-ratemen, 22.0). The gap between upper and lower percentiles of medication payments widened between 2008-2015; by 2015, 25% of reimbursed dispensed prescriptions had total payments exceeding $250. CONCLUSIONS Medication-specific dispensing rates for OAB changed when new alternatives became available. Recent changes in utilization and cost of OAB medications have implications for clinical guidelines, pharmacoepidemiologic studies, and payment policies.
Collapse
Affiliation(s)
- Alan C. Kinlaw
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
| | - Michele Jonsson Funk
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
| | - Mitchell M. Conover
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
| | - Virginia Pate
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
| | - Alayne D. Markland
- Birmingham/Atlanta Veterans Affairs, Geriatric Research Education and Clinical Center, 700 South 19th Street, Birmingham, AL USA 35233
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL USA 35233
| | - Jennifer M. Wu
- Center for Women’s Health Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
- Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
| |
Collapse
|
50
|
Zhao Y, Zhou J, Mo Q, Wang Y, Yu J, Liu Z. Acupuncture for adults with overactive bladder: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e9838. [PMID: 29465566 PMCID: PMC5841968 DOI: 10.1097/md.0000000000009838] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/06/2017] [Accepted: 01/19/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Overactive bladder is stated as the occurrence of urinary urgency which will cause negative impacts and decrease patients' health-related quality of life. The aim of this systematic review is to assess the efficiency and safety of acupuncture for adults with overactive bladder (OAB) comparing with sham-acupuncture, drugs, and acupuncture plus drugs. METHODS We independently searched 9 databases from beginning to August 15, 2017. Two writers extracted data at the same time independently. Study outcomes were calculated by standardized mean differences (SMD) with 95% confidence intervals (CIs) and mean difference (MD) with 95% CIs. RESULTS Ten randomized controlled trials (RCTs) with 794 patients were included in this systematic review. The combined results showed that electroacupuncture (EA) may be more effective than sham electroacupuncture (sham EA) in improving the 24-hour nocturia episodes and EA may enhance tolterodine for relieving voiding symptoms and enhancing patients' quality of life. However, more trials with high quality and larger sample sizes will be needed in the future to provide sufficient evidence. Only 15 of 794 OAB patients from the included studies reported mild adverse reactions related to EA, therefore, acupuncture is safe for treating OAB. CONCLUSION Acupuncture might have effect in decreasing the number of micturition episodes, incontinence episodes, and nocturia episodes. However, the evidence is insufficient to show the effect using acupuncture alone or the additional effect to drugs in treating OAB.
Collapse
Affiliation(s)
- Yuwei Zhao
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- Beijing University of Chinese Medicine, Beijing
| | - Jing Zhou
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Qian Mo
- Guiyang College of Traditional Chinese Medicine, Guiyang, China
| | - Yang Wang
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Jinna Yu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Zhishun Liu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| |
Collapse
|