Search

Purpose: Tamsulosin is formulated as sustained release beads within a capsule to prevent rapid absorption and associated hypotension. The package insert advises the capsule is swallowed whole; not crushed, chewed, or opened. To our knowledge, there are no current data on opening capsules for adults with enteral tube feeds. Given the unidentified safety and efficacy of administration via enteral tubes, alternative alpha blockers with less selectivity for alpha1A are often used. Methods: A single center retrospective chart review was conducted at two hospital sites. Adult patients that received at least one dose of tamsulosin or doxazosin while an enteral feeding tube was placed were included. Safety outcomes evaluated were the number of documented tube obstructions and incidence of medication associated hypotension. Results: 169 patients were included. Ten enteral feeding tube obstructions were reported, 4 of 110 (3.64%) in the tamsulosin arm and 6 of 59 (10.17%) in the doxazosin arm (RR.36, 95% CI.11 to 1.22, P =.099). At least 1 episode of medication associated hypotension occurred in 22 of 98 (22.45%) in the tamsulosin arm and 20 of 49 (40.82%) in the doxazosin arm (RR.55, 95% CI.33 to.91, P =.019). Conclusion: There was no statistically significant difference in the number of tube obstructions between patients receiving tamsulosin or doxazosin via enteral tube feeds. Patients receiving doxazosin were at increased risk of experiencing medication related hypotension. Tamsulosin capsules may be opened and administered via enteral feeding tubes if administered with content integrity intact. [ABSTRACT FROM AUTHOR]

Background: Alpha-1 adrenergic receptor antagonists (α1-ARAs) are frequently used in treatment of Hypertension and symptomatic benign prostatic hypertrophy (BPH). Numerous studies have demonstrated the association between α1-ARAs like Tamsulosin and increased surgical risks for patients undergoing cataract surgery. This study aims to identify and study the effects of α1-ARAs on iris parameters and the subsequent operative challenges encountered during cataract surgery. Methods: A cross-sectional, prospective study involving 30 patients on α1-ARAs planned for cataract surgery and equal number of age and sex matched controls were subjected to evaluation of changes on iris parameters and subsequent challenges in cataract surgery. Results: The study group had statistically significant lesser pupil diameter. Iris thickness at sphincter muscle region (SMR) was similar between groups (P = 0.53). Significantly lower values of iris thickness at dilator muscle region (DMR) found in treated subjects (P = < 0.001). There was statistically significant difference between DMR/SMR ratio of two groups (P < 0.001). Multiple regression analysis revealed longer duration of α1-ARAs treatment correlated with reduced DMR/SMR ratio (P = 0.001; r = 0.47). Conclusion: α1-ARAs have implications for pupil size regulation and surgical procedures involving the eye. Tamsulosin is more potent than alfuzosin in inducing IFIS. Systemic α1-ARAs lower values of DMR thickness, DMR/SMR ratio and reduces pupillary diameter. Therefore, ophthalmologists, primary care physicians, urologists, and patients should be aware of the potential difficulties that these drugs pose for cataract surgery. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a pervasive global health concern, with acute decompensated heart failure (ADHF) contributing significantly to morbidity and mortality. Medications used in patients with HF may exacerbate HF or prolong the QT interval, posing additional risks. Objective: The objective is to assess the prevalence and utilization patterns of medications known to cause or exacerbate HF and prolong the QT interval among patients with ADHF. Understanding these patterns is crucial for optimizing patient care and minimizing potential risks. Methods: A retrospective chart review was conducted at Huntsville Hospital, Huntsville, USA, covering 602 patients with ADHF over a 40-month period. Inclusion criteria involved age ≥ 18 years, a history of HF, and ADHF admission. The 2016 American Heart Association Scientific Statement was used to identify drugs that may cause or exacerbate HF and those that could prolong the QT interval Results: Among the 602 patients, 57.3% received medications causing or exacerbating HF, notably albuterol (34.9%) and diabetes medications (20.4%), primarily metformin, followed by urologic agents (14.3%), mostly tamsulosin, and nonsteroidal anti-inflammatory drugs (NSAIDs) (6.1%). Moreover, 82.9% were on medications prolonging the QT interval, with loop diuretics, amiodarone, ondansetron, and famotidine most prevalent. Furthermore, 42.1% of the patients received more than two concomitant medications that prolong the QT interval, which can further exacerbate the risk of torsades de pointes. Conclusion: This study underscores the high prevalence of HF-causing or HF-exacerbating medications and QT-prolonging drugs in patients with ADHF. Healthcare professionals must be cognizant of these patterns, advocating for safer prescribing practices to optimize patient outcomes and reduce the burden of HF-related hospitalizations. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to determine the typical clearance and volume of distribution values of tamsulosin in patients with benign prostatic hyperplasia (BPH), and to identify factors with a measurable impact on the drug's elimination. Methods: This open-label, single-arm population pharmacokinetic study involved 65 adult men with BPH who had been on tamsulosin therapy for at least seven days. The steady-state serum concentrations of tamsulosin were measured using liquid chromatography-tandem quadrupole mass spectrometry. Population pharmacokinetic parameters, their variability, and influencing factors were estimated based on a two-compartment pharmacokinetic model using NONMEM software. Results: The estimated tamsulosin clearance in BPH patients was 0.719 L/h, and the steady-state volume of distribution was 32 L. Neither renal nor liver function parameters had a statistically significant effect on tamsulosin clearance. However, a positive correlation was observed between hemoglobin levels and tamsulosin clearance in the BPH patient cohort. Conclusion: Our investigation reveals significant associations between tamsulosin pharmacokinetics and specific characteristics of patients with lower urinary tract symptoms (LUTS) due to BPH. The study highlights that tamsulosin clearance is associated with hemoglobin levels in patients with LUTS/BPH. This study underscores the importance of considering patient-specific factors when managing BPH treatment with tamsulosin, emphasizing associations rather than causative relationships. [ABSTRACT FROM AUTHOR]

