ROLE OF ALPHA BLOCKER IN URETERORENOSCOPY.

Objective: To determine the efficacy of alpha blockers in successful management of lower and mid ureteral stones by ureterorenoscopy. Study Design: Comparative prospective study. Place and Duration of Study: Department of Urology, Combined Military Hospital Quetta Pakistan, from Jul 2018 to Dec 2019. Methodology: Total of 150 patients having mid and lower ureteric calculi requiring ureterorenoscopy were divided into two groups. Group A included patients without pre-treatment with alpha blocker was administered before they were subjected to ureterorenoscopy. Study group B included patients who received daily oral dose of alpha blocker, Tamsulosin 0.4 mg twice daily, for 1 week before ureterorenoscopy. Per-operative findings in both the groups were recorded. Results were analyzed by comparing the outcome between both groups in terms of ease of performing procedure, duration of procedure, complications, duration of hospital stay and need for stent placement. Results: Mean operative time was significantly shorter in group B as compared to group A, (15.9 ± 3.81 min vs. 21.9 ± 3.63 min; p≤0.001). Demographic and stone characteristics were comparable between the both groups. Success rate was 74 (98.7%), in group B as compared to 68 (90.7%) in group A, with statistically significant difference (p=0.020). Complications in group B were less frequent 1 (1.3%) vs 7 (9.3%) in group A (p-value=0.027). Conclusion: Use of alpha blockers for one week before performing ureterorenoscopy resulted in fewer complications and made the procedure easier to perform as well.

Effect of alpha-blocker use on morbidity and lower urinary tract symptoms in patients undergoing transrectal ultrasound-guided prostate biopsy

Objective: To evaluate voiding dysfunction and morbidity after transrectal ultrasound (TRUS)-guided prostate biopsy and to investigate whether pre-intervention alpha-blocker treatment had any effect on morbidity and voiding dysfunction. Material and methods: The study included 197 consecutive patients who underwent TRUS-guided prostate biopsy between January 2014 and January 2018. The patients were divided into two groups, those receiving alpha-blocker (silodosin) and those not receiving alpha-blocker treatment before the procedure (controls). All patients were evaluated before and one week after the procedure with the International Prostate Symptom Score (IPSS), measurements of maximum flow rate ( Qmax), post-void residual urine volume (PVR) and prostate volume, and procedure-related complications were also recorded. All analyzed parameters were compared by within-group and between-group evaluations. Results: There was no significant difference between the two groups in terms of IPSS, Qmax and prostate volume values before biopsy. In the follow-up evaluation performed on the seventh day after biopsy, IPSS, PVR and prostate volume were found to be increased, whereas Qmax was decreased in the control group ( p < 0.05). In the silodosin group, an increase in prostate volume was observed, but there were no significant changes in IPSS, Qmax and PVR values. Acute urinary retention (AUR) after the biopsy procedure developed in two patients (2%) in the silodosin group, and in nine patients (9.1%) in the control group ( p = 0.02). No significant difference was found between the two groups in terms of biopsy-related complications, except for AUR. Conclusion: We believe that alpha-blocker treatment initiated before biopsy may be advantageous in preventing voiding dysfunction that may develop after the procedure.

Preliminary results of a randomized crossover clinical trial comparing a new electromagnetic and vibrating device and alpha-blocker agents in patients affected by bladder outlet obstruction secondary to benign prostatic hyperplasia

To the Editor, Benign Prostatic Hyperplasia (BPH) is one of the main causes of patients seeking urological counselling in Western countries. It has been estimated that nearly 70 percent of United States men between the ages of 60 and 69 years, and nearly 80 percent of men ≥ 70 years, have some degree of BPH [...].

