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Background: Pheochromocytomas and paragangliomas are rare chromaffin cell-derived tumors characterized by catecholamine-secreting activity. Pheochromocytomas account for 1.7% of pediatric hypertension cases. Surgical resection, the definitive pheochromocytoma treatment, carries risks of hemodynamic instability and cardiovascular complications. Nevertheless, mortality rates decreased significantly in the latter half of the 20th century due to effective perioperative blood pressure (BP) management. The literature on BP management tailored to pediatric pheochromocytoma is limited, while the sustained hypertension rate in this population is high (up to 90%) and related to a high risk of intraoperative complications. In this narrative review, we provide up-to-date recommendations regarding BP management to minimize perioperative comorbidities in children with pheochromocytoma. Summary: Antihypertensive agents, primarily alpha (α)-blockers, should be promptly administered for suspected pheochromocytoma. Beta (β)-blockers may be introduced thereafter to counteract reflex tachycardia. The patient must be salt- and water-replete preoperation. Intraoperatively, stable hemodynamics should be ensured during anesthesia and surgery, and short-acting intravenous medications and resuscitation fluid should be supplied. Postoperatively, patients should be admitted to the pediatric intensive care unit for close monitoring for at least 24–48 h. Genetic testing is recommended for all pheochromocytoma patients. Identifying underlying mutations, like in succinate dehydrogenase subunit B, which is linked to a higher risk of multifocality and metastasis, is imperative for tailoring treatment strategies and prognostication. Key Messages: Achieving optimal outcomes in pediatric pheochromocytoma relies on preoperative BP optimization with appropriate antihypertensive agents, intraoperative hemodynamic stability, and postoperative routine long-term follow-up to monitor for complications, recurrence, and metastasis. Future research should prioritize well-designed prospective multicenter studies with adequate sample sizes and, where feasible, randomized controlled trials with standardized protocols and appropriate endpoints. These studies should focus on the efficacy and safety of preoperative nonselective versus selective α-blockers, whether as monotherapy or combined with other medications (e.g., calcium channel blockers and/or β-blockers), or treatment without preoperative anti-hypertensives. [ABSTRACT FROM AUTHOR]

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

Purpose:: Ongoing monitoring of adverse events after medication approval can provide a real-world gauge of medication side effects in a larger, more diverse sample size. We report differences in post-marketing adverse event rates among commonly prescribed alpha blocker medications. Materials and Methods:: The alpha blockers doxazosin, alfuzosin, tamsulosin, prazosin and terazosin were studied (silodosin had insufficient data). Side effect incidence was estimated by dividing the number of side effects in the Food and Drug Administration’s adverse event reporting database by the number of patients on the medication from the Medical Expenditure Panel Survey database from 2013 to 2020. Limitations of the methodology include reporting bias, an inability to verify the side effect in a patient, the lack of information on dosing, and lack of indication for which the patient was on the medication. The primary outcome was the incidence analyzed by general linear modeling with effects of adverse event type, medication, and year with multiple comparisons by Tukey’s test. Results:: Overall, doxazosin had higher incidence of side effects than alfuzosin, which in turn had higher incidence than prazosin, tamsulosin, and terazosin; the latter three were not different from one another in rates of overall side effects. Alfuzosin was more likely to cause a fall than any other alpha blocker. Conclusions:: It is expected that doxazosin would have higher rates of vascular side effects given its selectivity profile and use as an anti-hypertensive. Alfuzosin had higher-than-expected probability of dizziness, hypotension, syncope, and dyspnea relative to the other alpha blockers (excluding doxazosin) and the highest rate of falls overall. This was unanticipated given that alfuzosin was marketed to be a somewhat uroselective medication and hence promoted as conferring fewer systemic effects.

ObjectiveTo evaluate existing clinical evidence for the efficacy of alpha blockers in the management of pediatric stone disease.MethodsWe conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort and randomized control trials of patients less than 18 years old with kidney stones managed with alpha-adrenergic antagonists were included. Outcomes included stone expulsion time, stone passage rate, mean number of pain episodes, and mean need for analgesics. We performed data extraction of the selected articles, and results were assimilated and synthesized qualitatively. Data extraction and risk of bias assessment was conducted by two independent reviewers.ResultsOf 257 relevant studies, 9 studies with 1,039 patients were included. Six studies measured stone expulsion time, with 5 studies noting statistically significant decreases in stone expulsion time for the treatment group compared to the control. Seven studies measured the stone expulsion rate, and 5 reported a statistically significant increased expulsion rate in the treatment group. Four studies reported a decrease in the mean number of pain episodes in the treatment group and two studies showed a decreased analgesic requirement compared to control. Two studies found alpha blockers not superior to watchful waiting after shock wave lithotripsy. Risk of bias was high in some studies, primarily due to incomplete reporting on methodology and study design.ConclusionsAlpha blockers are supported by a growing body of evidence to be effective against nephrolithiasis in children, however large-scale, well-designed studies are needed to confirm these findings.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=330068, PROSPERO (CRD42022330068).