Chronic coronary artery stenosis can lead to regional myocardial dysfunction in the absence of myocardial infarction by repetitive stunning, hibernation or both. The molecular mechanisms underlying repetitive stunning‐associated myocardial dysfunction are not clear. We used non‐targeted metabolomics to elucidate responses to chronically stunned myocardium in a canine model with and without β‐adrenergic blockade treatment. After development of left ventricular systolic dysfunction induced by ameroid constrictors on the coronary arteries, animals were randomized to 3 months of placebo, metoprolol or carvedilol. We compared these two β‐blockers with their different β‐adrenergic selectivities on myocardial function, perfusion and metabolic pathways involved in tissue undergoing chronic stunning. Control animals underwent sham surgery. Dysfunction in stunned myocardium was associated with reduced fatty acid oxidation and enhanced ketogenic amino acid metabolism, together with alterations in mitochondrial membrane phospholipid composition. These changes were consistent with impaired mitochondrial function and were linked to reduced nitric oxide and peroxisome proliferator‐activated receptor signalling, resulting in a decline in adenosine monophosphate‐activated protein kinase. Mitochondrial changes were ameliorated by carvedilol more than metoprolol, and improvement was linked to nitric oxide and possibly hydrogen sulphide signalling. In summary, repetitive myocardial stunning commonly seen in chronic multivessel coronary artery disease is associated with adverse metabolic remodelling linked to mitochondrial dysfunction and specific signalling pathways. These changes are reversed by β‐blockers, with the non‐selective inhibitor having a more favourable impact. This is the first investigation to demonstrate that β‐blockade‐associated improvement of ventricular function in chronic myocardial stunning is associated with restoration of mitochondrial function. Key points: The mechanisms responsible for the metabolic changes associated with repetitive myocardial stunning seen in chronic multivessel coronary artery disease have not been fully investigated.In a canine model of repetitive myocardial stunning, we showed that carvedilol, a non‐selective β‐receptor blocker, ameliorated adverse metabolic remodelling compared to metoprolol, a selective β1‐receptor blocker, by improving nitric oxide synthase and adenosine monophosphate protein kinase function, enhancing calcium/calmodulin‐dependent protein kinase, probably increasing hydrogen sulphide, and suppressing cyclic‐adenosine monophosphate signalling.Mitochondrial fatty acid oxidation alterations were ameliorated by carvedilol to a larger extent than metoprolol; this improvement was linked to nitric oxide and possibly hydrogen sulphide signalling.Both β‐blockers improved the cardiac energy imbalance by reducing metabolites in ketogenic amino acid and nucleotide metabolism.These results elucidated why metabolic remodelling with carvedilol is preferable to metoprolol when treating chronic ischaemic left ventricular systolic dysfunction caused by repetitive myocardial stunning. [ABSTRACT FROM AUTHOR]

Background Recent studies suggest that 5α-reductase inhibitors (5ARIs) for benign prostate hyperplasia (BPH) result in abnormal retinal anatomical alteration. Objective To compare age-related macular degeneration (AMD) incidence in BPH patients receiving 5ARIs or tamsulosin. Design Retrospective, population-based cohort study using new-user and active-comparator design. Setting General population. Subjects Males with BPH, newly receiving 5ARIs or tamsulosin from 2010 to 2018. Methods Data were extracted from Taiwan's National Health Insurance Research Database. We used Cox proportional hazards model with 1:4 propensity score (PS) matching, based on intention-to-treat analysis to determine the risk of incident AMD. Sensitivity analyses included an as-treated approach and weighting-based PS methods. We also separately reported the risks of incident AMD in patients receiving finasteride and dutasteride to determine risk differences among different 5ARIs. Results We included 13 586 5ARIs users (mean age: 69 years) and 54 344 tamsulosin users (mean age: 68.37 years). After a mean follow-up of 3.7 years, no differences were observed in the risk of incident AMD between 5ARIs and tamsulosin users [hazard ratio (HR): 1.06; 95% confidence intervals (95% CI): 0.98–1.15], with similar results from sensitivity analyses. However, increased risk of incident age-related macular degeneration was observed in patients receiving dutasteride [HR: 1.13; 95% CI: 1.02–1.25], but not in those receiving finasteride [HR: 0.99; 95% CI: 0.87–1.12], in the subgroup analyses. Conclusions We found no difference between 5ARIs and tamsulosin regarding the incidence of AMD in BPH patients. However, the risk profiles for AMD differed slightly between dutasteride and finasteride, suggesting that the potency of androgen inhibition is a factor related to AMD incidence. [ABSTRACT FROM AUTHOR]

The effect of changes in bladder volume on the caliber of adjacent veins is underappreciated but essential to recognize to avoid complications such as unnecessary stenting or clot migration causing pulmonary embolism. Here the authors illustrate the importance of this finding in 3 cases using venographic and endovascular sonographic imaging: the first in which BPH-induced chronic bladder outlet obstruction resulted in DVT formation, the second in which the cause was unrecognized and unnecessary stenting performed, and the third in which inappropriate treatment was avoided by decompressing the bladder. [ABSTRACT FROM AUTHOR]

Neurogenic lower urinary tract dysfunction (NLUTD) encompasses a broad spectrum of neurological conditions affecting the lower urinary tract. Managing NLUTD requires a tailored approach focused on preserving kidney function and enhancing patients' quality of life. Clinical guidelines provide valuable guidance for healthcare professionals, but discrepancies in recommendations arise among other factors due to limited high-quality clinical evidence. Prominent guidelines from organisations like the International Consultation of Incontinence, the European Association of Urology, the American Urological Association, and the National Institute for Health and Care Excellence offer varying recommendations for NLUTD management. This study reviews and summarizes the recommendations for conservative, pharmacological, and surgical management options across these guidelines. [ABSTRACT FROM AUTHOR]

Objective: This systematic review was done to critically appraise the various evidence available in the literature for the presenting symptoms, diagnosis, and management modalities for primary bladder neck obstruction diagnosed on invasive urodynamics in young adult men 18-50 years of age. Methods: A search was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials databases until July 2022 to find English-language studies relevant to the topic. Results: A total of 10 studies were included. The estimated difference in International Prostate Symptom Score between baseline and 3 months in the subgroup of medical and surgical treatment was found to be -8.82 and -11.25, respectively (P = .37), and after 12 months, it was found to be -7.69 and -17.70 respectively (P < .001). The pooled estimate for the difference in Qmax between baseline and 3 months after medical and surgical treatments in the subgroup was found to be 2.92 and 7.03, respectively (P = .18), and after 12 months, it was found to be 4.54 and 7.74, respectively (P < .001). The pooled estimate of the difference in post-void residue before and after 3 months of medical and surgical treatments in a subgroup was found to be -31.15 and -70, respectively (P < .001), and after 12 months, it was found to be -31.49 and -156.00, respectively (P < .001). Quality of life scores improved in both subgroups. Conclusion: The alpha-blockers are effective in managing primary bladder neck obstruction in the short term, while bladder neck incision is preferred for better longterm outcomes. [ABSTRACT FROM AUTHOR]

