scholarly journals BPH Importance of prostate volume and urinary flow rate in prediction of bladder outlet obstruction in men with symptomatic benign prostatic hyperplasia

Author(s):  
Darius Trumbeckas ◽  
Daimantas Milonas ◽  
Mindaugas Jievaltas ◽  
Aivaras Jonas Matjosaitis ◽  
Marius Kincius ◽  
...  
2000 ◽  
Vol 34 (2) ◽  
pp. 188-199 ◽  
Author(s):  
Mary Lee

OBJECTIVE: To review the information necessary to assess the efficacy and safety of tamsulosin compared with other adrenergic antagonists for treatment of symptomatic benign prostatic hyperplasia. DATA SOURCES: A search was conducted of Cumulated Index Medicus, January 1993–August 1999, which was restricted to human trials and English-language journals. STUDYSELECTION AND DATAEXTRACTION: Efficacy studies were included if the design was randomized and included a control group. Drug safety was assessed using data from any patient series or controlled study. DATA SYNTHESIS: Tamsulosin, a uroselective α1A-adrenergic receptor antagonist, relaxes smooth muscle in the prostate and bladder neck, thereby enhancing bladder emptying. In randomized, controlled clinical trials using standardized instruments, tamsulosin improves obstructive voiding symptoms by at least 25% in 65–80% of patients with symptomatic benign prostatic hyperplasia. Tamsulosin also improves peak urinary flow rate by 1.4–3.6 mL/sec in various studies and reduces post-void residual urine volume. The usual dosage of tamsulosin was 0.4 or 0.8 mg orally once a day in the studies performed in the US and Europe; daily doses of 0.1–0.4 mg were used in studies performed in Japan. The beneficial effects of tamsulosin on voiding symptoms, peak urinary flow rate, and bladder emptying appear to be dose-related, up to a ceiling dose of 0.4 mg. The most common adverse effects are headache, asthenia, dizziness, and rhinitis-like complaints. Retrograde or delayed ejaculation occurs in 4.5–14.0% of patients and has required discontinuation of treatment in a minority of these patients. At the usual dose of 0.4–0.8 mg/d, tamsulosin does not appear to significantly reduce blood pressure, increase heart rate, or cause first-dose syncope; therefore, dosage titration is not necessary when initiating treatment. Use of nifedipine, enalapril, atenolol, furosemide, or digoxin does not require dosage modification when tamsulosin is initiated concomitantly; hypotension has not been reported with combined use of tamsulosin and these commonly used agents. CONCLUSIONS: Tamsulosin is an improvement over other a-adrenergic antagonists for the management of symptoms of benign prostatic hyperplasia. It is a more convenient alternative that does not require initial dosage titration, has a fast onset of action, and has a low potential to cause hypotension when used alone or in combination with commonly used antihypertensive agents. It is more costly than some of the other second-generation α-adrenergic antagonists.


2018 ◽  
Vol 16 (2) ◽  
pp. 35-39
Author(s):  
Md Saifuddin Ahmed Siddique ◽  
Sharmin Nahar Bashar ◽  
Farid Uddin Ahmed

Background: Lower Urinary Tract Symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) are common in elder men and a number of drugs alone or in combination are clinically used for this disorder. To assess the efficacy and safety of combined Alfuzosin plus Finasteride, in patients with LUTS due to BHP.Methods: In this hospital-based, Quasi-experimental study (One-Group Pre test-Post test Design) without Control Groups, 30 consecutive patients were selected as per set criteria for medical management of BPH with combination of 10mg Alfuzosin and 5mg Finasteride, for 12-months, in the outpatient Department of Urology, in Chittagong Medical College Hospital. The primary efficacy criteria were improvement in symptoms (International Prostate Symptom Score (IPSS) peak urinary flow rate and reduction of prostate volume from baseline.Results: Combination therapy with Alfuzosin plus Finasteride was effective in improving the symptoms and peak urinary flow rate from the first follow-up visit (Day 90) in comparison to baseline score. The mean change in the IPSS from baseline at endpoint was 10±1.87 (p=0.001). The percentage increase in the peak urinary flow rate was 4.8 mL/s, compared with 11.0±1.82 mL/s at baseline (p=0.001). The patients’ quality of life also significantly improved. The percentage decrease in prostate volume at end point was 15.13±11.3 cc (p=0.001). Overall, this combination therapy was well tolerated. The incidence of orthostatic hypotension as determined by systematic blood pressure measurements was only 3(10%). No clinically relevant ejaculation disorders were observed.Conclusion: Alfuzosin plus Finasteride provides effective relief from the symptoms of benign prostatic hyperplasia by reducing the size of the prostate. It is well tolerated from a cardiovascular viewpoint and is not associated with abnormal ejaculation.Chatt Maa Shi Hosp Med Coll J; Vol.16 (2); July 2017; Page 35-39