Abstract Introduction and Objectives Voiding dysfunction remains a common side effect postprostate biopsy leading to significant morbidity. Alpha blockers have emerged as a potential therapeutic option to mitigate this risk, with various centres already incorporating its use in practice. Despite this, the literature regarding its efficacy remains inconclusive. Hence, a systematic review was performed to quantify the effect of perioperative alpha blockers on prostate biopsy‐related voiding function. Methods A systematic search in MEDLINE, Embase and PubMed between January 1989 and July 2023 was performed to identify relevant articles. Two independent reviewers independently screened abstracts, full texts and performed data extraction. Data including International Prostate Symptom Scores (IPSS), voiding flow rates (Qmax), postvoid residuals (PVR), rates of acute urinary retention (AUR) and quality of life (QoL) scores were extracted. Results were combined in an inverse variance random effects meta‐analysis. Results A total 808 patients from six randomised controlled trials (RCTs) comparing alpha blockers to controls were included. All articles excluded patients with pre‐existing voiding dysfunction. Pooled outcomes demonstrated statistically significant differences favouring alpha blocker usage in all objective and subjective measures including IPSS (mean difference 4.21, 95% confidence interval [CI] 2.58–5.84, p

Objective: To determine the effect of alpha blocker drugs on reduction of Double J Stent related symptoms. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Urology, The Kidney Centre, Post Graduate Training Institute, Karachi Pakistan, from May 2014 to Nov 2019. Methodology: Total 92 patients who had unilateral stent, inserted retrograde or antegrade, were studied. On 7th postoperative day double J stent related symptoms were documented on Ureteral Stent Symptom Questionnaire and alpha-blocker was started if score is >10. After 4 weeks, data was again colected to assess mean change in Ureteral Stent Symptom Questionnaire score. Results: Of 92 patients, pre-treatment mean Ureteral Stent Symptom Questionnaire score was 38.36±16.07 and post treatment was 14.87±8.62. Mean difference between pre and post Ureteral Stent Symptom Questionnaire score was found significant (p<0.05). Conclusion: Administration of Tamsulosin has a positive effect on stent related urinary symptoms and quality of life. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review aims to identify and summarize the current literature on the most recent therapeutic agents and combination strategies for the medical management of lower urinary tract symptoms resulting from benign prostatic hyperplasia. Recent Findings: The latest advancements in BPH therapy have been in combination strategies. Alpha blockers continue to be the mainstay of treatment, but research is exploring the synergistic benefits of combining them with 5-alpha reductase inhibitors (5-ARIs), phosphodiesterase-5 (PDE5) inhibitors, and beta-3 agonists. Summary: The alpha-blocker + 5-ARI combination remains ideal for enlarged, significantly reducing clinical progression risk compared to monotherapy. Alpha-blocker + PDE5 inhibitor combinations appear safe and potentially beneficial for men with concomitant erectile dysfunction; sildenafil might hold an edge over tadalafil based on limited data. Beta-3 agonists show synergistic effects with alpha blockers for residual storage symptoms, offering similar efficacy to anticholinergics but with a better side effect profile. [ABSTRACT FROM AUTHOR]

The seeds of Goat pea or Hatchet vetch [Coronilla securidaca L. syn. Securigera securidaca (L.) Degen & Dörfl.] are rich in phenolic compounds and have many biological activities. Here, we tried to evaluate the protective effects of hydroalcoholic extract of C. securidaca seeds (HECS) on serum levels of blood plasma parameters, antioxidant status and liver tissue changes in tamsulosin (TAM) treated rats. Rats were divided in 9 groups of 8 each including control, sham, TAM0.4, HECS200, HECS400, HECS800, TAM0.4 + HECS200, TAM0.4 + HECS400 and TAM0.4 + HECS800. HECS and TAM were administered orally for 28 days. At the end of the study, to investigate the changes in blood plasma parameters and antioxidant status, serum levels of glucose, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), albumin (Alb), total protein (TP), total bilirubin (TB), catalase (CAT), glutathione peroxidase (GPX) and superoxide dismutase (SOD) were measured. TAM0.4 administration significantly increased serum levels of glucose, ALT, AST, ALP and TB (P <0.05), in contrast, it significantly decreased serum levels of Alb, TP, CAT, GPX and SOD (P <0.05). TAM0.4 + HECS800administration decreased serum levels of glucose, ALT, ASP, ALP and TB (P <0.05), in contrast, it increased serum levels of Alb, TP, CAT, GPX and SOD (P <0.05). Liver tissue degradation and necrosis were observed in TAM0.4 but a relative improvement of liver tissue and mild necrosis was observed in TAM0.4 + HECS800. HECS administration at a dose of 800 mg/kg, can create protective effects on liver tissue by improving biochemical parameters, antioxidant status and prevent liver tissue destruction in TAM treated rats. [ABSTRACT FROM AUTHOR]