Chronic prostatitis, which frequently manifests with perineal or urethral ulcers, can have substantial impact on the quality of life experienced by affected individuals. Present treatment approaches primarily target the alleviation of symptoms and control of complications. In patients with chronic prostatitis, this investigation examined the potential synergistic effects of tamsulosin and levofloxacin on urinary function and urethral and perineal wounds healing. This cross‐sectional observational study was carried out at Chongqing Western Hospital, China, from February to November 2023. The participants comprised 88 males aged 40–75 years who had been clinically diagnosed with chronic prostatitis and complications that accompany the wound healing process. The participants were equally distributed into two groups: one assigned to the treatment group, which received a daily combination of levofloxacin (500 mg) and tamsulosin (0.4 mg) and other to receive conventional care. The wound healing rate and improvement in urinary function were the primary outcomes evaluated monthly for 9 months. Patient satisfaction and symptom amelioration were secondary outcomes, in addition to the surveillance of adverse effects. In comparison to the control, treatment group exhibited significantly higher rate of wound closure (78.08% at 1 month and 79.38% at 9 months) and urinary function improvement (66.69% at 1 month and 67.95% at 9 months). In addition, the treatment group exhibited a greater degree of symptom amelioration; however, a rise in adverse effects was observed. In every domain, patient satisfaction scores were significantly higher in the treatment group. Thus the combination of tamsulosin and levofloxacin improved urinary function and wound repair in patients with chronic prostatitis, while also exhibiting tolerable profile of adverse effects. [ABSTRACT FROM AUTHOR]

BACKGROUND Ureteral stones are a common urological condition causing significant discomfort and morbidity. Medical expulsive therapy (MET) is a noninvasive approach to facilitate the passage of stones. This study aimed to compare the efficacy and safety of silodosin and tamsulosin as MET in patients with distal ureteral stones (DUS). METHODS We searched CINAHL, Cochrane Library, PubMed, and ScienceDirect for randomized controlled trials (RCTs) on the administration of silodosin and tamsulosin for DUS. The primary outcomes analyzed were stone expulsion rates and expulsion times, measured as risk ratio (RR) and mean difference (MD), respectively. Statistical analyses were performed using Review Manager 5.4 and STATA 17. RESULTS 14 RCTs comprising 1,535 patients (770 received silodosin) met the inclusion criteria. The silodosin group had notably higher stone expulsion rates (RR 1.20, 95% confidence interval [CI] 1.13-1.27, p<0.00001, I² = 37%), shorter expulsion times (MD -2.98, 95% CI -4.35-1.62, p<0.01, I² = 85%), and fewer colicky pain episodes (MD -0.35, 95% CI -0.59-0.10, p<0.01, I² = 83%) than the tamsulosin group. Retrograde ejaculation was the only adverse event that had a significant difference between both groups, statistically favoring tamsulosin (RR 1.61, 95% CI 1.12-2.33, p = 0.01, I² = 0%). CONCLUSIONS Silodosin should be preferred as the first-line MET agent for DUS owing to its better expulsion rate, shorter stone expulsion time, and fewer colicky pain episodes. However, tamsulosin may be used in selected cases where patients experience retrograde ejaculation after receiving silodosin. [ABSTRACT FROM AUTHOR]

Background: To determine if the implementation of a posterior urethral valves (PUV) clinic and standardized management pathway improves the short-term kidney outcomes of infants with PUV. Methods: From 2016–2022, 50 consecutive patients were divided into groups after the implementation of the clinic (APUV, n = 29) and before (BPUV, n = 21) during a comparable timeframe. Assessed data included age at initial visit, timing and type of surgery, frequency of follow-up visits, medications, nadir creatinine, and development of CKD/kidney failure. Data are shown as median with interquartile range (IQR) and odds ratios (OR) with 95% confidence interval (CI). Results: APUV had higher rates of prenatal diagnoses (12/29 vs. 1/21; p = 0.0037), earlier initial surgical intervention (8 days; IQR 0, 105 vs. 33 days; IQR 4, 603; p < 0.0001), and higher rates of primary diversions (10/29 vs. 0/21; p = 0.0028). Standardized management led to earlier initiation of alpha blockers (326 days; IQR 6, 860 vs. 991; IQR 149, 1634; p = 0.0019) and anticholinergics (57 days; IQR 3, 860 vs. 1283 days; IQR 477, 1718; p < 0.0001). Nadir creatinine was reached at earlier ages in APUV (105 days; IQR 2, 303 vs. 164 days; IQR 21, 447; p = 0.0192 BPUV). One patient progressed to CKD5 in APUV compared to CKD3, CKD5 and one transplant in BPUV. Conclusion: Implementing the PUV clinic with standardized treatment expedited postnatal management and resulted in a higher number of cases detected prenatally, a shift in primary treatment, younger ages at initial treatment, reduced time to nadir creatinine, and timely initiation of supportive medications. [ABSTRACT FROM AUTHOR]

We present a patient with postoperative urinary retention requiring prostatic surgery who developed bacteremia postarthroplasty. Continuous temperature monitoring was utilized throughout his care, fevers were noted earlier with continuous temperature monitoring; thus, prompting the patient to seek additional life-saving care. [ABSTRACT FROM AUTHOR]

Background and Objectives: Postoperative urinary retention (POUR) is associated with significant morbidity. Our institution's POUR rate was elevated among patients undergoing elective lumbar spinal surgery. We sought to demonstrate that our quality improvement (QI) intervention would significantly lower our POUR rate and length of stay (LOS). Methods: A resident-led QI intervention was implemented from October 2017 to 2018 on 422 patients in an academically affiliated community teaching hospital. This consisted of standardized intraoperative indwelling catheter utilization, postoperative catheterization protocol, prophylactic tamsulosin, and early ambulation after surgery. Baseline data on 277 patients were collected retrospectively from October 2015 to September 2016. Primary outcomes were POUR and LOS. The focus, analyze, develop, execute, and evaluate (FADE) model was used. Multivariable analyses were used. P value <.05 was considered significant. Results: We analyzed 699 patients (277 pre-intervention vs 422 post-intervention). The POUR rate (6.9% vs 2.6%, Δ confidence interval [CI] 1.15-8.08, P =.007) and mean LOS (2.94 ± 1.87 days vs 2.56 ± 2.2 days, Δ CI 0.066-0.68, P =.017) were significantly improved following our intervention. Logistic regression demonstrated that the intervention was independently associated with significantly decreased odds for developing POUR (odds ratio [OR] = 0.38, CI 0.17-0.83, P =.015). Diabetes (OR = 2.25, CI 1.03-4.92, P =.04) and longer surgery duration (OR = 1.006, CI 1.002-1.01, P =.002) were independently associated with increased odds of developing POUR. Conclusions: After implementing our POUR QI project for patients undergoing elective lumbar spine surgery, the institutional POUR rate significantly decreased by 4.3% (62% reduction) and LOS, by 0.37 days. We demonstrated that a standardized POUR care bundle was independently associated with a significant decrease in the odds of developing POUR. [ABSTRACT FROM AUTHOR]

