Search

Introduction: Benign prostatic hyperplasia (BPH) is a condition that affects over 50% of men as they enter their fifth decade of life, often leading to lower urinary tract symptoms (LUTS). Primary treatment options include alpha blockers, 5-alpha reductase inhibitors, and phosphodiesterase-5 inhibitors. However, these medications can have some side effects, and there is a noticeable dearth of information addressing the long-term use of these medications. Thus, the exploration of all treatment modalities helps ensure patients receive personalized and effective care. Consequently, the primary objective of this review is to identify potential emerging medications for the treatment of BPH. Areas covered: We conducted an extensive review of articles discussing pharmacotherapy for BPH spanning the last 15 years. Our information gathering process involved Scopus, PubMed-MEDLINE, Cochrane, Wiley Online Library Google Scholar, ClinicalTrials.gov, and the PharmaProjects database. This approach ensures that readers gain an in-depth knowledge of the existing therapeutic agents as well as promising avenues for managing BPH. Expert opinion: BPH treatment targets a patient's specific constellation of symptoms. Therefore, a broad knowledge base encompassing various treatment options is paramount in ensuring optimal treatment. Looking forward, the emphasis on personalization promises to reshape the landscape of BPH treatment and improve patient outcomes. [ABSTRACT FROM AUTHOR]

We conducted a systematic review to evaluate the efficacy and adverse effects of newer drugs used to treat lower urinary tract symptoms (LUTS). The drugs were either Food and Drug Administration (FDA) approved for benign prostatic hyperplasia (BPH) or not FDA approved for BPH but have been evaluated for treatment of BPH since 2008. We searched bibliographic databases through September 2017. We included randomized controlled trials (RCTs) lasting one month or longer published in English. Outcomes of interest were LUTS assessed by validated measures. Efficacy was interpreted using established thresholds indicating clinical significance that identified the minimal detectable difference. Twenty-three unique, generally short-term, RCTs evaluating over 9000 participants were identified. Alpha-blocker silodosin and phosphodiesterase type 5 inhibitor tadalafil were more effective than placebo in improving LUTS (moderate strength evidence) but these drugs had more adverse effects, including abnormal ejaculation (silodosin). Anticholinergics were only effective versus placebo when combined with an alpha-blocker. Evidence was generally low strength or insufficient for other drugs. Evidence was insufficient to assess long-term efficacy, prevention of symptom progression, need for surgical intervention, or long-term adverse effects. Longer trials are needed to assess the effect of these therapies on response rates using established minimal detectable difference thresholds, disease progression, and harms. [ABSTRACT FROM AUTHOR]

In this review, we focus on current trends in the management of male lower urinary tract symptoms (LUTS), defined here as LUTS, namely, storage, voiding, and post-micturition symptoms presumed secondary to benign prostatic hyperplasia (BPH), and discuss possible novel approaches toward better care. According to results of a PubMed database search covering the last 10 years and using keywords pertaining to male LUTS, this condition continues to be globally undiagnosed or diagnosed late, partly because of men's hesitation to seek help for perceived embarrassing problems or problems considered a normal part of aging. In addition, the prevalence of male LUTS is continually increasing because of a constantly aging population. Male LUTS can be bothersome and affect the quality of life (QoL) and sexual function. Additional effective alternatives for managing this condition need to be identified and incorporated into the current care model. Considering that most male LUTS such as frequency, hesitancy, urgency, and intermittency are easy to self-identify, a self-management approach toward male LUTS is proposed. Limited evidence supports the efficacy of phytotherapies and herbals as self-management options for male LUTS. However, introducing over-the-counter (OTC) medication with proven efficacy, accompanied by lifestyle and behavioral modifications, may be a promising approach that will encourage more men to treat their symptoms in a timely manner. Formal guidelines, along with appropriate education programs for patients and support from the healthcare community, will be needed to ensure that the promise of this approach is fully materialized. [ABSTRACT FROM AUTHOR]