2019 ◽  
Vol 13 (4) ◽  
pp. 155798831987038 ◽  
Author(s):  
Bing-Hui Li ◽  
Tong Deng ◽  
Qiao Huang ◽  
Hao Zi ◽  
Hong Weng ◽  
...  

The objective of this study was to evaluate association between body mass index (BMI) and prostate volume (PV), international prostate symptom scores (IPSS), maximum urinary flow rate ( Qmax), and post-void residual (PVR) of Chinese benign prostatic hyperplasia (BPH) patients. All newly diagnosed BPH patients between September 2016 and August 2018 were selected and 788 patients were included. According to BMI, the patients were categorized into four groups, while according to PV, IPSS, Qmax, and PVR, they were categorized into two groups based on clinical significant cutoffs. Univariable and multivariable logistic regressions and a restricted cubic spline (RCS) were applied to explore the relationship of BMI with categorical PV, IPSS, Qmax, and PVR. Compared with normal BMI, obesity presented significant association with increased risk of larger PV (>80 ml) in both unadjusted and adjusted models (unadjusted odds ratio [OR] = 1.772, 95% CI [1.201, 2.614], p = .004; adjusted OR = 1.912, 95% CI [1.212, 3.017], p = .005); however, underweight or overweight did not present a significant connection with such risk. No significant effect was identified for BMI on IPSS, Qmax, or PVR in either unadjusted or adjusted model. Nonlinear test including BMI using RCS and adjusting for confounders showed no significance ( p > .05); however, a significant linear relationship was ascertained between BMI and the risk of larger PV ( p < .001). In conclusion, there was a significant linear association between BMI and the risk of larger PV in BPH patients. Hence, this suggests urologists should consider both BMI and PV when providing surgical treatment for BPH patients.


2019 ◽  
Vol 5 (2) ◽  
pp. 143-147
Author(s):  
Md Abul Hossain ◽  
Md Akter Alam ◽  
Md Fazal Naser ◽  
Md Shafiqul Azam

Background: BPH is one of the most common cause of LUTS which significantly impairs the quality of life. TURP is minimally invasive surgical procedure for Benign Prostatic hyperplasia which has impact on quality of life. Impact on quality of life can be measured by QoL score and effect of TURP can be evaluated. Objective: The purpose of the present study was to evaluate the impact of transurethral resection of prostate (TURP) on Quality of Life (QoL) score. Methodology: This prospective study was carried out in the Department of Urology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, from July 2015 to June 2016. Total fifty patients between 50 to 72 years attending for the treatment of benign prostatic hypertrophy (BPH) with lower urinary tract symptoms (LUTS) were included for the study according to inclusion & exclusion criteria. All of them were evaluated with baseline international prostate symptoms score (IPSS), QoL score, peak urinary flow rate (Qmax), voided volume, voiding time and PVR and were recorded in a predesigned data sheet. Selected patients underwent Transurethral Resection of Prostate. They were followed after 1 month and 3 months with same parameter and compared with the baseline values. Results: The baseline international prostate symptoms score (IPSS) in this study was 25.18±1.45. At one month and three months follow up visits after TURP, the IPSS was decreased to 15.0±1.07 and 8.14±0.76 respectively. There was significant improvement of peak urinary flow rate (Qmax) in the postoperative period, at the 1st follow up visit after one month of TURP (15.78±1.42, p<0.001) and at the 2nd follow visit after three months of TURP (18.78, p <0.001). The mean QoL score was 5.30±0.46 before TURP. After one month of TURP it was 3.20±0.45 and after 3 months of TURP it was 1.86±0.57. Conclusion: There is a significant improvement of quality of after TURP. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 143-147


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