Objective: Lower urinary tract symptoms (LUTS) are becoming more prevalent in the ageing population of males living with HIV. Drugs to treat LUTS are known for both their potential role as victims in drug–drug interactions (DDIs) and their side effects. We aimed to evaluate the current use of drugs to treat LUTS and to assess potential DDIs in our cohort of adult males living with HIV. Design: This was a retrospective review of pharmacy records. Methods: We recorded the combination antiretroviral therapy (cART) regimen and any use of drugs to treat LUTS (anatomical therapeutic chemical codes G04CA/CB/CX and G04BD). Potential DDIs were assessed using the interaction checker developed by the University of Liverpool (https://www.hiv-druginteractions.org/checker). Results: A total of 411 adult males living with HIV were included in this analysis. The median (interquartile range [IQR]) age was 53 (41–62) years. Nineteen (4.6%) patients used one or more drugs to treat LUTS. As expected, older patients were more likely to be receiving treatment for LUTS: Q1 (20–40 years) = 0%; Q2 (41–52 years) = 2%; Q3 (53–61 years) = 7%; Q4 (62–79 years) = 10%. Seven potential DDIs between cART and LUTS treatment were noted in six of the 19 (32%) patients. Following medication reviews of these six patients, the following interventions were proposed: evaluate safe use of alpha‐blocker (n = 4), change in cART (n = 2), and dose reduction of the anticholinergic agent (n = 1). Conclusion: Treatment for LUTS coincided with cART in 7%–10% of patients aged above the median age of 53 years in our cohort. Improvements in DDI management appeared to be possible in this growing cohort of males living with HIV and with LUTS. [ABSTRACT FROM AUTHOR]

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Benign prostatic obstruction (BPO) is a prevalent condition that affects men, primarily toward their old age. The condition is often accompanied by lower urinary tract symptoms (LUTS), which can significantly impair a patient's quality of life and lead to other medical complications. Accurate diagnosis of BPO is essential for effective management of complications secondary to BPO, and treatment plans should be tailored patients, and occasionally according to surgeon experience. As such, this literature review aims to analyze the current available data on male LUTS secondary to BPO by providing a comprehensive overview of relevant studies, as well as the surgical and medical management guidelines from the Canadian Urological Association (CUA), American Urological Association (AUA), and European Association of Urology (EAU). By synthesizing the existing literature, this review purports to summarize the current body of knowledge surrounding BPO and male LUTS, and support healthcare providers in making informed decisions about the management of male LUTS secondary to BPO, ultimately improving patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background/Objective: While several psychotropic and cardiovascular drugs have been identified as fall-risk-increasing drugs (FRIDs) in older adults, the intervening mechanisms linking FRIDs and falls are unclear. It is plausible that gait performance is an intermediate variable on the causal pathway between FRIDs and falls. The current evidence on the relationship between medication use and gait performance in older adults is scarce. We aimed to assess the association between FRIDs and gait performance in community-dwelling older adults. Methods: This was a cross-sectional analysis using data from the Gait and Brain Study, a study of community-dwelling older adults aged 65 years old and over (N = 345). The following drug classes were assessed: antidepressants, benzodiazepines, alpha-blockers, beta-blockers, vasodilators, diuretics, statins and aspirin. Medication use was ascertained through validated questionnaires and electronic medical records. Multiple linear regression models were used to assess the association between each of the drug classes and gait speed and gait variability. Gait variability was expressed as the coefficient of variation (CV = mean/standard deviation) of stride time. Models were adjusted for age, sex, education, body mass index (BMI), mini-mental status exam (MMSE) score, Geriatric Depression Scale (GDS) score, general activity level, use of other FRIDs and comorbidity propensity score. Results: Diuretic use was associated with significantly reduced gait speed (B = −7.97 cm/s, 95% CI: −13.94, −2.00, P = 0.009). Statin use was associated with significantly increased stride time CV (B = 0.13, 95% CI: 0.02, 0.24, P = 0.026). Other drugs did not have a statistically significant relationship with gait speed or variability. Conclusion: The association between diuretic use and reduced gait speed is consistent with existing evidence on diuretic use and increased fall risk. The association between statins and increased stride time variability is notable given inconclusive evidence in previous studies. Our results provide initial estimates of the association between FRIDs and gait performance in older adults for future longitudinal studies. [ABSTRACT FROM AUTHOR]

Background Delayed ejaculation (DE) is a disorder that can cause significant distress for sexually active men. The etiology of DE is largely idiopathic, with even less being known about clinical factors associated with the condition. Aim We sought to use data mining techniques to examine a broad group of health conditions and pharmaceutical treatments to identify factors associated with DE. Methods Using an insurance claims database, we evaluated all men with a diagnosis of DE and matched them to a cohort (1:1) of men with other male sexual disorders of urologic origin (ie, erectile dysfunction [ED] and Peyronie's disease [PD]). Given the low prevalence of DE, we incorporated the random forest approach for classification of DE vs controls, with a plethora of predictors and cross-validation with the least absolute shrinkage and selection operator (LASSO). We used both a high-performance generalized linear model and a multivariate logistic model. The area under the curve was reported to demonstrate classifier performance, and odds ratios were used to indicate risks of each predictor. We also evaluated for differences in the prevalence of conditions in DE by race/ethnicity. Outcomes Clinical factors (ie, diagnoses and medications) associated with DE were identified. Results In total, 11 602 men with DE were matched to a cohort of men with PD and ED. We focused on the 20 factors with the strongest association with DE across all models. The factors demonstrating positive associations with DE compared to other disorders of male sexual dysfunction (ie, ED and PD) included male infertility, testicular dysfunction, anxiety, disorders of lipid metabolism, alpha adrenergic blocker use, anemia, antidepressant use, and psychoses such as schizophrenia or schizoaffective disorder. In addition, the prevalence of several conditions varied by race/ethnicity. For example, male infertility was present in 5% of Asian men compared to <2% of men of other races. Clinical Implications Several medical conditions and pharmacologic treatments are associated with DE, findings that may provide insight into the etiology of DE and offer treatment options. Strengths and Limitations This study is to our knowledge the first to use using data mining techniques to investigate the association between medical conditions/pharmacologic agents and the development of subsequent DE. The generalizability of our findings is limited given that all men were commercially insured. Conclusion DE is associated with multiple medical conditions, a finding that may help identify the etiology for this disorder. [ABSTRACT FROM AUTHOR]