Introduction: Alpha blockers (AB) are the main group of drugs used for medical expulsive therapy (MET) in patients with ureteral stones. However, there is no consensus on the relative efficacy and safety of individual AB in MET. Areas covered: The present work is a network meta-analysis of randomized controlled trials comparing AB with either placebo or standard of care in patients with ureteral stones. Electronic databases of Medline, Cochrane CENTRAL and Google Scholar were searched for eligible clinical studies. Inverse variance heterogeneity model was used for mixed treatment comparisons. Stone expulsion rate (SER) and stone expulsion time (SET) were the primary outcomes. Sub-group analyses for the following sub-groups were carried out: children; after shockwave lithotripsy; stone size of ≤5 mm; >5 mm; proximal and distal ureteral stones. Expert review: AB, phosphodiesterase inhibitors and combined AB with corticosteroids were observed with significant stone expulsion rate compared to control group in a recent network meta-analysis. Due to lack of head-to-head clinical trials within AB, only tamsulosin has been widely recommended by various urological guidelines. The results of this network meta-analysis will guide the future researchers in evaluating other promising ABs as agents for MET. [ABSTRACT FROM PUBLISHER]

A sensitive and simple reversed-phase high-performance liquid chromatographic method (RP-HPLC) was developed and validated for the simultaneous determination of four α-adrenergic receptor blockers: terazosin (TER), alfuzosin (ALF), tamsulosin (TAM) and doxazosin (DOX) using moxifloxacin (MOX) as an internal standard. The chromatographic separation was carried out isocratically at 40°C on a Prontosil C-18 reversed-phase column with a mobile phase consisting of acetonitrile : 50 mM phosphate buffer in a ratio of 30:70 with pH 3 adjusted by o-phosphoric acid. The analysis was performed in less than 8 min at a flow rate of 1.0 mL/min for terazosin and alfuzosin, and a flow rate of 1.5 mL/min for tamsulosin and doxazosin using time programming technique. UV-detection was performed at 230 nm. The proposed method was linear over concentration ranges of 2.5 - 25.0 μg/mL for TER, ALF, TAM and DOX, with limits of detection of 0.23, 0.17, 0.20 and 0.28 μg/mL in a respective order. The developed method was successfully applied to determine the four drugs in their dosage forms and the results were satisfactory as revealed by statistical analysis of the data. [ABSTRACT FROM AUTHOR]

Purpose:In Asian countries, low-dose tamsulosin (0.2 mg) is used widely but this dose has been less popular than 0.4 mg tamsulosin or other types of alpha blockers. The aim of this study was to investigate the efficacy and safety of low-dose tamsulosin by systematic review and meta-analysis. Methods:We conducted a meta-analysis of improvements of lower urinary tract symptoms using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QOL). Relevant studies were found using MEDLINE, Embase, and the Cochrane library. Final inclusion was determined by randomized controlled trials (RCT) and performance of IPSS. Results:A total of fourteen studies were included, with a total sample size of 2147 subjects (1044 experimental and 1103 controls). Study durations ranged from 4 to 52 weeks. The mean change of IPSS improvement from baseline for tamsulosin was −7.18 (95% CI: −7.83, −6.54). The mean change of QOL improvement from baseline was −1.34 (95% CI: −1.46, −1.22). The overall Qmax improvement from baseline was 2.32 ml/sec (95% CI: 1.95, 2.70). The mean change of PVR improvement from baseline was −11.12 ml (95% CI: −17.61, −4.64). Regarding safety, four studies did not report any adverse events while others reported that adverse events were all tolerated. Conclusions:Although this study did not consider placebo effect and has high IPSS baseline scores, this study clarifies that low-dose tamsulosin has generally positive effect and safety in treatment of LUTS and could be a suitable option as an initial treatment, especially for patients with low body mass index, as is typical of Asian people. [ABSTRACT FROM PUBLISHER]