Tamsulosin, versus Tamsulosin in combination with Solifenacin versus Tamsulosin in combination with Trospium chloride for treatment of Double-J stent-related symptoms

Background Stenting has been primarily used to treat urinary obstruction and the frequency of this use is increasing with the increase in ureteroscopic management. In cases of acute obstruction, a stent is used temporarily to stabilize the patient until definitive therapy. The stent is generally placed if there is accompanying ureteric injury or in those with a residual stone after ureteroscopic lithotripsy. Placing a ureteric stent after ureteroscopy with stone extraction is done by some urologists routinely to prevent possible stenosis or to decrease secondary pain caused by mucosal oedema. However, routinely placing a stent to prevent late complications or to relieve flank pain from a ureteric stricture or mucosal oedema after surgery is questionable. Stent-related symptoms are quite problem in nearly 80% of patients that has been implicated in short-term morbidities in terms of negative impact on the patients’ quality of life, body pains and hematuria. Various attempts had been made to minimize these symptoms but pharmacological treatment is the simplest and a noninvasive option. Numerous drugs had been tried to relieve these symptoms like alpha blockers, anticholinergics and analgesics. Objective To compare the efficacy of tamsulosin alone, tamsulosin in combination with solifenacin and tamsulosin in combination with trospium chloride in in the relief of Double-J stentrelated symptoms following uncomplicated ureteroscopic lithotripsy (URSL). Patients and Methods The present study was a prospective randomized comparative study conducted on 60 patients whith double-J stent inserted following uncomplicated ureteroscopic lithotripsy (URSL) in Ain Shams University Hospital and Karmouz Hospital over a period of 1 year. The patient were randomized into 3 equal groups (1:1:1 randomization): Group A:20 patients were treated by Tamsulosin (0.4 mg) alone once daily. Group B:20 patients were treated by Tamsulosin (0.4 mg) once daily in combination with Solifenacin (5 mg) once daily. Group C: 20 patients were treated by Tamsulosin (0.4 mg) once daily in combination with Trospium chloride (20 mg) twice daily. All patients were assessed 1 week postoperatively after Double-J stent insertion. Then, the patients were start the medical treatment and were assessed 3 weeks after starting the medical treatment. Results The study shows that the combination of the tamsulosin 0.4 mg/day and trospium chloride 20 mg twice/day are significantly superior to the tamsulosin 0.4 mg once alone / day and the combination of the tamsulosin 0.4 mg /day and the solifenacine 5 mg /day for the treatment of the LUTS in d.j stent cases except in the frecuncy the combination of tamsulosin 0.4 mg/day and the solifenacine 5 mg/day are signicantly superior. Also, the drugs are safe with mild few side effects. There were no significant differences regarding headache, dizziness, backache, myalgia and orthostatic hypotension. Conclusion The study show that the combination of the tamsulosin 0.4 mg/day and the trospium chloride 20 mg twice /day are significantly superior to the tamsulosin 0.4 mg once alone / day and the combination of the tamsulosin 0.4 mg /day and the solifenacine 5 mg /day for the treatment of the LUTS in d.j stent cases except in the frecuncy the combination of tamsulosin 0.4 mg/day and the solifenacine 5 mg/day are signicantly superior.

Development, optimization and pharmacokinetic evaluation of biphasic extended-release osmotic drug delivery system of trospium chloride for promising application in treatment of overactive bladder

