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Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are common disorder in older men. The mainstay of conservative treatment for BPH is 1-adrenoblockers. A review of the literature on silodosin, a selective -adrenergic blocker, is discussed in the article. In clinical studies, there was a significant improvement in IPSS scores and maximum urinary flow rate in patients who received silodosin at a daily dose of 8 mg compared to those receiving placebo. It should be noted that silodosin has demonstrated long-term safety and early onset of efficacy. Compelling literature data to support the clinical benefit of silodosin for the treatment of LUTS associated with BPH is presented.

To compare the effects of selective α-1 adrenoceptor antagonists on subfoveal choroidal thickness (SFCT) and pupil diameter size (PDS). This prospective study included 87 patients diagnosed with benign prostatic hyperplasia who were treated with tamsulosin hydrochloride (n = 41) or silodosin (n = 46). SFCT measurements were obtained using spectral domain optic coherence tomography (SD-OCT), and PDS measurements were obtained under mesopic, photopic and scotopic conditions using a photography-based topography system. SFCT and PDS were evaluated at baseline and 3-, 6- and 12-mo follow-ups. The initial mean SFCT was 270.53 ± 21.48 µm in tamsulosin group and 271.95 ± 24. 73 in silodosin group (P = 0.078). There was no statistically significant change in SFCT at the 3-mo visit. At the 6-mo follow-up, the mean SFCT was 281.34 ± 22.09 µm in tamsulosin group and 272.5 ± 22.4 µm in silodosin group. At the 12th month, the mean SFCT in tamsulosin group was 290.80 ± 17.27 µm, and it was 270.80 ± 13.14 µm in silodosin group. There was statistically significant difference in at 6th and 12-mo visits (P = 0.014 and P = 0.00). During the follow-up, both drugs induced a similar significant decrease in PDS under all conditions. Tamsulosin hydrochloride caused a significant increase in SFCT. In contrast, SFCT did not increase in silodosin group. The decreases in PDS achieved using both drugs were similar. This should be kept in mind when choroidal disease and its response to treatment are followed by CT imaging.

This is a critical review of the current literature data about sexual dysfunction as a potential side effect related to drugs commonly used for the treatment of Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. In this narrative review, we analyzed data from the literature related to the development of sexual dysfunctions during the treatment of BPH or LUTS. Both α-blockers and 5-alpha reductase inhibitors (5-ARIs) can induce erectile dysfunction, ejaculatory disorders and a reduction in sexual desire. The sexual side effect profile of these drugs is different. Among the α-blockers, silodosin appears to have the highest incidence of ejaculatory disorders. Persistent sexual side effects after the discontinuation of finasteride have been recently reported; however, further studies are needed to clarify the true incidence and the significance of this finding. However, most of the published studies are affected by a weak methodology and other important limitations, with only a few RCTs available. Therefore, it is desirable that future studies will include validated tools to assess and diagnose the sexual dysfunction induced by these medications, especially for ejaculation and sexual desire disorders.

To evaluate the correlation between ureteral wall thickness (UWT) and stone passage (SP) and its cut-off value in distal uncomplicated ureteral stones. In the prospective study from January 2019 to January 2020 at a tertiary care hospital, we reviewed 212 patients aged above 18 years with single, symptomatic, radiopaque, and distal ureteric stone sized 5–10 mm, who were treated with MET (Silodosin 8 mg once daily) until SP or a maximum of 4 weeks. There were 2 groups: responders and non-responders. Demographic data of the patients and all stone radiological parameters including stone size, laterality, density, UWT, the diameter of the ureter proximal to the stone (PUD), and the degree of hydronephrosis were recorded and compared between the 2 groups. There were 126 (59.4%) in the responder group and 86 (40.6%) in the non-responder group. On univariate analysis, gender, stone density, stone size, PUD, UWT, and the degree of hydronephrosis were significant factors for stone passage. However, using multivariate analysis, only UWT and the degree of hydronephrosis were significant. ROC analysis showed that 3.75 mm is the cut-off value for UWT, with 86% and 87.3% sensitivity and specificity, respectively. UWT and hydronephrosis can be used as potential predictors for SP and can help with decision-making in patients with uncomplicated 5–10 mm lower ureteric stones.

We performed a post hoc analysis of data from phase 3 and 4 studies to evaluate the efficacy of silodosin 8mg in patients with severe lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). The presence of two or more of the following criteria was adopted to define severity: total International Prostate Symptom Score (IPSS) 20-35, quality of life (QoL) score 5-6, maximum urinary flow

Objective: The aim of our study was to assess the comparative patient satisfaction and side-effects of the currently prescribed drugs – tamsulosin and silodosin for benign prostatic hyperplasia (BPH). Methods: A prospective study was conducted in a total of 110 BPH patients from the Department of Urology for a period of 6 months. Fifty-five patients in each group received silodosin 8 mg or tamsulosin 0.4 mg once daily. Data were collected using a suitably designed pro forma and the patient satisfaction was assessed with patient’s perception of study medication (PPSM) scale. International prostate symptom score (IPSS) was used for assessing the severity of symptoms. Results: The current study found that the treatment had a significant effect on improving scores of PPSM and IPSS at which all changes were significant at p

OBJECTIVES To investigate and compare the effects of tadalafil and silodosin on lower urinary tract symptoms and voiding functions in men with non-neurogenic detrusor underactivity. METHODS A total of 126 treatment-naive men with lower urinary tract symptoms diagnosed as non-neurogenic detrusor underactivity received tadalafil (5 mg/day) or silodosin (8 mg/day) for 12 months. After propensity score matching, parameter changes from before administration to 12 months since treatment initiation were assessed based on subjective symptoms and urodynamic findings, including bladder contractility index and maximum urinary flow rate, and were compared between the tadalafil treatment group and the silodosin group. Detrusor underactivity was defined as bladder contractility index

Purpose: The objective of this study was to investigate the change in near visual function after the administration of oral silodosin to patients with lower urinary tract symptoms (LUTS).Methods: This prospective study included treatment-naive patients who were scheduled to start treatment with silodosin for LUTS. A comprehensive ophthalmological evaluation including the near vision and the automated pupillometry was performed at baseline and after 3 months of silodosin treatment. For subjective assessment of near visual ability and satisfaction, a Near Activity Visual Questionnaire-10 (NAVQ-10) was also used at the same time (higher scores indicating worse quality).Results: Of 23 patients enrolled in this study, 15 continued with silodosin (8 mg once daily) treatment for 3 months and completed a follow-up evaluation. The mean age of participants was 60.4±8.4 years. Distant visual acuity and spherical error were unchanged after silodosin treatment. However, near vision acuity (logMAR) was improved after treatment (right, 0.47±0.36 vs. 0.38±0.39, P=0.018; left, 0.41±0.37 vs. 0.31±0.34, P=0.068; both, 0.27±0.26 vs. 0.21±0.27, P=0.043). Pupil size under room light decreased significantly in both eyes (right, 3.77±0.60 vs. 3.16±0.58, P=0.001; left, 3.72±0.80 vs. 3.21±0.75, P=0.002). The Rasch scale at NAVQ-10 improved from 54.7±9.9 to 48.5±11.2 (P=0.004).Conclusions: This preliminary study demonstrated that highly selective alpha-1A adrenergic receptor antagonists such as silodosin improve near visual acuity and quality in patients with LUTS/benign prostatic hyperplasia. Decrease in pupil size caused by inhibition of adrenergic alpha 1 mediated contraction of iris dilator muscle is a possible mechanism underlying improved near vision.