Simple Summary: Prostate cancer radiation therapy (RT) to the pelvis is one of the curative approaches for patients with localized prostate cancer. Most patients treated with prostate RT experience some degree of radiation-induced lower urinary tract symptoms (RI-LUTSs). These symptoms may have a negative impact on patients' quality of life after treatment. The aim of our prospective study was to determine if prophylactic α-blockers improved RI-LUTSs in men undergoing prostate RT. Overall, we found that there were no important effects of prophylactic α-blockers on RI-LUTSs. Therefore, treating prostate cancer patients preventatively with α-blockers may cause additional drug toxicity and financial burden without significantly improving their urinary symptoms. This trial was registered with ClinicalTrials.gov under the registration number NCT02220829. Purpose: The present phase III randomized trial assessed the efficacy of prophylactic versus therapeutic α-blockers at improving RI-LUTSs in prostate cancer patients receiving external beam radiotherapy (EBRT). Methods: A total of 148 prostate cancer patients were randomized 1:1 to receive either prophylactic silodosin on day one of EBRT or the occurrence of RI-LUTSs. LUTSs were quantified using the international prostate symptom score (IPSS) at regular intervals during the study. The primary endpoint was the change in the IPSS from baseline to the last day of radiotherapy (RT). Secondary endpoints included changes in IPSS from baseline to 4 weeks and 12 weeks after the start of RT. Results: Patient demographics, baseline IPSS, and prescribed radiation doses were balanced between arms. On the last day of RT, the mean IPSS was 14.8 (SD 7.6) in the experimental arm and 15.7 (SD 8.5) in the control arm (p = 0.40). There were no significant differences in IPSSs between the study arms in the intention-to-treat (ITT) analysis at baseline, the last day of RT, and 4 and 12 weeks post-RT. Conclusion: Prophylactic α-blockers were not effective at significantly reducing RI-LUTSs in prostate cancer patients treated with EBRT. Treating patients with α-blockers at the onset of RI-LUTSs will avoid unnecessary drug exposure and toxicity. [ABSTRACT FROM AUTHOR]

The military situation in Ukraine significantly worsened the quality of medical care for the population. Of all Ukrainian men the age category from 30 to 60 years old who take part in military operations is the most effective one. Another, no less important part of the male population is the old persons, who, as a result of military operations, have limited opportunities to receive medical care. Currently, observing by urologist, required for benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) due to combat operations in the country, is often performed via distance curation. The doctor needs a clear understanding of the patient's medical history, taking into account his psychological and somatic status, the use of medicines. Stress negatively affects men's health, worsening the hormonal background, mental state and aggravating problems of the genital and urinary systems. Psychological stress is a factor in the exacerbation or occurrence of urological complaints, which can lead to the pathological activation of certain parts of the sympathetic nervous and hormonal systems, the development of LUTS by BPH. Tamsulosin is considered to be the most recognized and widely used treatment for LUTS in patients with BPH. The classic medicament approach of BPH monotherapy is the use of Serenoa repens extract. The distance appointment of selective α-adrenoblockers, both in monotherapy and in combinations, is an important measure of providing specialized urological care to the population. [ABSTRACT FROM AUTHOR]

The goal of Minimal Invasive Laser Enucleation of Prostate (MiLEP) surgery is to reduce complication rates and risk of urethral trauma, while providing similar success rates by using smaller caliber instruments. Enucleation was performed with 22 Ch outer resectoscope sheath, a rotatable 19 Fr inner sheath, a 2.9 mm 30 degrees telescope (Tontarra - Germany). In this surgery, a 100 W pulse thulium YAG laser (Dornier Thulio® High Power Laser) with a 550 μm fiber laser was used. Enucleation was performed at 2 J & 50 Hz (enucleation mode), and coagulation at 0.4 J & 75 Hz (soft tissue mode). The total surgical time was 32 minutes. The enucleation duration was 17 minutes, and morcellation took 11 minutes. No intraoperative complications were observed. MiLEP surgery aims to provide similar efficacy to standard endoscopic laser enucleation of the prostate while using smaller endoscopic instruments and reducing postoperative complications. [ABSTRACT FROM AUTHOR]

Purpose To determine if administration of tamsulosin before and/or after surgery is safe and effective in preventing postoperative urinary retention (POUR). Methods A systematic review and meta-analysis comparing tamsulosin to control in patients undergoing surgery was conducted. The primary outcome was the incidence of POUR. Secondary outcomes included maximum urinary flow rate, surgery duration, International Prostate Symptom Score (IPSS), quality of life (QOL) score, and incidence of urinary tract infection (UTI). Results Twenty-three randomized controlled trials (N = 3,555) met inclusion criteria. All were qualitatively analyzed, but one was excluded from quantitative analysis due to lack of statistical data. The risk of POUR was significantly lower with tamsulosin compared with control (relative risk, 0.50; 95% CI, 0.38-0.67; P < 0.001). A significant increase in maximum urinary flow rate with use of tamsulosin versus control was also observed across 4 studies (difference in means, 2.76 mL/sec; 95% CI, 1.21-4.30; P < 0.001). No significant differences between tamsulosin and control were observed amongst the studies that reported mean duration of surgery (P = 0.932), IPSS (P = 0.133), QOL score (P = 0.166), and UTI incidence (P = 0.624). Conclusion Administration of tamsulosin before and/or after surgery significantly reduced the risk of POUR and improved maximum urinary flow rate compared to control; however, it had no significant impact on mean duration of surgery, IPSS, QOL score, or UTI incidence. Nonetheless, it may be reasonable for providers to consider administering tamsulosin before and/or after surgery to prevent POUR. [ABSTRACT FROM AUTHOR]

Objective: The incidence of benign prostatic hyperplasia (BPH) directly increases with age, and side effects related to drugs in the alpha-blocker group used in these patients are more important. In this study, we evaluated the safety of tamsulosin in cardiac arrhythmias, which are common in this age group. Methods: Between May and June 2017, 835 patients with BPH were evaluated retrospectively. Patients with cardiovascular and endocrine system diseases were excluded from the study. Tam In 55 patients who met the study criteria, tamsulosin was started as BPH treatment. Moreover, a control group was formed with patients who had not on tamsulosin treatment yet. Electrocardiographies (ECGs) of 37 patients who completed 3 weeks of tamsulosin use were obtained. Control and reference P-wave distribution (PWD) were calculated for each patient. The difference between the largest and narrowest p-waves on the ECG was calculated to determine the PWD. PWD values before and after treatment were compared. Results: The mean age was 53.6±8 years. PWD values in reference and control ECG were calculated and compared. While the mean PWD was 55 ms (30-75) before tamsulosin use, it was 60 ms (45-70) 3 weeks after tamsulosin use. Conclusion: PWD change in ECG was found to be significant in patients with BPH patients treated with tamsulosin. According to the results, I an increase in PWD is a finding that indicates an increased risk of supraventricular tachycardia. Therefore, the clinician should be more careful when using tamsulosin in these patients. [ABSTRACT FROM AUTHOR]

Background: Rauwolscine (RW), also known as a-Yohimbine, is an α-2-adrenergic receptor antagonist which possesses sympathomimetic properties. RW is commercially sold in pre-workout and energy supplements. However, the ergogenic potential of RW has not been determined. The purpose of this study was to investigate the effects of acute RW supplementation on repeated sprint performance. Methods: Healthy male participants (n=12) completed 3 × 15-second Wingate anaerobic tests (WAnT) separated by 2 minutes of active recovery. Blood lactate (La) was collected before exercise (Pre) and immediately following exercise (Post). Mean power, peak power, fatigue index, heart rate (HR), and rate of perceived exertion (RPE) were taken immediately after each WAnT. Point of application #1: Acute RW supplementation does not result in the enhancement of repeated anaerobic sprint performance. Point of application #2: HR and RPE are not altered during repeated sprints with RW ingestion. Point of application #3: RW ingestion results in higher La levels post-exercise despite no changes in fatigue index. [ABSTRACT FROM AUTHOR]