Hiệu quả kết hợp các thuốc alpha blocker và ức chế 5 alpha reductase trong điều trị bệnh nhân tăng sản lành tính tuyến tiền liệt

Mục tiêu: Đánh giá hiệu quả của liệu pháp kết hợp avodart 0,5mg và doxazosin 2mg so với đơn trị liệu bằng doxazosin 2mg trong điều trị các bệnh nhân tăng sản lành tính tuyến tiền liệt có triệu chứng IPSS ở mức độ trung bình. Đối tượng và phương pháp: Nghiên cứu ngẫu nhiên, nhãn mở, nhóm song song. Tổng số 100 bệnh nhân tăng sản lành tính tuyến tiền liệt có điểm IPSS 8-19, thể tích tuyến tiền liệt ≥ 30gram, PSA < 4ng/ml. Các bệnh nhân được chia ngẫu nhiên làm 2 nhóm, nhóm 1 gồm 50 bệnh nhân được điều trị avodart 0,5mg kết hợp doxazosin 2mg, nhóm 2 gồm 50 bệnh nhân chỉ được điều trị doxazosin 2mg, theo dõi và đánh giá kết quả điều trị sau 6 tháng. Tiêu chí đánh giá là thay đổi điểm IPSS, tình trạng tiến triển lâm sàng, chất lượng cuộc sống, thể tích tuyến tiền liệt, nước tiểu tồn dư, tình trạng bí đái cấp và chuyển sang phẫu thuật ở thời điểm 6 tháng so với bắt đầu điều trị. Kết quả: Điều trị kết hợp hai thuốc làm giảm điểm IPSS 4,68 điểm, trong khi đơn trị liệu bằng doxazosin 2 mg chỉ giảm 0,02 điểm IPSS sau 6 tháng điều trị (p<0,05). Sau 6 tháng, điều trị kết hợp thuốc cũng làm giảm 66% nguy cơ tiến triển lâm sàng, trong khi đơn trị liệu chỉ làm giảm 34% (p<0,05). Chất lượng cuộc sống được cải thiện hơn ở nhóm điều trị kết hợp so với nhóm đơn trị liệu, tương ứng là -1,46 điểm so với 0,14 điểm (p<0,05). Sau 6 tháng, thể tích tuyến tiền liệt giảm 26,3% ở nhóm điều trị phối hợp, trong khi đó tăng 0,5% ở nhóm đơn trị liệu. Thể tích nước tiểu tồn dư cũng giảm 40% ở nhóm điều trị phối hợp, nhưng lại tăng đến 40% ở nhóm đơn trị liệu. 12% bệnh nhân nhóm đơn trị liệu có bí tiểu sau 6 tháng điều trị, trong khi tỷ lệ này ở nhóm điều trị phối hợp chỉ 2%. Sau 6 tháng, 2% số bệnh nhân ở nhóm đơn trị liệu phải chuyển sang phẫu thuật. Kết luận: Liệu pháp điều trị phối hợp làm giảm nhanh và bền vững các triệu chứng ở bệnh nhân tăng sản lành tính tuyến tiền liệt có triệu chứng ở mức độ trung bình, cải thiện chất lượng cuộc sống và giảm đáng kể nguy cơ tiến triển của bệnh.

What Is the Interaction between Urine C-Reactive Protein, Prostatic Inflammation, and Doxazosin Treatment in Patients with Benign Prostatic Hyperplasia? A Pilot Study

<b><i>Introduction:</i></b> It was aimed to show the relationship between benign prostatic hyperplasia and inflammation by measuring urinary C-reactive protein values before and after alpha-blocker treatment. <b><i>Methods:</i></b> A total of 71 patients with a total prostate-specific antigen &#x3c;3.5 ng/mL, International Prostate Symptom Score &#x3e;7, and maximum urinary flow rate &#x3c;15 mL/s were included in the study. Doxazosin 4 mg p.o. once daily was started orally as an alpha-blocker treatment. Serum and urine C-reactive protein values, International Prostate Symptom Score, maximum urinary flow rate, and the post-void residual volume of patients were recorded at the first admission and in the first month of alpha-blocker treatment. <b><i>Results:</i></b> The mean age of the patients was 59.2 ± 7.5 years. The mean serum C-reactive protein values of the patients at the first admission and follow-up were 2.62 ± 1.8 (range, 0–5) mg/L and 2.83 ± 1.6 (0–6) mg/L, respectively. The mean urine C-reactive protein values of the patients at the first admission and follow-up were 0.45 ± 0.11 (range, 0.28–0.99) mg/L and 0.14 ± 0.04 (range, 0.79–0.328) mg/L, respectively, which was statistically significantly different. In the subgroup analysis, the urine C-reactive protein level change was more prominent in severely symptomatic patients than in moderately symptomatic patients. <b><i>Conclusion:</i></b> Our results showed that C-reactive protein was detectable in urine, alpha-blocker treatment significantly reduced urine C-reactive protein levels, and the decrease was more prominent in severely symptomatic patients.