Gianluigi Califano,1 Claudia Collà Ruvolo,1 Massimiliano Creta,1 Marco Capece,1 Roberto La Rocca,1 Giuseppe Celentano,1 Luigi Napolitano,1 Francesco Paolo Calace,1 Gianluca Spena,1 Francesco Trama,1 Felice Crocetto,1 Francesco Mangiapia,1 Nicola Longo,1 Ferdinando Fusco2 1Department of Neurosciences, Reproductive Sciences and Odontostomatology – Federico II University of Naples, Naples, Italy; 2Department of Urology, Luigi Vanvitelli University of Naples, Naples, ItalyCorrespondence: Massimiliano CretaDepartment of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, via Sergio Pansini 5, Naples 80131, ItalyTel/Fax +390817462611Email max.creta@gmail.comAbstract: Medical management of lower urinary tract symptoms related to benign prostatic obstruction engages healthcare professionals worldwide. Currently, alpha-1 adrenergic antagonists are strongly recommended as first-line therapy for patients with moderate to severe symptoms because of their safety, efficacy and good tolerability. These agents are highly heterogeneous in terms of pharmacological selectivity for the adrenergic receptor subtypes with silodosin being the agent characterized by the highest α1A/α1B affinity ratio. This property has been proposed to confer to silodosin advantages in terms of bladder outlet obstruction improvement and lower incidence of cardiovascular side effects at the cost of a higher incidence of ejaculatory dysfunction. These aspects should be carefully taken in consideration when personalizing medical therapy for lower urinary tract symptoms related to benign prostatic obstruction.Keywords: alpha-1 adrenergic antagonists, benign prostate enlargement, lower urinary tract symptoms, bladder outlet obstruction

Background: The purpose of this study was to compare once daily (QD) usage of 4 and 8 mg of silodosin in patients divided as those with moderate and with severe lower urinary tract symptoms (LUTSs) according to International Prostate Symptom Score (IPSS) categories in terms of effectiveness and adverse events. Methods: A total of 234 patients aged ≥ 40 years were evaluated prospectively. All participants were divided firstly into two groups according to their IPSS severity as moderate and severe. They were further allocated to receive 4 mg of silodosin and 8 mg of silodosin QD. Demographic features and laboratory tests were recorded. The patients were questioned with International Index of Erectile Function-5 and IPSS along with quality of life index. Uroflowmetric measurements were applied to the patients. All tests and measurements were repeated at the 3rd month, and changes from pretreatment to posttreatment were analyzed by SPSS 21.0 Program. The statistical significance level was set at p

Background Urolithiasis is considered one of the most common diseases in urological practice. Its prevalence is about 1% to 15% with 30 years old as the peak age of incidence. Medical expulsive therapy (MET) has been used as a conservative treatment for patients with ureteral stones. Nitrergic fibers have been identified to have a relaxant effect on the distal ureteral smooth musculature. The objective of our study was to evaluate the efficacy and safety of the combination of silodosin and vardenafil as a medical expulsive therapy in comparison with each drug alone. Methods One hundred and two male patients with uncomplicated distal ureteric stone 6–10 mm were enrolled in the study. The patients were randomly divided into 3 equal groups, and each one consists of 34 patients. Group I received silodosin 8 mg once daily, group II vardenafil 5 mg once daily and group III combination of silodosin 8 mg and vardenafil 5 mg once daily. The treatment was given for all the patients until stone expulsion or a maximum of 4 weeks. The primary endpoint was the stone expulsion rate, and the secondary endpoints were time to stone expulsion, number of hospital visits for pain, amount of analgesic required and side effects associated with MET. Results Our study showed that the stone expulsion rate was higher in combination = 90.0% than silodosin = 76.7% and vardenafil groups = 60.0% (P = 0.025), the time to stone expulsion was significantly shorter in combination = 11.23 ± 3.14 than silodosin = 12.50 ± 1.66 and vardenafil groups 14.67 ± 1.24 days (P P = 0.038) and lesser amount of analgesic required in combination 313.6 ± 2.85.5 than silodosin 613.44 ± 483.62 and vardenafil groups 716.97 ± 685.3 (P = 0.008). There was no significant difference among the studied groups as regards the drugs side effects except for retrograde ejaculation (silodosin and combination = 86.7% vs vardenafil groups = 0.0%) (P P = 0.010). Conclusion The prescription of vardenafil in combination with silodosin is safe and more effective than silodosin or vardenafil alone as a MET.

The aim of our study will be to evaluate the effect of combining pelvic floor muscle training (PFMT) with the urgency-suppression technique and silodosin in comparison with silodosin alone in men with Benign Prostatic Hyperplasia (BPH) and Overactive Bladder (OAB) after 12 weeks of treatment. The primary outcome will be a change in the number of voidings and intensity of urgencies over 24 h using a micturition diary, and the secondary outcomes will be a change in lower urinary tract symptoms, a change in incontinence quality of life, a change in patients’ global impression of improvement, and a lower incidence of adverse events. A randomized intervention parallel multicenter study will be conducted in collaboration with 45 urological clinics at the national level. Patients will be assigned at a 1:1 ratio to the experimental and control groups using simple randomization according to odd and even patient sequence numbers in each ambulatory clinic. The experimental group will receive oral silodosin at a daily dose of 8 mg once daily and pelvic floor muscle training (PFMT) 5 times a week for 20–30 min a day, for 12 weeks. The control group will receive oral treatment with silodosin at a daily dose of 8 mg once daily for 12 weeks. The study protocol presents the starting points and design of a randomized, interventional, parallel, multicenter study looking at the effect of a combination of silodosin and PFMT versus silodosin treatment in men with BPH and OAB.

Purpose: Alpha-adrenergic blockers are commonly used as a medical expulsive therapy (MET) for patients with ureteral calculi. The aim of this meta-analysis was to evaluate the efficacy and safety of alpha-adrenergic blockers compared with a placebo when used as a MET. Materials and methods: We carried out a systematic search of the PubMed, EMBASE, and Web of Science databases, and the Cochrane Library, for relevant articles from inception to November 2020. Our aim was to identify placebo-controlled trails in which patients were randomized to receive either alpha-adrenergic blockers (tamsulosin, alfuzosin, doxazosin, terazosin, naftopidil, or silodosin) or a placebo for the treatment of ureteral calculi. Results: According to strict inclusion criteria, database searches identified 8 placebo-controlled studies that included 2284 patients. Generally, α-blockers had no significant effect on the clearance of stones in the urinary tract (risk ratio [RR] = 1.05; 95% confidence interval [CI] = 1.00–1.11). However, subgroup analysis showed that α-blockers were effective in treating distal urinary tract stones (RR = 1.08; 95% CI = 1.02–1.15). With regards to adverse events, our analysis showed that the combination of MET with α-blockers was likely to cause dizziness (RR = 1.37; 95% CI = 1.06–1.79) and retrograde ejaculation (RR = 3.10; 95% CI = 1.81–5.29). Conclusion: Although α-blockers cannot improve the overall ureteral stone clearance rate, these drugs are still effective for the treatment of stones in the distal urinary tract. However, the application of α-blockers is likely to cause dizziness and/or retrograde ejaculation.