Paediatric functional bladder disorders especially those causing daytime symptoms are a common cause of significant psychosocial and/or physical morbidity and impaired quality of life. Despite the availability of many therapeutic modalities, a significant number of children appear to be refractory to treatment and continue to have symptoms. In this review, we aim to evaluate the current evidence in the use of existing and novel therapeutic options for the management of daytime lower urinary tract disorders in children. We also aim to highlight the controversies around the terminology and diagnosis of paediatric lower urinary tract dysfunction (LUTD) and specific conditions. The article will then provide a reasonable critique of the existing and emerging treatment modalities in functional daytime LUTD in children including their mode of action, efficacy, indications, and recent advances. These include standard urotherapy, specific urotherapy comprised of biofeedback, alarm therapy and electrical neural stimulation and pharmacotherapy involving selective and non-selective anticholinergics, ß3 adrenergic agonists, alpha blockers and botulinum toxin. A better understanding of this common clinical problem may help clinicians achieve better profiling of these children's diagnoses to further enable specific, targeted treatment. Plain language summary: A review article about new treatment options for otherwise healthy children with long-term urinary symptoms occurring during the daytime Management of paediatric functional daytime LUT disorders is complex and may benefit from a combination of treatment modalities. Urotherapy and anticholinergics appear to be effective in the majority however, non-responders warrant careful re-evaluation to characterize the specific type of LUTD to target appropriate treatment. Various novel therapies and adjuncts have been shown effective and range from smartphone apps, bladder alarms, neuromodulation systems and more effective drug delivery systems. Despite being effective, non-selective antimuscarinics are less favoured for long-term use in children due to the side-effect profile. Therefore, more selective anticholinergics, ß3 agonists and combination treatment options are being evaluated to improve compliance while maintaining/enhancing treatment efficacy. Use of alpha blockers and intravesical injection of botulinum toxin have shown promising results especially in refractory cases. [ABSTRACT FROM AUTHOR]

Background: Chemoprotective effect of 5-alpha reductase inhibitors (5-ARi) on bladder cancer (BCa) risk in men with Benign Prostatic Hyperplasia (BPH) has been explored with conflicting results. We sought to examine the effect of 5-ARi on new BCa diagnoses in a large US database. Methods: Men ≥ 50 y/o with a prescription for 5-ARi after BPH diagnosis were identified in the IBM® Marketscan® Research de-identified Databases between 2007 and 2016 and matched with paired controls. Incident BCa diagnoses were identified after BPH diagnosis and/or pharmacologic treatment. Multivariable regression modeling adjusting for relevant factors was implemented. Sub-group analyses by exposure risk were performed to explore the association between 5-ARi and BCa over time. Administration of alpha-blockers (α-B) w/o 5-ARi was also examined. Results: In total, n = 24,036 men on 5-ARi, n = 107,086 on 5-ARi plus alpha-blockers, and n = 894,275 without medical therapy for BPH were identified. The percentage of men diagnosed with BCa was 0.8% for the 5-ARi, 1.4% for the 5-ARi + α-B, and 0.6% for the untreated BPH group of incident BCa (adjusted hazard ratio [aHR], 0.90, 95% confidence interval [CI] 0.56 – 1.47), and 1.08, 95%CI 0.89 – 1.30, respectively). This was also true at both shorter (≤ 2 yr) and longer-term (> 2 yr) follow up. In addition, α-B alone had no change in BCa risk (HR 1.06, 0.86–1.30). Conclusions: We did not find any diminished risk of new BCa in men treated with 5-ARi (i.e., chemoprotective effect). The current report suggests that 5-ARi do not change a man's bladder cancer risk. [ABSTRACT FROM AUTHOR]

Objective: The incidence of urolithiasis in pediatrics increases to 4-10% annually. One of the methods for treating urolithiasis is ureteroscopy (URS). The small anatomy in pediatrics often makes the initial URS unsuccessful. Alpha blockers, a drug that can relax the ureteral muscles, is a therapy that can be considered before URS is carried out. The objective of this study is to evaluate the efficacy of preoperative tamsulosin for URS access in pediatrics. Materials and Methods: We conducted a search using four databases, including PubMed, EBSCO, Cochrane Library, and ProQuest. This study includes randomized controlled trials (RCTs), retrospective and prospective studies, which compared the efficacy of preoperative alpha blockers and placebo or non-placebo controls in pediatrics undergoing ureteroscopy. The outcome of interest was the success rate of URS access and the duration of surgery. Results: A total of 120 studies were identified from a database search. There were 3 studies included in this review involving 235 patients. The meta-analysis was conducted using a random-effects model. The results of the metaanalysis showed that alpha blockers provided a successful rate of ureteroscopy access in pediatric patients (Odds ratio (OR) 2.73; 95% confidence interval (CI) 1.52 up to 4.91; p=0.0008). Duration of surgery did not show significant results (Mean difference (MD) 3.46; 95% CI -3.59 up to 10.50; p=0.34). Conclusion: Preoperative administration of tamsulosin may increase the success rate of ureteroscopy access in pediatric patients. [ABSTRACT FROM AUTHOR]