Background The research was aimed with an approach to formulate biphasic extended-release system of trospium chloride resulting in controlled release of drug up to 24 h with prospects of better control on urinary frequency, efficacy, tolerability, and improved patient compliance. The push–pull osmotic pump (PPOP) bi-layered tablet of trospium chloride (60 mg) was developed with the use of immediate-release polymers in the pull layer (30 mg drug) and polyethylene oxide in the push layer (remaining 30 mg drug). The tablet was formulated by compression after non-aqueous granulation, seal coating, and semipermeable coating. The tablet prepared was laser drilled to create an orifice for drug release. Results Comparative in vitro dissolution and in vivo pharmacokinetic analysis of available marketed formulations demonstrated the complete drug release within 16–18 h; hence the developed biphasic extended-release system has its great importance as it provides zero-order release up to 24 h. Conclusions The developed biphasic extended-release drug delivery system of trospium chloride provides the drug release for 24 h with effective plasma concentration in comparison with the available marketed formulation. Extended release of drug from the developed formulation provides scope for its promising application in the treatment of overactive bladder (OAB).

Trospium Chloride Transport by Mouse Drug Carriers of the Slc22 and Slc47 Families

Background: The muscarinic receptor antagonist trospium chloride (TCl) is used for pharmacotherapy of the overactive bladder syndrome. TCl is a hydrophilic positively charged drug. Therefore, it has low permeability through biomembranes and requires drug transporters for distribution and excretion. In humans, the organic cation transporters OCT1 and OCT2 and the multidrug and toxin extrusion MATE1 and MATE2-K carriers showed TCl transport. However, their individual role for distribution and excretion of TCl is unclear. Knockout mouse models lacking mOct1/mOct2 or mMate1 might help to clarify their role for the overall pharmacokinetics of TCl. Method: In preparation of such experiments, TCl transport was analyzed in HEK293 cells stably transfected with the mouse carriers mOct1, mOct2, mMate1, and mMate2, respectively. Results: Mouse mOct1, mOct2, and mMate1 showed significant TCl transport with Km values of 58.7, 78.5, and 29.3 µM, respectively. In contrast, mMate2 did not transport TCl but showed MPP+ transport with Km of 60.0 µM that was inhibited by the drugs topotecan, acyclovir, and levofloxacin. Conclusion: TCl transport behavior as well as expression pattern were quite similar for the mouse carriers mOct1, mOct2, and mMate1 compared to their human counterparts.

Bladder and bowel: friends or enemies?

Overactive bladder (OAB) is a very common condition. OAB undoubtedly requires correction since it significantly affects the patient’s quality of life. Literature review showed that pharmacokinetic and metabolic characteristics of trospium chloride make it a drug of choice in elderly and comorbid patients. There is a clear correlation between intestine and bladder dysfunction. The effects of rebamipide discovered by experiments, such as restoration of the damaged urothelium structure and function, as well as suppression of the overactive bladder, require further in-depth study and introduction of the drug to clinical practice for treatment of patients with chronic cystitis and OAB.

Role of Trospium chloride and tamsulosin therapy for treating patients with symptoms of over-active bladder related to benign prostatic enlargement

To assess the benefit and safety of composite therapy (Tamsulosin and Trospium drugs) in treating benign prostatic enlargement complain, mainly overactive urinary bladder symptoms. OBJECTIVE: The study has been designed to estimate the benefit and safety of Trospium and Tamsulosin in processing of symptoms of excessive bladder and benign prostate hyperplasia (BPH). Patients and Methods: Prospective clinical trial study conducted at Al-Diwaniya teaching hospitals and private clinics from march 2016 to march 2017, to patients BPH and bothersome symptoms. 60 patients were treated with Tamsulocin and 60 patients were treated by Tamsulocin and Trospium. RESULTS: Median scores of IPSS, OABSS, and QOL proved no big difference between two study sets before staring treatment (P = 0.544), (P = 0.287) , (P = 0.668) consecutively. After one month, both treatments led to a big reduction in IPSS, OABSS median score; (P < 0.001), (P < 0.001). Following three months, both treatments resulted in significant reduction in IPSS (P < 0.001), OABSS (P < 0.001), QOL result, (P < 0.001) consecutively. Conclusion: These results suggest which treatment with Trospium and tamsulosin therapy provides benefit for men with natural - Syndrome of the acute urinary tract and benign enlarged prostate.