AIM to compare the efficiency of monotherapy with -blockers vs combined therapy (-blockers in combination with Androgel) in patients with BPH and hypogonadism. MATERIALS AND METHODS a total of 60 men with BPH and hypogonadism, who were randomly selected from outpatient department were included in the study. All patients were divided into 2 groups (n=30). In Group 1 patients received silodosin, while in Group 2 men were prescribed to silodosin plus Androgel 1% topically. The duration of therapy was 6 months. The results of treatment were evaluated during baseline assessment and further visits every 2 months after starting therapy (total 4 time points). RESULTS according to the ICEF-5 questionnaire, in the Group 2 an improvement in sexual function domain score (from 6.3 to 26.8 points) was shown. In addition, in combination group there were significant changes in PSA level (from 2.25 to 1.8 ng/ml), prostate volume (from 55.1 to 61.3 cm3), residual urine volume (from 72 to 19 ml), urine flow rate (from 13.34 to 21.1 ml/s), waist circumference (from 116 to 103.2 cm) and body mass index (from 35.4 to 27.2 kg/m2), while in monotherapy group none of these indicators significantly improved. CONCLUSIONS the use of topical hormone replacement therapy in combination with -blockers in patients with BPH and concomitant hypogonadism is justified and effective in comparison with monotherapy with -blockers.

Objectives To evaluate the short-term efficacy and safety of two α1-adrenoceptor (AR) antagonists, tamsulosin and silodosin, in treating patients with untreated lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), with a focus on stool form. Methods This study was a non-blinded, open-label, prospective randomized comparative study. Tamsulosin or silodosin was administered to patients with untreated LUTS/BPH, and their efficacy and safety in the early stage of treatment were compared using the questionnaire of International Prostate Symptom Score (IPSS)/quality of life (QOL), the Gastrointestinal Symptom Rating Scale (GSRS), and the Bristol Stool Form Scale (BSFS). Results The per protocol set consisted of 22 patients in tamsulosin group (mean age, 70.15 ± 5.70 years) and 20 patients in silodosin group (73.00 ± 6.48 years). The total IPSS and QOL score improved within 2 weeks in both groups. Although the overall GSRS score showed no significant change in either group, "hard stools" score was significantly decreased in silodosin first at week 2, then in both groups at week 4. Furthermore, the subscale score for "constipation" was significantly decreased only in silodosin at week 4. BSFS was significantly increased at week 4 in silodosin alone. Conclusions This study suggests that silodosin was associated with increased digestive symptoms such as diarrhea and loose stools. Therefore, oral drugs for BPH need to be selected by taking into consideration the possibility of digestive symptoms including both the state and type of stools.

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.

As silodosin 8 mg, used for treating BPH, is known to cause absence of sperms in the ejaculate, its potential as an on-demand, reversible, nonhormonal oral contraceptive for males was assessed in this pilot study. In this randomized, double-blind, placebo-controlled pilot study, healthy, sexually active adult male volunteers in a stable sexual relationship with a female partner with proven fertility were recruited. Those using other contraceptive methods were excluded. During the first part of the study, silodosin 8 mg and placebo were crossed over among the randomly assigned two groups of participants and their post-masturbation semen and post-ejaculation urine were analyzed for spermatozoa. During the second part, both groups received silodosin 8 mg 3 h prior to heterosexual vaginal intercourse for 1 year. The primary outcome measure was the number of unintended pregnancies in their female partners. The secondary outcome measure was dropout rate due to adverse events. The clinical trial registry number was CTRI/2017/09/009872. The study period was January 2017 to December 2017 with sample size 63. Reversible azoospermia was noted following silodosin intake during the first part of the study. During the second part, no untended pregnancy was reported. None of the participants dropped out due to adverse events. Four patients were lost to follow-up. Silodosin 8 mg achieved total reversible azoospermia, hence prevented unintended pregnancies in the female partners of the males who used the drug as an on-demand oral contraceptive.

INTRODUCTION In this study an attempt was made to determine some reasons that prompted the urologist to make a choice in favor of particular drug or combination from a wide variety of available drugs. The prescribing habits and subjective evaluation of efficiency and safety of the drugs for the treatment of lower urinary tract symptoms/benign prostatic hyperplasia by the urologists in Russia was analyzed. MATERIALS AND METHODS a prospective multicenter epidemiological study "LUTS/BPH - who treats?" was carried out in 12 centers using data obtained from May 1 to July 31, 2018 with anonymous survey of 500 urologists living in 9 cities of the Russian Federation. The survey consisted of 46 questions reflecting a level of education, involvement in scientific life of urologic community, membership in various professional organizations, and subjective assessment of safety and efficiency of drugs used in Russian Federation for the treatment of urinary disorders. The obtained data was analyzed for a whole group and further in the subgroups. RESULTS Alpha-blockers are the most commonly prescribed drugs. These drugs constitute 63.4% of all appointments, followed by the 5-a-reductase inhibitors (23.98%) and combined therapy by the both drugs (24.68%). The most frequently used alpha-blocker is tamsulosin, but professors, MD and urologists, who read special literature at a regular basis, prescribed tamsulosin and silodosin equally. In primary cases and in patients with concomitant cardiac pathology, silodosin was prescribed more commonly in comparison with other alpha-blockers. CONCLUSION the results of the study indicate a concordance with global trends in the treatment of these patients. Our data reflect a significant influence of the level of education, work experience and involvement in scientific professional life of urologic community on the choice of a particular drug for the treatment of LUTS/BPH and prove the feasibility of further work which should be aimed at popularization of the modern medical knowledges among the urologists and organization of a process of continuous medical education.

Introduction: To determine the pre-treatment factors related to the improvement of overactive bladder (OAB) symptom after alpha-1 blocker monotherapy in patients with benign prostatic hyperplasia complicated by OAB (BPH/OAB). Methods: Post-hoc analysis of a prospective study in patients with BPH/OAB, randomized to receive silodosin 8 mg (n = 157) or naftopidil 75 mg (n = 157) treatment for 12 weeks, was performed. At 12 weeks post-administration, patients were divided into 2 groups (good responder [GR] group and poor responder [PR] group), according to the improvement in the OAB symptom score (OABSS). We compared the pre-administration parameters between both groups and evaluated the factors related to OAB improvement. Results: Of 314 patients, 159 patients (50.6%) were classified into the GR and 155 (49.4%) into the PR. International Prostate Symptom score, total OABSS, OABSS urgency-score, OABSS urgency urinary incontinence (UUI)-score, post-void residual urine volume (PVR), and selection rate of naftopidil were significantly higher in the PR than in the GR. On multivariate logistic regression analysis, larger PVR, higher OABSS-UUI-score, and the choice of naftopidil were significant risk factors for insufficient improvement of OAB symptoms. Conclusions: Pre-treatment PVR, UUI severity, and the choice of treatment agent are predicting factors related to OAB improvement after alpha-1 blocker monotherapy in patients with BPH/OAB.