Abstract Background Urinary leakage after removal of the nephrostomy tube post-percutaneous nephrolithotomy (PNL) is a common complication which could be secondary to ureteral stone fragments, blood clots, ureteral edema at the ureteropelvic or ureterovesical junction, or rupture calyx. Unfortunately, it could impact the patient’s hospital stay causing it to be lengthy, delaying time to return to work, and the negative psychological effect. The current study aimed at assessing the role and effectiveness of alpha blockers (tamsulosin) in minimizing the duration of urinary leakage post-percutaneous nephrolithotomy (PNL). Methods In this prospective randomized clinical study, 62 cases of PNL were included. Physical examination, laboratory investigations and radiological work up (KUB and plain computed tomography) were done. Cases were randomized into two equal groups: Group A (31 cases) received tamsulosin perioperatively; Group B (31 cases) did not receive tamsulosin. The two groups were followed postoperatively as regards duration of urinary leakage, urinary catheterization and hospital stay. Results Duration of urinary leakage was statistically significantly shorter in group A (10.61 ± 6.66 h) compared to group B (21.48 ± 12.41 h) (p-value ˂ 0.001). Similarly, duration of hospital stay was shorter in group A (2.52 ± 0.72 days) compared to group B (3.10 ± 0.98) (p-value 0.020). Conclusions In patients undergoing PNL for renal stones and receiving tamsulosin, the duration of urinary leakage, and eventually hospital stay was shorter compared to those not receiving tamsulosin.

Objective: The incidence of urolithiasis in pediatrics increases to 4-10% annually. One of the methods for treating urolithiasis is ureteroscopy (URS). The small anatomy in pediatrics often makes the initial URS unsuccessful. Alpha blockers, a drug that can relax the ureteral muscles, is a therapy that can be considered before URS is carried out. The objective of this study is to evaluate the efficacy of preoperative tamsulosin for URS access in pediatrics. Materials and Methods: We conducted a search using four databases, including PubMed, EBSCO, Cochrane Library, and ProQuest. This study includes randomized controlled trials (RCTs), retrospective and prospective studies, which compared the efficacy of preoperative alpha blockers and placebo or non-placebo controls in pediatrics undergoing ureteroscopy. The outcome of interest was the success rate of URS access and the duration of surgery. Results: A total of 120 studies were identified from a database search. There were 3 studies included in this review involving 235 patients. The meta-analysis was conducted using a random-effects model. The results of the meta-analysis showed that alpha blockers provided a successful rate of ureteroscopy access in pediatric patients (Odds ratio (OR) 2.73; 95% confidence interval (CI) 1.52 up to 4.91; p=0.0008). Duration of surgery did not show significant results (Mean difference (MD) 3.46; 95% CI -3.59 up to 10.50; p=0.34).

Background: Five-alpha reductase inhibitors (5ARIs) are used in the management of benign prostatic hyperplasia (BPH). 5ARIs prevent the conversion of testosterone to dihydrotestosterone, which is important in prostate development. It has been suggested that 5ARIs can be used a chemopreventative agent for prostate cancer. The aim of this study was to assess the risk of prostate cancer associated with 5ARI use among men with BPH. Methods: Using Clinical Practice Research Datalink (CPRD) from 1992 to 2011 in UK, prostate cancer risk was retrospectively compared in men with a new diagnosis of BPH, with no history of prostate cancer who were treated with 5ARIs, to men treated with alpha blockers (ABs) and those given no pharmacological treatment. Incidence rate of prostate cancer was calculated by treatment group; the association between BPH treatment group and prostate cancer was estimated by a multivariate Cox model. Results: 77,494 men with newly diagnosed BPH were included. The crude incidence rate of prostate cancer was 892.4 cases per 100,000 person-years amongst those treated with 5ARIs, compared with 1209.0 and 1542.9 in those treated with ABs and untreated individuals, respectively. The HR adjusted for potential confounders was 0.79 (0.72-0.86) for 5ARI vs ABs and 0.72 (0.66-0.79) for 5ARI vs untreated. After excluding the first year after BPH diagnosis, adjusted HRs attenuated to 0.87 (0.79-0.97) for 5ARI vs ABs and 0.97 (0.87-1.08) for 5ARI vs untreated. Conclusion: Among men diagnosed with BPH, we found evidence of lower risks of subsequent prostate cancer in those treated with 5ARIs, but this appeared to be driven by cases diagnosed within a year of BPH, possibly reflecting prevalent prostate cancers that were initially misdiagnosed. After excluding the first year after BPH diagnosis, there was little evidence of a reduced prostate cancer risk in those taking 5ARIs.