Introduction: Tamsulosin is the most commonly used medical expulsive therapy (MET). However, it does not alleviate ureteral colic. It is important to develop MET that can reduce ureteral colic while maintaining a high stone clearance rate. Silodosin is an α1A adrenoceptor with high affinity and selectivity for the distal ureter, which may reduce ureteral colic and enable stone expulsion for distal ureteral stones. Therefore, we performed this systematic review and meta-analysis to evaluate the efficacy of silodosin as MET and its role in reducing ureteral colic among patients with distal ureteral stones. Materials and Methods: This research was conducted in accordance with the Cochrane Handbook for Systematic Review and Intervention, in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42021249003). A comprehensive literature search was performed in several databases including Medline, EMBASE, and Scopus up to July 2021 for randomized trials comparing silodosin with placebo for MET. RevMan 5.4 was used for data analysis. Results: A total of six randomized controlled trials were included in this analysis with a total of 907 patients. Our analysis revealed that the patients who received silodosin had significantly higher stone expulsion rate (SER) (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.34, 4.76, P < 0.01), significantly shorter stone expulsion time (SET) (mean difference −3.79, 95% CI −4.51, −3.06, P < 0.01), and lower analgesic use (OR 0.4, 95% CI 0.23, 0.69, P < 0.01) compared to the group receiving placebo. Conclusion: Silodosin showed significantly higher SER, lower SET and lower analgesic use in patients with distal ureteral stones as compared to a placebo. [ABSTRACT FROM AUTHOR]

What is known and objective: Alpha‐blockers have been associated with orthostatic hypotension (OH). We aimed to assess the prevalence of OH measured with beat‐to‐beat blood pressure monitoring in older male outpatients who used alpha‐blockers for lower urinary tract symptoms (LUTS). In addition, we investigated associations of OH with duration of alpha‐blocker use, concomitant medication use and comorbidity. Methods: Cross‐sectional explorative study in a urology outpatient clinic. Older white males ≥65 years using alpha‐blockers for LUTS were included. Blood pressure responses to standing up from supine were recorded using a validated beat‐to‐beat blood pressure device (Finapres). Prevalence rates were derived from the beat‐to‐beat data to include OH measured between 60–110 s (OH), impaired recovery OH at 40 s (OH[40]), initial OH (IOH) and normal orthostatic response. Subgroups were defined based on duration of alpha‐blocker use, polypharmacy, and Charlson comorbidity index (CCI), to obtain relative risks. Results and discussion: Sixty‐five patients were included. Median age was 75 years (range 65–92). The prevalence of OH was 7.7% (n = 5). The prevalence of OH(40) was 16.9% (n = 11) and of IOH 38.5% (n = 25). Thirty‐six patients (55.4%) had a normal orthostatic response. The relative risk of OH for the subgroup using ≥ 10 medications (n = 13) was 6.0 (95%CI 1.1–32.3). For the subgroup with multimorbidity (CCI ≥3, n = 11) this was 7.4 (95%CI 1.4–39.0). Recent initiation of alpha‐blocker use (<3 months) did not increase OH risk (RR 0.6 [95%CI 0.1–5.1]). What is new and conclusion: The overall prevalence of OH was low and comparable to age‐matched population prevalence, suggesting that the relative contribution of alpha‐blockers to OH was small. However, OH risk significantly increased in patients with multimorbidity or polypharmacy. For these patients, the benefits of starting alpha‐blockers for LUTS should be weighed against the increased risk of OH. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 4-8% of the population in children, adolescents and adults. Aspects of ADHD can persist from childhood and adolescence into adulthood in 50% to 70% of persons with this DSM-5 disorder. Co-morbidities are common in persons with ADHD and must be considered in the overall therapy plan. Management considerations include behavioral-psychology therapy typically along with psychopharmacology. Nonpharmacological approaches to ADHD include placement in appropriate educational classes, social skills training, biofeedback, parental training, occupational training, physical therapy, and psychological therapy as needed in an individualized approach. Psychopharmacology can include psychostimulants, alpha-2 agonists, a norepinephrine reuptake inhibitor, and others. Careful, long-term management is important for pediatric persons with ADHD and co-morbid conditions that may be present. [ABSTRACT FROM AUTHOR]

The article offers a glimpse of pheochromocytona and paraganglioma (PPGL) management through ambulatory blood pressure monitoring (ABPM), with reference to a study on ABPM in PPGL in patients on amlodipine. It points out the challenge in the surgical management of PPGL and offers reminders about the use of calcium channel blockers as monotherapy, high-sodium diet and fluid intake. The efficacy of preoprative blockade with amlodipine in preventing hemodynamic instability in PPGL is discussed.

Benign prostatic hyperplasia (BPH) is a condition that affects up to 50% of men over the age of 50; the condition's prevalence increases with age, particularly after the age of 40. (1, 2) BPH can lead to lower urinary tract symptoms (LUTS) which can have a significant negative impact on health-related quality of life (HRQoL). (2-4) Men presenting with a gradual onset of LUTS are often suspected to have BPH. However, the clinician must recognize that LUTS possess many different aetiologies. This article aims to provide medical students with a stepwise approach to the diagnosis and management of LUTS that are secondary to BPH. The outlined approach describes the differential diagnoses, required investigations, and management-related details for LUTS that are secondary to BPH. This approach is based off of relevant Canadian, American, and European urological association guidelines. [ABSTRACT FROM AUTHOR]

This case illustrates important management issues: fragmented care and neurogenic bladder with resulting kidney stones. This case is notable because the patient did not have many of the symptoms that may be associated with bladder stones, most notably hematuria, dysuria, difficulty with initiating the urinary stream, and cloudy smelly urine. [ABSTRACT FROM AUTHOR]