Background: benign prostatic hyperplasia represents one of the main fields of urology. objective: aim of the study to verify the efficacy and safety of the alfa one adrenoreceptor blocker silodosin compared with tamsulosin in patients with lower urinary tract symptoms associated with bph. patients and methods: outcomes were assessed by change from baseline in ipss, quality of life (qol), qmax, pvr. responders to the treatments on the basis of ipss decrease ≥ 25% and qmax increase ≥ 30% were calculated. results: silodosin and tamsulosin significantly improved ipss total score in (p=0.625). both no statistically significant difference. improved qol (p

Benign prostatic hyperplasia/benign prostatic enlargement (BPH/BPE) is a common proliferative disease, and giving rise to associate with lower urinary tract symptoms (LUTS). However, the pathogenesis is not well clarified, and thought to be multifactorial. There are some lines of evidence that impairment in the blood supply of the lower urinary tract causes development of BPH/BPE. Clinical data showed an association between the development of BPH/BPE and atherosclerotic disease such as hypertension, diabetes and hyperlipidemia. The spontaneously hypertensive rat (SHR) has been used as model of genetic hypertension. SHR also shows decreased blood flow and hyperplastic morphological abnormalities in the ventral prostate. Our previous studies demonstrated that chronic treatment with vasodilative drugs nicorandil (ATP sensitive potassium channel opener) and silodosin (alpha1 adrenoceptor antagonist) increased blood flow and suppressed the growth factor and morphological abnormalities in the SHR ventral prostate. These data suggested that prostatic blood flow could be therapeutic targets for BPH/LUTS.

Objectives Our objective was to investigate the effectiveness and safety of silodosin in patients with benign prostatic hyperplasia (BPH) who switched to silodosin from another α1 blocker because of inadequate response. Methods This was a prospective observational study conducted at 715 medical facilities in Japan in patients with BPH who received an α1 blocker other than silodosin for at least 3 months but had experienced unsatisfactory treatment outcomes. Patients completed questionnaires, including the International Prostate Symptom Score (IPSS), quality of life (QOL) score and Overactive Bladder Symptom Score (OABSS) at baseline (time of switching) and after 3 months of treatment with silodosin. Results Overall, 3355 patients were assessed for safety and 3144 patients for effectiveness. Mean ± standard deviation age was 73.1 ± 8.2 years, and most patients had been receiving tamsulosin (53.6%) or naftopidil (45.5%) before silodosin. Silodosin was well tolerated, with an overall incidence of adverse drug reactions of 8.1% and no unexpected safety signals. Significant improvements were observed after switching to silodosin in all effectiveness outcome measures, including total IPSS, all IPSS subscale scores, QOL score, total OABSS, all OABSS subscale scores and residual urine volume. Significant improvements in total IPSS were seen in patients who had been receiving tamsulosin or naftopidil before switching and in almost all other patient subgroups, with the exception of patients with mild symptoms (total IPSS ≤ 7) at baseline. Conclusions This post-marketing analysis indicates that switching to silodosin from tamsulosin or naftopidil significantly improved symptoms associated with BPH, and silodosin was well tolerated in Japanese patients.

Aim. Comparative study of clinical effectiveness of doxazosin, tamsulosin and silodosin as monotherapy for patients with chronic non-inflammatory prostatitis. Methods. Outpatient medical records (OMR) of patients with the diagnosis of chronic non-inflammatory prostatitis who were treated in “The clinic of ambulatory urology” (Kazan) in 2012-2017, were analyzed: all 173 OMR of patients receiving doxazosin 1 mg QD for 30 days as monotherapy; all 150 OMR of patients receiving doxazosin 2 mg per day BID for 30 days as monotherapy; all 54 OMR of patients receiving doxazosin 4 mg per day BID for 30 days as monotherapy; all 77 OMR of patients receiving tamsulosin 0.4 mg QD for 30 days as monotherapy; all 36 OMR of patients receiving silodosin 8 mg QD for 30 days as monotherapy. Based on these OMR the “Clinical index of chronic prostatitis” (CI CP) was analyzed before the start of pharmacotherapy and 30 days after the beginning. According to the clinical index, the discrete sample was ordered containing the values of CI from 0 points (no complaints) to 50 points (maximal score - the most marked symptoms). Results. Before the beginning of the treatment every sample of patients is homogeneous and after 30-day treatment they lose homogeneity and tend to divide into several homogeneous samples. Conclusion. Clinical effectiveness of doxazosin, tamsulosin and silodosin in men with CNP varies in wide range, is poorly predictable, poorly explainable and needs further studies according to the principles of modern evidence-based medicine.

Purpose: To evaluate the correlation between silodosin and Intraoperative Floppy Iris Syndrome (IFIS) and compare it with other a1- adrenergic receptor antagonists (a1-ARAs) and other factors predisposing to IFIS.Methods: From the cases who underwent phacoemulsification between 2014 and 2020, we identified all patients who, during their preoperative assessment, reported an a1-ARAs intake (exposed group). These patients were matched utilizing a propensity score matching analysis, with an otherwise homogenous group of patients (control group), based on demographics and systemic/ocular comorbidities.Results: 350 patients were included in each group. In the exposed group, 177 (50.6%) patients were exposed to tamsulosin, 105 (30%) to alfuzosin, 43 (12.2%) to silodosin. Regarding IFIS, it was observed in 21.5% of patients on tamsulosin (38/177), 11.4% on alfuzosin (12/105), 37.2% on silodosin (16/43), and 3.4% in the controlled group (12/350). In a multiple regression model analysis, the only two factors that were significantly associated with IFIS development were silodosin and tamsulosin yielding an adjusted odds ratio of 8.471 (95%CI: 4.005-17.920), and 3.803 (95%CI: 2.231-6.485), respectively.Conclusion: Silodosin has been demonstrated as a predisposing factor, strongly correlated with IFIS development. These results should increase awareness to cataract surgeons, to carefully assess their patients preoperatively for exposure to silodosin, and employ the appropriate prophylactic measures to ameliorate the impact of silodosin intake on the surgical outcome.

Background:In men, lower urinary tract symptoms (LUTS) are associated with benign prostatichyperplasia (BPH). Therapeutic options aim to relax prostate smooth muscle and/or reduce prostate enlargement. Objectives:To evaluate the efficacy of Silodosin 8 mgalone versus the combinationof Tadalafil 5mg and Silodosin 4 mgfor treatment of LUTS related to BPH. Patients and methods: About 203 patients with LUTS of BPH who completed the study up protocolpresented to our department classified into two groups group A (101 patients) received Silodosin 8 mg, group B (102 patients) received the combination of Tadalafil 5mg and Silodosin 4 mg. All results recorded and analyzed with Statistical Package for Social Science® (SPSS) and Microsoft Excel 2010. Results: The IPSS, QOL, IIEF score, Q-max and PVR showed significantly greater improvement in the combination of Tadalafil 5mg with Silodosin 4mg than monotherapy of Silodosin 8mg. Conclusions:Despite Silodosin 8mg is well-tolerated and effective treatment option in men with LUTS of BPH, butthe combination of tadalafil 5m and Silodosin 4mg is more effective and feasible for these patients.

Background Intraoperative floppy iris syndrome is a variant of the small pupil syndrome that has been observed during cataract surgery in some patients currently or previously treated with α1 adrenergic blockers. It is important for cataract surgeons to predict the probable complications preoperatively. Our study aims to evaluate the static and dynamic pupil characteristics of patients treated with silodosin—a selective α1 adrenergic blocker—for benign prostate hypertrophy (BPH) and to compare these values with healthy subjects using an automatic quantitative pupillometry system. Methods A total of 74 BPH patients treated with silodosin for six months (group 1) and 30 healthy subjects (group 2) were enrolled in this prospective multidisciplinary cross-sectional study. Static and dynamic pupillometric measurements were obtained under optimized conditions, and the results were compared between the two groups. Results Seventy-four male patients with a mean age of 63,35 ± 7,21 (46–77) years with BPH treated with silodosin and 30 normal male subjects with a mean age of 63,07 ± 4,73 (52–71) years were analyzed. There were statistically significant differences between the groups with regard to scotopic pupil diameter (PD), high photopic PD, and low photopic PD (p Conclusion The static and dynamic pupil characteristics of subjects treated with silodosin for BPH are different from those of healthy eyes. In addition, our results may have shed light on the risk for intraoperative floppy iris syndrome (IFIS) before cataract surgery; thus, surgeons can be alert and take precautions.