Background: Dhat Syndrome is difficult to treat due to the unwavering belief of the patients about the harmful effects of semen loss. We hypothesized that this belief can be overcome by objective demonstration of zero health benefit of zero semen loss using reversible anejaculation property of silodosin., Aim: To prospectively evaluate the efficacy of objective demonstration of zero health benefits of zero semen loss as treatment strategy to alter the mental construct of the Dhat syndrome patients using a randomized double blind placebo controlled two arm switchover study design., Methods: The patients with complaints of Dhat syndrome were recruited post-confirmation of the diagnosis by Dhat Syndrome Evaluation Questionnaire (DSEQ). After excluding participants based on exclusion criteria, participants' anxiety and perceived physical fitness was assessed using Hamilton Anxiety Rating Scale (HARS) and Perceived Physical Fitness Scale (PPFS) respectively. They were randomized into two groups with Group 1 receiving placebo and Group 2 receiving silodosin 8 mg respectively with counseling being common for both. After 2 months, and a drug wash out period of 7 days, the participants were switched and interventions continued for another two months. In the end, Dhat symptomatology with DSEQ, anxiety with HARS and perceived physical fitness with PPFS were assessed and compared with initial assessment and discussed with the participants in a one to one session. Main outcome measure: The post-intervention change in Dhat Syndrome symptomatology in our study participants., Results: A total of 32 adult males grouped as 1 (N = 18, mean age 28.9 ± 4.8 years) and 2 (N = 14, mean age 27.4 ± 4.3 years) participated in the study with none and 59% reporting semen loss while on silodosin and placebo respectively. The PPFS showed no statistically significant difference irrespective of the type of treatment in our participants and approximately 2/3rds of the participants reported relief from Dhat symptomatology and significant reduction in anxiety related to semen loss., Clinical Implications: Objective demonstration of zero health benefits of total prevention of semen loss to the patients of Dhat syndrome directly contradicts the unwavering belief about the harmful effects of semen loss in these patients thus altering their mental constructs., Strengths and Limitations: Prospective randomization design and objective demonstration of zero health benefits of zero semen loss are the strengths and the small sample size is the limitation of the study., Conclusions: The alteration of the mental construct of the Dhat syndrome patients using novel treatment strategy was successful in majority of our study participants., (© The Author(s) 2025. Published by Oxford University Press on behalf of The International Society for Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.)

PBNO although rare when missed may have the debilitating effect of obstructive uropathy in children. The gold standard for its diagnosis requires videourodynamics and electromyography (EMG) studies which are not available in nearly all hospitals in developing countries. We present a case demonstrating the usefulness of readily available imaging in diagnosis of PBNO as well as demonstrate effectiveness of alpha blockade in children. MCUG and cystoscopy should suffice in cases of suspected PBNO in neurologically normal children to inform trial of therapy in resource limited settings.

Background: Selective alpha blockers have been used for treatment for ureteric stones as medical expulsive therapy (MET). Recently they have been successfully used in passive ureteric dilatation before semirigid ureteroscopy. Objective: This study enables us to know the role of silodosin in ureteric dilatation to facilitate ureteral access sheath placement in Retrograde Intrarenal Surgery (RIRS) with flexible ureteroscopy (F-URS). Patients and Methods: A total of 120 patients with renal or upper ureteric stone of 2cm or less were enrolled, after consenting each of them and divided into two groups; group A (study group) that included 60 patients who underwent flexible ureteroscopy using Ho-YAG laser for stone disintegration. These patients received silodosin 'one tablet 8mg per day' for three days preoperatively and group B (control group) included 60 patients who underwent non-stent ureteroscopy using Ho-YAG laser for stone disintegration. These patients received placebo for three days. All patients were blind to the medication received. Our primary outcome was to assess success of ureteric access sheath placement as follows: spontaneous passage of ureteral access sheath without dilatation or passage of UAS after dilatation or failure of the ureteral access sheath insertion. All cases were classified accordingly. Results: Successful placement and spontaneous uretroscopy passage without dilatation were statistically significant higher with less frequency of failed dilatation in silodosin group. Also, operative time, frequency of stone residual, hospital stay and total cost were statistically significant lower. Finally, postoperative complications as pain, hematuria and mucosal injuries were statistically significant lower. Conclusion: Preoperative use of silodosin increases the success rate of UAS insertion while decreasing the risk of ureteral wall injury in intrarenal endoscopic procedures. [ABSTRACT FROM AUTHOR]