Fall-risk-increasing drugs (FRIDs)—psychotropics and cardiovascular disease (CVD) drugs—may elevate the risk of falling, with strong evidence observed in psychotropic FRIDs, whereas findings from cardiovascular disease (CVD) FRIDs remain inconclusive. Existing studies on FRIDs and falls are often hampered by methodologic limitations. Leveraging longitudinal observational data, we aimed to determine the long-term patterns of FRID use and their association with falls in residential aged care (RAC) homes. A retrospective longitudinal cohort study. A total of 4207 permanent residents newly admitted to 27 RAC homes in Sydney, Australia. The outcomes were incidence of all and injurious falls. We measured exposure to each FRID over 60 months using the Proportion of Days Covered (PDC) metric. We used group-based multitrajectory modeling to determine concurrent usage patterns of psychotropics and CVD FRIDs and applied negative binomial regression to assess their associations with the outcomes. A total of 83.6% (n = 3516) and 77.3% (n = 3254) residents used psychotropic and CVD FRIDs, respectively. The PDC values ranged from 67.3% (opioids) to 86.9% (antidepressants) for specific psychotropics and 79.0% (α-adrenoceptor antagonists) to 89.6% (β blockers) for CVD FRIDs. We identified 4 groups: group 1, low psychotropics–low CVDs use (16.7%, n = 701); group 2, low psychotropics–high CVDs (25.0%, n = 1054); group 3, high psychotropics–high CVDs (41.0%, n = 1723); and group 4, high psychotropics–low CVDs (17.3%, n = 729). Group 4 had a significantly higher rate of falls than the other groups for both outcomes, including relative to group 3, in which exposure to both FRID classes was high. Our findings reveal concerningly high FRID use in RAC homes and highlight a critical difference in the impact of the 2 major FRID classes on falls. Psychotropics were strongly associated with falls, whereas the studied CVD FRIDs did not elevate risk of falling. [ABSTRACT FROM AUTHOR]

In the context of improved medication management of older patients, we wished to evaluate the overprescription of potentially inappropriate drugs [α1-blockers and 5α-reductase inhibitors (5-ARI)] for benign prostate hyperplasia (BPH). These drugs are considered by geriatricians to increase the risk of falls and pharmacodynamic interactions, but these properties have not yet been proven. This was a descriptive study of drug prescriptions in a geriatric academic center. We included all patients older than 75 years who received a prescription for α1-blockers or 5-ARIs for 2 weeks in our hospital. We evaluated the prevalence of the potentially inappropriate prescription of α1-blockers and 5-ARI in older people during hospitalization using a new tool consisting of an 8-item list of explicit indicators developed using the most recent summary of product characteristics (SmPC) and latest European Association of Urology (EAU) guidelines. Results : A population of 117 patients (≥75 years) was included in the study. The median age was 84.5 (±6.3) years. The average time since urological medication prescription was 1.2 ± 1.6 years. According to explicit criteria, 84 patients (71.8%) received at least 1 potentially inappropriate urologic medication, 77 (91.7%) related to α1-blockers. Patients with a potentially inappropriate prescription for α1-blockers and/or 5-ARIs more frequently had urological assessments (P =.026), more frequently showed pharmacological interactions, with the risk of orthostatic hypotension (P =.005) or arrhythmia (P =.028), and experienced more falls in their history (P =.043). The misuse group was associated with an increased risk of falls, with an odds ratio of 3.22 (P =.039, 95% confidence interval 1.08–10.2). In our study, potentially inappropriate prescriptions for older individuals for BPH was close to 72% and mainly involved α1-blockers. Potentially inappropriate prescriptions for BPH were associated with a threefold higher frequency of falls. [ABSTRACT FROM AUTHOR]

Background: Men are more likely to develop benign prostatic hyperplasia (BPH) and gout as they age. However, the role of alpha-1-adrenergic antagonists, the medication for BPH, in the development of gout is uncertain.Objective: To investigate the effect of alpha-1-adrenergic antagonist use on the risk of developing gout in BPH patients.Methods: Data of patients with newly diagnosed BPH were retrieved from Taiwan's 2000-2013 National Health Insurance Research Database (total number: 15,390 patients; 7,695 patients in each cohort). Propensity score matching was conducted according to age, comorbidities, medication history for cohorts that received or did not receive alpha-1-adrenergic antagonists. Hazard ratios (HRs) were assessed for gout development using Cox proportional hazards regression models.Results: Use of alpha-1-adrenergic antagonists was not associated with gout development in BPH patients (HR = 0.92; 95% confidence interval [CI], 0.78-1.10; P = 0.35). However, after stratification according to the average number of days of alpha-1-adrenergic antagonist use per year, patients with an average of >300 days had a significantly higher risk of gout development than patients who did not receive alpha-1-adrenergic antagonists (adjusted HR = 1.57; 95% CI, 1.25-1.97; P < 0.001). Patients with more days of medication use per year had a higher risk of gout development than those with fewer days of medication use (P < 0.001).Conclusion: Patients who received more doses of alpha-1-adrenergic antagonists per year had a higher risk of developing gout. A causal proof of the role of alpha-1-adrenergic antagonists use in gout development should be analysed in future studies designed as double blind randomized controlled trials. [ABSTRACT FROM AUTHOR]

The article reports that alcohol affects several neurotransmitters and biological systems making it difficult to identify pharmacological targets for treating AUD. Topics include examines additionally, the complex constellation of AUD makes it challenging to develop effective treatments and considered precision medicine and the development of biomarkers for monitoring drug response are crucial for developing AUD pharmacotherapy.

The prospective clinical, non-inferiority study aimed to investigate the effectiveness of Thai traditional massage on lower urinary tract symptoms (LUTS) compared with Tamsulosin in Thai men. It was conducted on men aged 50 to 75 years old with LUTS (N = 45). Participants were blocked four randomly assigned into 2 groups. The control group (n = 25) was received 0.4 mg Tamsulosin daily and the study group (n = 20) was given Thai traditional massage for 4 weeks. The efficacy evaluation was performed by the International Prostate Symptoms Score (IPSS), a Thai version of the World Health Organization Quality of Life Questionnaire (WHO-QoL Brief), Uroflowmetry, and Post-void residual urine (PVR) at baseline and end of study. The background characteristics of participants were not significantly different between groups. Both interventions relieved LUTS in the total IPSS and the quality of life score associated with urination were decreased, described as symptoms and quality of life due to urination improvement after 4 weeks of intervention. Interestingly, the Thai traditional massage has significant improvement in total IPSS and voiding score (p <.05). Additionally, the time to peak flow rate, peak flow rate (Qmax), average flow rate (Qave) and voided volume of both interventions were improved with no statistical significance. PVR was decreased in both interventions. The WHO-QoL brief score was improved the total score. There was no significant difference in terms of uroflowmetry, PVR, and WHO-QoL brief scores compared between groups. The result suggests that Thai traditional massage has the potential to be an alternative treatment for LUTS. [ABSTRACT FROM AUTHOR]

Pheochromocytomas and sympathetic paragangliomas are rare tumours arising from chromaffin cells, producing catecholamines in various amounts. Fatal hypertensive episodes may occur perioperatively, which are preventable by alpha adrenergic receptor blockers. The perioperative mortality rate of diagnosed versus undiagnosed catecholamine‐producing tumours is significant, considering that only a minority of tumours develop metastasis. Herein we describe a case of a primary adrenal pheochromocytoma referred to as a pancreatic tumour, successfully diagnosed by endoscopic ultrasound‐guided fine needle aspiration biopsy, with a distinct morphology (prominent nuclear anisonucleosis, intranuclear pseudoinclusions, and multinucleation) and immunohistochemical signature. [ABSTRACT FROM AUTHOR]