Objective: Our study aimed to the efficacy of silodosin in patients with LUTS associated with BPH who were not-responder to previous ARs blocker therapy. Methods: Patients who did not benefit from alpha blockers treatment, but did not want surgical treatment are included in this study. At enrollment, 75 patients and 75 patients were assigned to group 1 and group 2, respectively. Group 1 received silodosin 8 mg, group 2 received their previous α blocker. Results: Although, in group 1 mean IPSS score at baseline was 20,81±0,97, and it significantly decreased to 17,12±1,25 at third months, in group 2 no significant changes were observed. On the other hand in group 1 a decrease was also observed for both IPSS sub score was significantly reduced at third months, when it is compared with baseline. At the end of the third month, a significant improvement in this parameter was observed after switching to silodosin, as compared with first value (p< 0,05). As to the residual urine, significant improvement was observed in the silodosin group but no significant improvement was observed in group 2. Conclusion: This study was conducted to investigate the effectiveness and safety of silodosin in patients with BPH who had not achieved satisfactory symptom control with other α blockers in routine clinical practice before surgical treatment. Thus, at least patients who have different comorbidities will be protected from morbidities of surgery.

OBJECTIVES To compare the effects of naftopidil and silodosin administration on the quality of life of patients with prostate cancer who underwent low-dose-rate brachytherapy. METHODS In total, 141 men diagnosed with localized prostate cancer who were treated with low-dose-rate brachytherapy were enrolled. Patients were randomized (1:1) to the naftopidil (75 mg/day, n = 63) or silodosin group (8 mg/day, n = 64). Naftopidil and silodosin were administered 1 day after low-dose-rate brachytherapy, and were continued for at least 3 months. Using the University of California at Los Angeles Prostate Cancer Index and Sexual Health Inventory for Men scores, the mean changes and rates of deterioration from baseline were compared. The deterioration rates in the quality of life of patients at 1 and 3 months after low-dose-rate brachytherapy were evaluated based on the minimal important difference. RESULTS The rates of deterioration from baseline to 1 and 3 months after low-dose-rate brachytherapy were not significantly different between the two groups in terms of urinary function, urinary bother, bowel bother, sexual function or Sexual Health Inventory for Men scores. In contrast, there were significant differences in bowel function (naftopidil 1 month, 52%; 3 months, 52%; silodosin 1 month, 28%; 3 months, 34%; 1 month, P

Background The main purpose of this study is to investigate the effect of silodosin on the urodynamic consequences in a previously established model of lower urinary tract symptoms associated with benign prostate hyperplasia, the spontaneously hypertensive rats (SHR) supplemented with testosterone. Methods Three groups of animals (8-week-old; n = 10/group) were considered: Wistar Kyoto (control) rats (WKY), SHR supplemented with testosterone at 3 mg/kg/day and treated with either vehicle (SHR-T, n = 10) or silodosin at 0.1 mg/kg/day (SHR-T + silodosin, n = 10) by oral gavage for 6 weeks. Cystometry experiments were performed. The bladder was harvested, weighed and paraffin-embedded for morphometric analysis. The prostate was also harvested and weighed. Results The number of animals included in the analysis were n = 10/10 for WKY and n = 7–8/10 for each SHR rats supplemented with testosterone group. SHR-T displayed a significant decrease in the intercontraction interval, infused volume and mean flow rate whereas the frequency of non-voiding contractions was increased. Silodosin improved the voiding behavior of SHR-T by significantly increasing the intercontraction interval, the infused volume and the mean flow rate and decreasing the number of non-voiding contractions. SHR-T displayed a significant increase in prostate and bladder weights and a 15% increase in the detrusor wall area compared to WKY. Conclusions Chronic silodosin treatment relieved storage symptoms in SHR supplemented with testosterone and decreased the frequency of non-voiding detrusor contractions during the filling phase.

Introduction: The efficacy of alpha-blockers as medical expulsive therapy (MET) is well established. However, it is not known which of the three most commonly used alpha-blockers (tamsulosin, alfuzosin and silodosin) is the most efficacious. With this study we aimed to assess the efficacy of the three commonly used alpha-blockers as MET for distal ureter stones. Materials and Methods: For this review, we searched multiple databases such as PubMed/Medline, Scopus, Embase, OviD SP, CINAHL, and web of science to identify all the relevant randomized studies comparing the efficacy of tamsulosin, alfuzosin, and silodosin. Preferred reporting items for systematic reviews for network meta-analysis (PRISMA-NMA) were followed while conducting this review and the study protocol was registered with PROSPERO (CRD42020175706). Results: In this review, 31 studies with 7077 patients were included. Compared to placebo all the treatment groups were more effective for both stone expulsion rate (SER) and stone expulsion time (SET). For both SER and SET, silodosin had the highest SUCRA (94.8 and 90.4) values followed by alfuzosin (58.8 and 64.9) and tamsulosin (46.2 and 44.5). The incidence of postural hypotension was similar with all the drugs, whereas, the incidence of retrograde ejaculation was significantly higher for silodosin. Overall confidence for each comparison group in this review ranged from “very low” to “moderate” according to the CINeMA approach. Conclusion: Among the three commonly used alpha-blockers silodosin is the most efficacious drug as MET for lower ureter stones followed by alfuzosin and tamsulosin.

Intraoperative floppy iris syndrome (IFIS) is described by three characteristics: floppy iris that billows in reaction to intraocular fluid currents during phacoemulsification surgery, flaccid iris stroma that tends to prolapse through well-constructed surgical incisions, and progressive pupillary miosis despite preoperative pharmacologic dilatation. A 63-year-old man presented with decreased vision in both his eyes. Ophthalmic examination revealed bilateral nuclear cataract. He was prescribed silodosin for the management of benign prostatic hyperplasia a month ago. Consecutive cataract surgery was planned at a 2-week time interval. All features of IFIS were encountered in both eyes of the patient during phacoemulsification surgery. IFIS was successfully managed by the aid of an iris retractor, and a 20/20 final visual acuity was achieved postoperatively in both eyes of the patient. To the best of our knowledge, this is the first study about bilateral IFIS associated with silodosin intake. Ophthalmologists and urologists prescribing silodosin should be aware of this possible association.