Chad Morley,1 Ali Hajiran,1 Amr A Elbakry,1 Hosam S AL-Qudah,2 Osama AL-Omar1 1Department of Urology, West Virginia University, Morgantown, WV, USA; 2Division of Urology, AL Zahra Hospital, Dubai, United Arab EmiratesCorrespondence: Osama AL-OmarDepartment of Urology, West Virginia University, PO Box 9238, 6300 HSS, Morgantown, WV, PO Box 9238, 6300 HSS, USATel +1 304-293-2706Fax +1 304-293-2807Email Osama_alomar@yahoo.comPurpose: To address whether preoperative tamsulosin increases the rate of successful ureteral orifice navigation for ureteroscopy (URS) without prestenting in school-age pediatric patients.Methods: We retrospectively reviewed all pediatric patients who had undergone ureteroscopy (URS) at our institution from 2013 to 2020. Patients were divided into two groups: those who had received tamsulosin 0.4 mg daily ≥ 48 hours preoperatively and those who had not. Statistical analysis was done using independent-sample t-tests and Mann–Whitney U tests for continuous variables, and χ2 and Fisher’s exact tests were used for categorical variables. Multivariate analysis was done using binary logistic regression test.Results: Overall, successful ureteral orifice navigation occurred in 44 of 50 patients (88%) who had received tamsulosin and 17 of 26 (65.4%) who had not (p=0.019). On further subanalysis based on stone location and instrumentation used, successful ureteral orifice navigation had occurred in 21 of 24 patients (87.5%) in the tamsulosin group and one of five (20%) in the no-tamsulosin group for semirigid ureteroscopy for mid–distal ureterolithiasis (p=0.007). For proximal ureteral and renal stones, successful ureteral orifice navigation with a flexible ureteroscope or ureteral access sheath had occurred in 23 of 26 patients (88.5%) in the tamsulosin group and 16 of 21 (76.2%) in the no-tamsulosin group (p=0.437). Multivariate analysis showed no significant difference between success rates in the two groups after controlling for patient weight, height, BMI, and stone location. We did not observe any adverse effects from tamsulosin.Conclusion: This is the first study to evaluate preoperative tamsulosin on successful ureteral orifice navigation in school-age pediatric patients. Although not reaching statistical significance, further evaluation should be done on larger cohorts. Patient height was found to be an independent predictor of successful ureteral orifice navigation.Keywords: ureteroscopy, pediatric, tamsulosin, ureteral orifice navigation, α-blockers, renal stone

Background: Increasing data suggests that androgen receptor signaling may play an important role in the carcinogenesis of urothelial cancers. While the chemoprotective effect of 5-alpha reductase inhibitors (5-ARi) on bladder cancer risk in men with Benign Prostatic Hyperplasia (BPH) has been explored with conflicting results, the evidence regarding 5-ARi treatment, and the risk of incident Upper Tract Urothelial Carcinoma (UTUC) development is lacking. Therefore, our objective was to investigate the impact of the 5-ARi administration on the incidence of new UTUC cases using a large US database., Methods: The Merative TM Marketscan® database was used to identify men ≥ 50 years old with a diagnosis of BPH and an active 5-ARi prescription between 2007 and 2021 and were subsequently matched with paired controls. A multivariable Cox regression model was implemented to ascertain the association of 5-ARi and/or alpha-blocker (α-B) medications on the incidence of UTUC. Additional subgroup analyses were conducted based on exposure risk (with a 2-year threshold) to investigate the relationship between 5-ARi and UTUC over time., Results: Overall, n=1,103,743 men BPH without prescriptions for BPH, n=31,142 men on 5-ARi, and n=160,049 using 5-ARi + α-B were identified. Over the follow-up period, a total of n=4,761 patients were diagnosed with UTUC. After matching, UTUC incidence ranged from 0.36% to 0.41% in men without active BPH therapy vs. 0.30% and 0.52% for the 5-ARi and 5-ARi + α-B groups, respectively. In multivariable analysis, the chemoprotective effect on UTUC risk was not observed for either 5-ARi monotherapy (adjusted hazard ratio [aHR]: 0.91, 95% CI: 0.58-1.44) or 5-ARi + α-B combination (aHR: 1.02, 95% CI: 0.87-1.19). This remained true for both short-term (≤ 2 years) and long-term (> 2 years) follow-up periods., Conclusions: The use of 5-ARi for BPH, whether used alone or in combination with α-B, is not associated with incident UTUC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Nocturia is one of the most bothersome symptom of lower urinary tract symptoms in males with Benign Prostatic Hyperplasia (BPH). Alpha blockers has good effect in relieving bladder outlet obstruction. Objective: The aim of the present study was to provide best available medical treatment for nocturia in patients of BPH. Patients and methods: This prospective study was carried out on 44 male patients complaining of lower urinary tract symptoms (LUTS) of BPH with nocturia, were enrolled in this prospective randomized study for 12 weeks. They were divided randomly into 2 groups, each group included 22 patients. Group A: the patient received oral desmopressin added to tamsulosin once daily. Group B, the patient received oral tamsulosin daily. Results: The mean serum Na of patients at group A was 142.35. No significant difference regarding in-between groups before treatment but at after 12 week of treatment; group A was (mean of Na=137.68±2.033) significantly lower than group B and significantly decreased from before to after treatment. There was no significant difference between groups in both nocturnal void and nocturnal volume before treatment and after treatment as group A was significantly lower and both groups significantly changed and improved from before to after treatment. No significant difference was found at before treatment regarding total International Prostate Symptom Score (IPSS) but group A was significantly lower regarding total IPSS after treatment and both groups significantly decreased after treatment (6.36±2.59 in group A and 10.55±4.13 in group B). Conclusion: Addition of desmopressin to α-blockers is an active therapy for men with BPH and suffering nocturia and is preferred than α-blockers therapy alone. [ABSTRACT FROM AUTHOR]