The efficacy of adjunctive alpha-blocker on ureteroscopy procedure for ureteral stone: a systematic review/meta-analysis

Background: Urolithiasis cases are a common condition, and the number is still growing today. The prevalence of urinary tract stones globally currently ranges from 2-20% with a recurrence rate of around 50%. The present study aims to investigate the efficacy of adjunctive alpha-blockers in improving the success rate of ureterorenoscopy (URS) procedure for urolithiasis. Methods: We reviewed articles obtained from MEDLINE, CENTRAL, CINAHL, and Elsevier from 14 August to 9 September 2020, comparing alpha-blockers as adjunctive therapy, versus either a placebo or no drug at all, in post-URS urolithiasis patients. There were no restrictions on the type of URS and alpha-blockers given to patients. The quality of studies included was assessed using Cochrane’s Risk of Bias Assessment for Randomized-Controlled Trials. Results: Forest plot analysis emphasizes the statistically significant difference among the group, where the adjunctive alpha-blocker group had pooled relative risk (RR) of being stone-free, readmitted due to initial URS failure, having an overall complication, having haematuria, getting their ureteral mucous injured, and suffering a colic episode was 1.71 (95% CI, 1.11–1.24), 0.50 (95% CI, 0.25–1.01), 0.41 (95% CI, 0.27–0.61), 0.42 (95% CI, 0.22–0.79), 0.31 (95% CI, 0.13–0.73), and 0.21 (95% CI, 0.06–0.69), respectively. Conclusions: Alpha blocker minimizes the frequency and duration of ureteral contractions, allowing smooth stone expulsion. With this knowledge, it is expected to help clinicians decide the importance of adjunctive alpha-blocker administration.

The Efficacy of Terazosin, Finasteride, or Both in Benign Prostatic Hyperplasia

This chapter summarizes the landmark Veterans Affairs Cooperative Benign Prostatic Hyperplasia Study in patients with lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH) that randomized men to receive terazosin, the 5-alpha reductase inhibitor (5-ARI) finasteride, their combination, or placebo. This study demonstrated the benefit of alpha-blocker therapy for men with BPH symptoms but did not demonstrate an added benefit of combination alpha-blocker and 5-ARI therapy.

Can We Use the Silodosin as Second Line Treatment of Benign Prostate Hyperplasia?

Objective: We aimed to investigate the efficacy of silodosin in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) refractory to previous α-adrenergic receptor (AR) blocker therapy. Materials and Methods: Patients who did not benefit from alpha-blocker therapy but avoided surgical treatment constitute the population of our study. Seventy-five patients were studied in each group; Group 1 was given 8 mg of silodosin, while Group 2 continued the previous alpha-blocker treatment. Results: The initial mean international prostate symptom score (IPSS) was calculated as 20.81±0.97 in Group 1, in the third month there was a decrease of 17.12±1.25 (p<0.05). No significant change was observed in Group 2. In addition, a significant decrease was observed in IPSS subscores (storage and voiding symptoms) in Group 1 compared to baseline at the third month. There was an improvement in residual urine in the silodosin group and no improvement in the other group. Conclusion: In patients with BPH who refuse surgical treatment and could not achieve adequate symptom relief with other α-blockers in routine practice, silodosin was found superior in terms of LUTS recovery. Silodosin is also an effective option in patients who cannot undergo surgical treatment due to comorbidities.