Background: Silodosin is a new high-selective α1A-adrenoceptors antagonist. A systematic review of literature and meta-analysis were performed to compare the clinical efficacy and safety outcomes of silodosin with placebo, tamsulosin, naftopidil and alfuzosin in treating benign prostatic hyperplasia (BPH) males with lower urinary tract symptoms (LUTS). Materials and Methods: We systematically searched literature among EMBASE, PubMed, Cochrane Library, ScienceDirect and Web of Science databases until April 2019. 18 related randomized controlled trials were included according to eligibility criteria. Random-effects model were applied for data analysis. Results: 5,985 patients were included in our study. Silodosin presented superiority to placebo in improving LUTS and better efficacy than tamsulosin and naftopidil in improving IPSS void subscore and post-void residual urine volume with statistically significance (all P values < 0.05). Greater QoL index improvement were found in silodosin than alfuzosin groups (MD = -0.44, 95%CI: [-0.83, -0.05], P = 0.03) while no differences in total IPSS score and Qmax changes between these two groups. Retrograde ejaculation was significantly frequent in silodosin than placebo, tamsulosin and naftopidil groups (all P values < 0.05). Besides, silodosin increased incidence of upper respiratory tract infection compared to tamsulosin groups (RR = 0.69, 95%CI: [0.50, 0.96], P = 0.03). A higher rate of nasal congestion (RR = 7.76, 95%CI: [1.80, 33.41], P = 0.006) were found in silodosin than placebo groups while no difference for nasopharyngitis ((RR = 1.16, 95%CI: [0.54, 2.47], P = 0.71). Prevalence of headache (RR = 0.54, 95%CI: [0.27, 1.06], P = 0.07) and postural hypotension (RR = 0.14, 95%CI: [0.03, 0.77], P = 0.02) were lower in silodosin than tamsulosin groups, although dizziness and vertigo was more frequent in silodosin than placebo (RR = 2.26, 95%CI: [1.21, 4.21], P = 0.009). Conclusions: Our study demonstrated silodosin’s possible superiority to placebo and naftopidil while noninferiority to tamsulosin and alfuzosin in LUTS improvement of BPH males. Better cardiovascular safety was in silodosin groups, although incidence of retrograde ejaculation and respiratory adverse events were higher.

Background Alpha-adrenergic antagonist treatment for benign prostatic hyperplasia (BPH) and drug-related sexual side effects are frequent in aging men. Aim To investigate functional changes in erectile and ejaculatory aspects of male sexuality under Silodosin 8 mg per day treatment for BPH. Methods Sexually active patients diagnosed with BPH and who initiated Silodosin treatment were the subjects of the study. The International Prostate Symptom Score, premature ejaculation patient profile (PEP-male) questionnaire, Sexual Health Inventory for Men (SHIM) questionnaire, and estimated intravaginal ejaculation latency time (IELT) values of the participants were used to evaluate sexual functions. Data evaluation was performed in 8 urology clinics retrospectively. Outcomes Participant ratings for SHIM, PEP, and estimated IELT were the primary outcome measures in the study. Results Among 187 recruited patients, data of 98 patients, who completed the trial period in the study, were eligible. The median age of the eligible participants who completed the trial period for 3 months was 59.5 years (range 45–82). 16 patients of 187 (8%) reported a desire for drug withdrawal for anejaculation during the recruitment period. 46 (46.9%) and 49 (50%) patients reported anejaculation in the first and third month of the treatment, respectively. De novo erectile dysfunction was noticed in 15 patients (15.3%). There was a significant increase in the estimated IELT of subjects in both the first (P = .01) and third (P = .002) month. SHIM-1 (P = .008), SHIM-total (P = .009), and PEP scores (P = .008) were also improved in the third month of the treatment. Neither baseline patient characteristics nor changes in the International Prostate Symptom Score after treatment predicted final outcomes with multivariable analysis. The subgroup analysis of participants who reported “anejaculation” also revealed better outcomes compared with participants ejaculating naturally in the third month as per SHIM ratings. Clinical Implications Despite several male patients having dry orgasms due to Silodosin-induced anejaculation, the majority experienced improved erectile function. Strengths & Limitations The present study demonstrated pioneering results while investigating both erectile and ejaculatory dimensions of the male sexual function during Silodosin treatment for BPH. However, lack of partner evaluation, low follow-up rates, and lack of knowledge about reasons why subjects are lost to follow-up after drug initiation have limited our interpretation. Conclusion Most patients using Silodosin 8 mg per day for BPH treatment experienced improvement in their erectile function, estimated IELT, and premature ejaculation profile in the third month of the treatment. Underlying mechanisms and reasons for individual differences necessitate further investigation.

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Context: International guidelines do not make any specific recommendations on Serenoa repens (SeR) for the treatment of male lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE), due to product heterogeneity and methodological limitations of the published trials and meta-analyses.Objective: We aimed to compare the clinical efficacy of hexanic extract of SeR (HESr) versus non-HESr (nHESr) versus placebo versus alpha-blockers (ABs) in patients affected by LUTS secondary to BPE through a network meta-analysis method.Evidence acquisition: The search was conducted until December 31, 2018 using Medline, Scopus, and Web of Science databases without restriction. We included randomized controlled trials (RCTs) with at least one comparison between SeR, ABs, or placebo for the treatment of LUTS/BPE. Outcomes of the study were the mean change in the International Prostate Symptom Score (IPSS) and peak flow (PF). This systematic review has been registered on PROSPERO (CRD42018084360).Evidence synthesis: In total, 2115 articles were identified. After the global assessment, 22 RCTs matched with the inclusion criteria, including 8564 patients. For IPSS, the mean efficacies against placebo were +0.48 and -1.69 for HESr and nHESr, respectively, at 3 mo; 0.59 for nHESr at 6 mo; and -1.31 and -3.30 for nHESrand HESr, respectively, at 12 mo. For PF, the mean efficacies against placebo were +0.53 and +2.82 for HESr and nHESr, respectively, at 3 mo; +1.85 for nHESrat 6 mo; and +4.05 and +5.52 for HESrand nHESr, respectively, at 12 mo. Based on the surface under the cumulative ranking curve rankograms, terazosin showed the highest score (99.6%), whilealfuzosin, tamsulosin, silodosin, HESr, and nHESr showedscores of 53.7%, 42.3%, 68.5%, 36.7%, and 47.3%, respectively.Conclusions: In this network meta-analysis, we demonstrated that SeR did not show clinically meaningful improvement in LUTS and PF.Patient summary: In the present study, we found no clinically meaningful improvement of Serenoa repens for the treatment of lower urinary tract symptoms/benign prostatic enlargement. The analysis showed that the benefit over placebo was minimal and may not justify its clinical use before higher level of evidence will be available. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Silodosin is a selective alpha-1 adrenergic receptor antagonist approved for the treatment of lower urinary tract symptoms associated with benign prostatic hypertrophy. Adverse events include retrograde ejaculation, dizziness, diarrhea, vasodilator symptoms, and postural hypotension. Skin adverse reactions to silodosin such as eruption, purpura, and jaundice are uncommon. This article reports a case of unusual silodosin-related skin rash, Naranjo score 5, which regressed after applying combined intense pulsed light (IPL)/fractional CO2 laser/chemical treatments and drug interruption. Level of evidence: Level V, risk/prognostic.

OBJECTIVE To assess the efficacy of silodosin as second-line α-blocker monotherapy in patients with lower urinary tract symptoms as a result of benign prostatic hyperplasia. METHODS Men who were given an α-blocker other than silodosin for ≥8 weeks, aged ≥50 years, had a total International Prostate Symptom Score ≥13 and quality of life index ≥4 were enrolled. After treatment with 8 mg/day silodosin for 8 weeks, symptoms and treatment satisfaction were assessed. If the patients still complained and hoped for readministration of the first-line α-blocker, the previous medication was administered again for 8 weeks in the case of persisting symptoms, and efficacy was again evaluated. RESULTS A total of 73 patients were enrolled and analyzed at 8 weeks. Silodosin administration significantly improved the International Prostate Symptom Score and Overactive Bladder Symptom Score. The quality of life index was improved by at least 1 point in 49.3% patients, and its mean change was significantly greater in the group with previous naftopidil treatment than in those with tamsulosin. A total of 59 patients hoped to continue silodosin, and 13 requested administration of the first-line α-blocker. Previously taking naftopidil and having a shorter duration of prior α-blocker treatment at baseline were associated with silodosin continuation. Although prior α-blocker readministration in the 13 patients did not show significant efficacy, six preferred to continue the previous α-blocker. CONCLUSIONS Silodosin represents an effective second-line α-blocker monotherapy, even in those who still have moderate lower urinary tract symptoms.