Iodinated contrast is used for imaging and invasive procedures and it can cause contrast induced acute kidney injury (CI-AKI), which is the third leading hospital-acquired health problem. The purpose of the present study was to determine the effect of α-adrenergic receptor-1b (Adra1b) inhibition by using terazosin on change in kidney function, gene, and protein expression in C57BL/6J male mice, 6-8 weeks with chronic kidney disease (CKD). CKD was induced by surgical nephrectomy. Twenty eight days later, 100-µL of iodinated contrast (CI group) or saline (S group) was given via the carotid artery. Whole-transcriptome RNA-sequencing (RNA-Seq) analysis of the kidneys was performed at day 2. Mice received either 50-µL of saline ip or terazosin (2 mg/kg) in 50-µL of saline ip 1 hour before contrast administration which was continued every 12 hours until the animals were euthanized 2 and 7 days later. The kidneys were removed for gene expression, immunohistochemical analysis, and blood serum analyzed for kidney function. Differential gene expression analysis identified 21 upregulated and 436 downregulated genes (fold change >2; P < 0.05) that were common to all sample (n = 3 for both contrast and saline). We identified Adra1b using bioinformatic analysis. Mice treated with terazosin had a significant decrease in serum creatinine, urinary Kim-1 levels, HIF-1α, apoptosis, and downstream Adrab1 genes including Ece1, Edn1, pMAPK14 with increased cell proliferation. Contrast exposure upregulated Adra1b gene expression in HK-2 cells. Inhibition of Adra1b with terazosin abrogated Ece1, Edn1, and contrast-induced Fsp-1, Mmp-2, Mmp-9 expression, and caspase-3/7 activity in HK-2 cells. [ABSTRACT FROM AUTHOR]

Recent reports indicate that alpha blockers are effective in selected children with bladder dysfunction. The aim of this case series was to report the subjective and objective outcomes of using low dose alpha blocker therapy in children with refractory bladder dysfunction. A chart review of prospectively recorded data from 2015-- 2019 was performed at a tertiary level paediatric urology service. Children with high post-void residual volumes or those with lower urinary tract symptoms characterised by hesitancy, and for whom standard treatments were unsuccessful or not tolerated, were offered additional low dose alpha blocker therapy and were included in this study. We collected data on subjective outcomes based on International Children's Continence Society definitions in the form of symptomatic response and objective outcomes measured by post-void residual and uroflowmetry as well as side effects of treatment. Thirteen patients (11 male, median age 8 years) were prescribed low dose alpha blockers, with a median followup of 12 months. Low dose alpha blockers were commenced due to ongoing high post-void residual (n=11) or frequency urgency syndrome (n=2). Alpha blockers used were tamsulosin (n=5), terazosin (n=6) and prazosin (n=2). Complete symptomatic response in 31% (4/13) and partial symptomatic response in 62% (8/13) was noted. In the high post-void residual cohort (6/13), median post-void residual volume decreased by 89% from 55mL to 6mL post-alpha blocker use. Severe nausea was noted in one patient on terazosin, necessitating discontinuation. Low dose alpha blocker therapy appears safe and may provide symptomatic improvement in a diverse aetiological group of well selected children with refractory bladder symptoms characterised predominantly by high post-void residual volume and/or hesitancy. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of tadalafil compared with four alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive treatment for ureteral stones in male adults. Materials and methods: Male adults who were admitted to urology clinic with flank pain and diagnosed with non complicated < 10 mm ureteral stone on non-contrast computed tomography (NCCT) between June 2014-September 2015 were retrospectively evaluated. A total of 273 patients with ureteral stone were divided into five groups. Alfuzosin 10 mg/daily, doxazosin 8 mg/daily, tamsulosin 0.4 mg/daily, silodosin 8 mg/daily and tadalafil 5 mg/daily for 6 weeks were prescribed respectively. Stone localization, diameter, volume and Hounsfield units were noted as NCCT findings. The patients were divided into the two groups based on their stone localization as distal and mid-proximal stones. These two groups were evaluated separately. Expulsion rate were noted at the end of 6 weeks. NCCT and treatment findings were compared between five drug groups in distal and mid-proximal stones separately. Results: Age was higher in tadalafil group in distal stones (p = 0.032). Expulsion rate was found 78.1% for alfuzosin, 75.7% for doxazosin, 76.5% for tamsulosin, 88.6% for silodosin and 90% for tadalafil in distal (p = 0.44) and 21.7%, 30%, 30%, 30% and 54.5% in mid-proximal stones (p = 0.034) respectively. Conclusions: Expulsion rate was higher in silodosin and tadalafil for distal ureteral stones but the difference didn’t meet statistical significance. However the expulsion rate was significantly higher in tadalafil than in the other groups for mid-proximal ureteral stones. The result of this study showed that tadalafil may increases ureteric stone expulsion.