Background: Urothethiasis is the most common urinary tract disease with a global prevalence rate of 2-20%. Alfa-blocker has a relaxation effect on the smooth muscles of the ureter making the removal of ureteric stone easier during the ureteroscopic procedure. Objectives: To evaluate the effect of preoperative -adrenoreceptor antagonists therapy (tamsulosin) in the treatment of ureteral stone using a ureteroscope regarding operative time, access to the ureter, and the complication rate. Materials and methods: A prospective case-control study was conducted at Al-Jamhory Teaching Hospital, Mosul, Iraq. During the period from June 2019 to August 2020. Subjectts with ureteral stones (7-15 mm) scheduled for ureteroscopic intervention were enrolled in the study. The patients were classified into two groups, the first group was received a pre-operative alpha-blocker (tamsulosin 0.4 mg capsule per day for 7 days), and the second group (Control) did not receive further medication. The operative time, uretric access, and intra- and postoperative complications were registered for both groups. Results: There was a matching between the two groups regarding the age, gender, and side, size, and location of the ureteric stones. There was a statistically significant difference between the two groups regarding the operative time (23.2 ± 4.569 minute in the treated group vs. 25.48 ± 4.904 minute in the control group) (P-value = 0.009). Besides, the ureteroscopic operation was easier (P-value = 0.031) in treated group (n = 51 easy case, 85%) than the control group (n=41, 68.33% easy case). The intraoperative and postoperative complications were mucosal injury, perforation, bleeding, pain, hematuria, and fever. The total number of complicated cases was 14 (23.33%) in the treated group and 25 (41.66%) in the control group, and there was a significant difference between the two groups (P-value = 0.032). Conclusion: The study revealed that the preoperative alpha-blocker tamsulosin was improved the outcome of ureteroscopy (shorter operative time, easier access to the ureter, and low complication rate). [ABSTRACT FROM AUTHOR]

A clinical quiz about a case of a teenage female patient with a parotid mass and hypertension is presented.

Among the anorectal surgeries, hemorrhoidectomy procedure is most often performed. Following this procedure, urinary retention is the most common complication. The aim of this article was to prevent post-operative urinary retention (POUR) in patients undergoing hemorrhoidectomy. The objective of this article was to administer tamsulosin during the pre and post-operative phases in the study group and observe its efficacy in the prevention of the development of POUR in patients undergoing hemorrhoidectomy and compare with the non-tamsulosin group. In our prospective observational study, 128 patients were reviewed and were divided into study and control group. In the study group, tamsulosin 0.4 mg was administered orally 6 h before surgery and 6 to 12 h after surgery. Patients were closely followed up for the next 24 h, the immediate post-operative period for voiding difficulties. Each group has 64 patients; in the control group, 14 cases with POUR required catheterization, and in the tamsulosin group, 4 cases with POUR required catheterization. This difference in requirement of catheterization between two groups was statistically significant. During the perioperative period, the use of tamsulosin was found effective in the prevention of POUR in patients undergoing hemorrhoidectomy. [ABSTRACT FROM AUTHOR]

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common and often heterogenous condition that can have severe consequences on patient quality of life. In this review, we describe the pathophysiology, diagnostic work-up, and treatment of patients with CP/CPPS incorporating the most recent literature. Studies have demonstrated that CP/CPPS involves a complex pathophysiology, including infectious, immunologic, neurologic, endocrinologic, and psychologic etiologies, with frequent intersections between the different entities. Despite robust research assessing a variety of therapeutics targeting these etiologies, clinical trials have failed to identify an empiric treatment strategy applicable specifically to older adult male patients with CP/CPPS. As such, it can be challenging to manage older male patients with this condition. The advent of clinical phenotyping of patients with CP/CPPS has led to advances in tailored management strategies. Monomodal therapy has been largely unsuccessful because of the unclear and complex etiology of CPPS. As a result, CP/CPPS therapy has transitioned to a multimodal approach, including both pharmacologic and non-pharmacologic therapies. The best studied pharmacologic therapies include antibiotics, alpha-blockers, anti-inflammatory and immunomodulatory agents, phytotherapies, phosphodiesterase inhibitors, hormonal agents, neuromodulatory agents, and antidepressants. The best studied non-pharmacological therapies include pelvic floor physical therapy, myofascial trigger point release, acupuncture and electroacupuncture, psychological support and biofeedback, and electrocorporeal shockwave therapy and local thermotherapy. [ABSTRACT FROM AUTHOR]

Pheochromocytoma in pregnancy is a rare entity. Undiagnosed and untreated pheochromocytoma can lead to life threatening complications in both mother and foetus. We witnessed a case of pheochromocytoma masquerading as severe preeclampsia. A 19-year-old primigravida presented to gynae casualty at 29 weeks gestation with severe headache, blurring of vision followed by loss of far vision, with blood pressure of 200/130 mm Hg. A provisional diagnosis of impending eclampsia made. Patient was started on magnesium sulphate and anti-hypertensives with simultaneous induction of labour. But she didn't respond to induction and was planned for emergency caesarean section. Intraoperatively and postoperatively control of blood pressure remained a therapeutic challenge for both anaesthesia and the surgical team. Postoperatively, diagnosis was made with non-contrast computed tomography (NCCT) and contrast-enhanced computed tomography (CECT) abdomen and patient was optimized with alpha adrenergic blockers followed by surgical resection of adrenal tumour. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy and safety of vibegron add-on therapy in men with persistent storage symptoms receiving α-1 blockers or PDE5 inhibitor for benign prostatic hyperplasia and then determine the independent factors affecting the efficacy of vibegron.Methods: Vibegron 50 mg was administered for 12 weeks to 42 patients (72.0 ± 8.2 years) with persistent storage symptoms who had taken α-1 blockers (22 patients) or PDE5 inhibitor (20 patients). The primary endpoint was change in the overactive Bladder (OAB) Symptom Score from baseline to end of treatment. The secondary endpoints were changes in each question of several questionnaires, maximum flow rate and residual urine volume. Finally, independent factors affecting the efficacy of vibegron were investigated.Results: Total OAB Symptom Score was significantly decreased (6.21 ± 3.12 vs 4.38 ± 2.46; P < .001). Although each score of several questionnaires, especially for storage symptoms, improved significantly, no significant improvement was found in stress incontinence, straining, bladder pain and urethral pain in the Core Lower Urinary Tract Symptom score. Maximum flow rate and residual urine volume did not change, and no patient discontinued vibegron because of adverse events. Multiple regression analysis showed that OAB Symptom Score, Core Lower Urinary Tract Symptom score, prostate volume and monotherapy with α-1 blocker were independent factors affecting the efficacy of vibegron.Conclusion: Add-on therapy of vibegron to monotherapy with α-1 blockers or PDE5 inhibitor for patients with benign prostatic hyperplasia and persistent storage symptoms was effective and safe. [ABSTRACT FROM AUTHOR]