Prostatitis is one of the most frequent urology diseases of men of reproductive age. Recommendations for rational pharmacotherapy prostatitis are included into the State Formulary of Medicines, which is reviewed and updated annually. Thus, the aim of our work was to study the dynamics of the assortment of prostate protectors.The State Formulary of Medicines of 1–9 issues and the State Register of Medicines of Ukraine dated 01. 08. 2017 were the materials of the research. The methods of search, content analysis, statistics, comparison and generalization were applied. It was established that the first, second and third issues of State Formulary of Medicines include three therapeutic and chemical subgroups of prostate protectors: alpha-adrenergic receptors antagonists (G04CA), testosterone-5-alpha reductase inhibitors (G04CB), other drugs used in benign prostatic hypertrophy (G04CX). And since the fourth issue – only the first two subgroups of prostate protectors were icnluded. Assortment prostate protectors was stabilized in State Formulary of Medicines of 8, 9 issues. Depth of assortment of the State Formulary of Medicines of the ninth issue is 55,8% in comparison with the State Register of Medicines of Ukraine along with 100% index for prostate protectors trade names based on alfuzosin, terazosin (G04CA – Аntagonists of alpha adrenergic receptors), finasteride and dutasteride (G04CB – Inhibitors of testosterone-5-alpha reductase), as well as the absence of drugs based on silodosin, dutasteride-tamsulosin, solifenacin-tamsulosin (G04CA – Antagonists of alpha-adrenergic receptors) and prostate protectors with G04CX – Other drugs used in benign prostatic hypertrophy.

Background: Benign prostatic hyperplasia (BPH) is a noncancerous increase of the size of the prostate gland. The two main medication classes for BPH management are alpha blockers and 5α -reductase inhibitors .Urinary bladder stones account for 5% of all urinary stone disease. Lithotripsy with the holmium: YAG laser started with making small perforations on the stone surface. the laser fiber should be moved over the surface of the stone vaporizing the stone rather than fragmenting it till fragments become small enough to pass spontaneously or can be safely retrieved. The aim: This study was conducted to investigate the outcomes of Cystolithotripsy with medical Treatment for Benign Prostatic Hyperplasia as an option for treatment of Patients with Bladder Stone and Benign Prostatic Hyperplasia. Methods: prospective short term cohort study. 44 Patients with urinary bladder stone and benign prostatic hyperplasia BPH who are programmed for endoscopic removal of bladder stone with subsequent medical management of BPH, including alpha-blocker (Silodosin 8mg).from January 2017 – June 2017. All laboratory investigation within normal level no renal Hydronephrosis detected by radiological imaging and no malignancy in urinary bladder. Results: In our study shows significant improvement in IPSS which started 17.89±2.35 preoperative to 8.48±0.84 after six months, also significant improvement in PVR which started 90.62±.13.30 Before operation to become 27.27±14.3 After operation and lastly significant improvement in Q-max which started 11.93±1.64 Before operation to become 16.46±0.77 after six month. Conclusion: Medical treatment of benign prostatic hyperplasia after endoscopic removal of bladder stone is an appropriate option for managing patients with bladder stone and benign prostatic hyperplasia. Lithotripsy with Holmium: YAG laser is an appropriate line in management of bladder stone associated with Benign prostatic hyperplasia. Key words. Holmium YAG laser, cystolithotripsy, Benign prostatic hyperplasia, alpha- blocker.

OBJECTIVE: To determine the impact of physicians’ financial relationships with the pharmaceutical industry on prescribing marketed alpha-blockers and overactive bladder 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 overactive bladder (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 (OR 34.1); fesoterodine (OR 5.9); solifenacin (OR 2.7); and mirabegron (OR 6.8) (all p

Aims We investigated the effects of silodosin, an α1A-adrenoceptor (AR) antagonist, on bladder function, especially on non-voiding contractions (NVCs), in a male rat model of bladder outlet obstruction (BOO) by evaluating cystometry (CMG) findings and bladder mechanosensitive single-unit afferent activities (SAAs), related with microcontractions, which may be similar with NVCs and to be of myogenic origin, in the rat model. Methods BOO was created by partial ligation of the posterior urethra. At 4 days after surgery for BOO, an osmotic pump filled with silodosin (0.12 mg/kg/day) or its vehicle was subcutaneously implanted. At 10 days after surgery, CMG and SAAs measurements were taken under conscious and urethane-anesthetized conditions, respectively. The SAAs of Aδ- and C-fibers, which were identified by electrical stimulation of the pelvic nerve and by bladder distention, and intravesical pressure were recorded during constant bladder-filling with saline. Microcontractions were divided into three phases: "ascending," "descending," and "stationary." Results The silodosin-treated group showed a smaller number of NVCs in CMG measurements and lower SAAs of both Aδ- and C-fibers than the vehicle-treated group during bladder-filling. Moreover, in the vehicle-treated groups, the SAAs of both fibers for the ascending phase of microcontractions were significantly higher than those for the other two phases. On the contrary, no significant change was found between any of these three phases in the silodosin-treated group. Conclusion The present results suggest that silodosin inhibits the SAAs of mechanosensitive Aδ- and C-fibers at least partly due to suppressing myogenic bladder contractions in male BOO rats.

Objective: Benign prostatic hyperplasia (BPH) is a nonmalignant enlargement of the prostate associated with aging. BPH can cause lower urinary tract syndrome (LUTS). Medical therapy for patients with moderate and severe LUTS symptoms comprises a-1 adrenergic receptor antagonists. This study aimed to determine whether there are differences in the international prostate symptom score (IPSS) and maximal flow rate (Qmax) of patients with BPH receiving either silodosin or tamsulosin over 12 w. Methods: This study was a double-blind randomized clinical trial. Subjects were 50 men aged ³ 50 y diagnosed with BPH with an IPSS ³ 8 at the Gatot Soebroto Indonesian Army Hospital. The participants received either silodosin or tamsulosin. Their IPSS and Qmax were assessed at the initial assessment and after 4, 8, and 12 w of treatment. Results: The initial median IPSS was 15 in the tamsulosin group and 17 in the silodosin group (P = 0.808). After 12 w of therapy, the median IPSS decreased to 9 in the tamsulosin group and 10 in the silodosin group (P = 0.186). The initial median Qmax was 10.1 ml/s in the tamsulosin group and 10.9 ml/s in the silodosin group (P = 0.290). After 12 w of therapy, the median Qmax increased to 12.1 ml/s in the tamsulosin group and 11.9 ml/s in the silodosin group (P = 0.969). Although the differences between groups were not significant, the initial and 12-week IPSS and Qmax values differed significantly within each group. Conclusion: There were no significant between-group differences in the IPSS or Qmax after 12 w of therapy. However, both silodosin and tamsulosin produced significant differences between initial and 12-week assessments of IPSS and Qmax.

Objective: To review the literature for α-blocker treatment of kidney stones. Data Sources: PubMed search performed November 15, 2017, using the following search terms: alpha-blocker, alfuzosin, silodosin, or tamsulosin AND kidney or ureteral stones. Additional studies found through references of primary and tertiary literature. Inclusion criteria included English language, randomized controlled trials (not included in meta-analyses), and meta-analyses evaluating US available alpha-blockers as medical expulsive therapy with or without lithotripsy in adults with renal or ureteral stones, and no date limits. Study Selection and Data Extraction: Seven randomized controlled trials (RCTs), 1 case-control trial, and 6 meta-analyses were found and included in this review. Two RCTs and 4 meta-analyses evaluated alpha-blockers without lithotripsy. Five RCTs, 1 case-control trial, and 2 meta-analyses evaluated their use post-lithotripsy. The primary endpoint was stone clearance rate in most studies. Data Synthesis: For ureteral stones ≤10 mm treated without lithotripsy, alpha-blockers increased clearance in all meta-analyses and one RCT versus control. For ureteral or renal stones treated with lithotripsy, 4 RCTs and all meta-analyses found benefit with alpha-blockers compared with control. When results were stratified by stone size, alpha-blockers performed better for stones 10 to 20 mm, while there was no difference for stones 10 mm. They can be considered post-lithotripsy for stones 5 to 10 mm, but little benefit may be seen. Although all uroselective alpha-blockers have been found to be effective, most data are with tamsulosin 0.4 mg daily.

Background Holmium laser enucleation of the prostate (HoLEP) is an effective, size independent procedure for management of benign prostatic hyperplasia (BPH). 1 Additionally, HoLEP is able to be performed successfully after prior surgical BPH treatments without complication and a low rate of long term retreatment. 2 Objectives To demonstrate challenging case of HoLEP in a patient with multiple, prior ablative BPH surgeries. Material A 63 year old male with refractory lower urinary tract symptoms after 2 focal laser ablations, one Rezum treatment, and medications (silodosin 8 mg and tadalfil 5 mg) presented to our clinic with obstructive lateral lobe BPH. The prostate was approximately 50 ml on digital rectal exam and preoperative cystoscopy demonstrated prostatic urethral calcifications and lateral lobe hypertrophy. Preoperative AUA symptom score (AUAss) was 12, peak urinary flow was 5.3 ml/s. A HoLEP was performed to alleviate the patients lower urinary tract symptoms and allow him to stop his medications. Results Total procedure time was 44 minutes, with enucleation time of 20 minutes and morcellation time of 1 minute. The HoLEP was started as a 2-cut technique, however due to poor surgical planes we changed to top-down technique. 3 There was a small, posterior, nonclinically significant capsular perforation. Five grams of benign adenoma were removed. Patient was discharged on the day of surgery. Catheter was removed on postoperative day four due to patient desiring to return home (over 150 miles away) for catheter removal, instead of having it done in our clinic on postoperative day one. At most recent follow-up, AUAss was 5 and peak urinary flow was 13.2 ml/s. Conclusion HoLEP can be performed after prior, multiple BPH treatments successfully. These can prove to be more challenging cases. Prior ablative techniques can lead to fibrosis of transition zone tissue and distort the natural plane between adenoma and surgical capsule.

We compared the effects on lower urinary tract symptoms and bladder outlet obstruction of combination therapy with α1-blocker and 5α-reductase inhibitor or a switch to 5α-reductase inhibitor monotherapy. We determined the factors influencing changes in lower urinary tract symptoms after α1-blocker withdrawal.A total of 140 outpatients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia received combination therapy with silodosin 8 mg per day and dutasteride 0.5 mg per day for 12 months. Of the patients 132 were randomized to continue combination therapy or switched to dutasteride monotherapy through silodosin withdrawal as the monotherapy group. Parameter changes from before randomization to 12 months after randomization were assessed based on subjective symptoms and urodynamic findings of voiding and storage function.Efficacy analysis included 57 patients on combination therapy and 60 on monotherapy. The change in I-PSS (International Prostate Symptom Score) after randomization was -0.7 and -0.6 in the combination therapy and monotherapy groups, respectively. The bladder outlet obstruction index changed from 46.1 to 41.8 in the combination therapy group and from 42.9 to 39.9 in the monotherapy group. No significant differences in subjective symptoms and bladder outlet obstruction were observed between the 2 groups. However, storage function decreased in the monotherapy group and lower urinary tract symptoms deteriorated significantly after the switch to dutasteride monotherapy in patients with a higher body mass index.We found that α1-blocker withdrawal from combination therapy was reasonable and tolerable with regard to the effect on lower urinary tract symptoms and bladder outlet obstruction. However, withdrawal must be performed carefully in patients with a high body mass index.

Background Both hypertension and lower urinary tract symptoms (LUTS) are common conditions in the elderly population. This study investigated the efficacy and safety of silodosin in the treatment of LUTS in elderly men who were taking antihypertensive medications. Methods This is an observational study which collected the medical records of patients who started silodosin medication for their LUTS between April 2015 and December 2015. Inclusion criteria were age ≥ 65 years, currently taking antihypertensive medication, and International Prostate Symptom Score (IPSS) ≥ 8. Pretreatment evaluation included IPSS, Male Sexual Health Questionnaire, systemic symptoms, blood pressure, and uroflowmetry. Post-treatment evaluation was performed 3 months after the initial administration of silodosin medication. Results Mean age of the total 48 patients was 70.7 ± 5.2 years. Thirty-two (66.7%) patients who continued silodosin single treatment showed a significant decrease in IPSS Quality of life scores (4.2 ± 1.1 vs. 3.0 ± 1.6, P = 0.001) and an increase in the maximum flow rate (10.7 ± 6.0 mL/s vs. 14.0 ± 4.5 mL/s, P = 0.001). Blood pressures did not change, and none of the patients needed to adjust their antihypertensive medication. New development of orthostatic hypotension was observed in one (2.5%) patient. Among the six patients who had orthostatic hypotension before silodosin treatment, none of the patients showed symptom aggravation. Ejaculatory dysfunction that required discontinuation of silodosin medication developed in only one (2.5%) patient. Conclusion Silodosin is an effective and safe agent in elderly men who are taking antihypertensive medications. Silodosin has an advantage in the treatment of LUTS in this population, even if the patients have orthostatic hypotension before treatment.

Objective To evaluate the efficacy and safety of add-on therapy with the phosphodiesterase type 5 inhibitor tadalafil for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH) treated with the α1-adrenoceptor blocker silodosin. Materials and Methods We analyzed 103 patients with LUTS/BPH with an International Prostate Symptom Score (IPSS) of >8 after ≥4 weeks of silodosin treatment from April 2016 through December 2016 at Kori Hospital. The patients subsequently received silodosin 4.0 mg twice daily (monotherapy group) or silodosin 4.0 mg twice daily plus tadalafil 5.0 mg once daily (add-on therapy group) for 8 weeks. We assessed adverse events and evaluated the mean change from baseline to 8 weeks in the IPSS, Overactive Bladder Symptom Score (OABSS), maximum urine flow rate (Qmax), and post-void residual urine volume. Results Of 103 patients, 101 (98.1%) could continue medical treatment. The IPSS, OABSS, and Qmax showed significantly greater improvement in the add-on therapy than in the monotherapy group (−3.92 vs −1.24, −1.18 vs 0.10, and 1.09 vs −1.04, respectively; all P Conclusion Add-on therapy with tadalafil may be effective for patients with LUTS/BPH resistant to silodosin monotherapy.