Objective: Transrectal ultrasound-guided prostate biopsy is the gold standard in the diagnosis of prostate cancer. Major and minor complications may develop at varying rates after prostate biopsies, one of which is voiding impairment. This study aimed to evaluate whether all alphal-blockers were effective in preventing voiding impairment after a transrectal ultrasound-guided prostate biopsy and if so, was one superior to the others. Material and methods: This study included 240 patients who underwent a transrectal ultrasound-guided 12-core prostate biopsy and were prospectively randomized. Of the patients, 40 received 10 mg alfuzosin, 40 received 4 mg doxazosin, 40 received 8 mg silodosin, 40 received 0.4 mg tamsulosin, and 40 received 5 mg terazosin beginning on the day before the biopsy and for the following 30 days. The international prostate symptom score (IPSS), maximal flow rate, and post-void residual urine were recorded in all the patients before the procedure and on post-biopsy days 7 and 30. All he patients were followed up and questioned about voiding difficulty and acute urinary retention after the procedure. Results: In all the alphal-blocker groups, the IPSS and post-void residuals were statistically significantly lower, and the maximal flow rate was statistically significantly greater on post-biopsy days 7 and 30 compared with the baseline values (p<0.05). No patient in any of the alphal-blocker groups developed acute urinary retention after the biopsy. Conclusion: To prevent voiding impairment and deterioration in the quality of life after a prostate biopsy, preemptive therapy with alpha1-blockers may have a protective role, especially in patients with large prostate volumes. [ABSTRACT FROM AUTHOR]

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in preoperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before, during and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications. [ABSTRACT FROM AUTHOR]

Enhanced recovery programs (ERP) is aimed at reducing a patient's surgical stress response, specifically by reducing the duration of catheterization. In cases of colorectal surgery, there is pronounced heterogeneity in urinary catheterization, which is largely explained by fear of acute urinary retention (AUR). The objective of the work is to report on the current literature on postoperative urinary catheterization following colorectal surgery, particularly with regard to the risk of AUR, and thereby contribute to the standardization of perioperative practices. In colon surgery without preoperative urinary disorders, catheterization must not exceed 24 h. In rectal surgery, catheter removal starting on postoperative D2 seems reasonable in the absence of AUR risk factor (RF). Male sex, past history of lower urinary tract obstruction, abdomino-perineal amputation (APA) and low rectal anastomosis are AUR risk factors that must be taken into account when deciding to withdraw the urinary catheter. While the role of a suprapubic catheter is not clearly defined, it may be of use following APA. The epidural catheter is another AUR risk factor, but it seems possible to withdraw the urinary catheter on postoperative D1, before the epidural catheter, provided that the other risk factors have been taken into full account. Lastly, up until now no satisfactorily conducted study has assessed the prophylactic value of systematic perioperative alpha-blocker treatment in colorectal surgery. [ABSTRACT FROM AUTHOR]

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The present paper, aims to assess and compare the therapeutic efficacies of silodosin, Tadalafil, and their combination for the negotiation of large semi-arid ureteroscopic through ureteric orifice during ureteral stone management. During endoscopy, the patients groups A, B, and C exhibited wider ureteric orifice than the patients group D. About 70.6%, 60.6%, 62.9% and 32.4% of patients belonging to groups A, B, C, and D, respectively, exhibited easy negotiation. Significantly lower proportions of patients in groups A, and C (35.3%, 39.4%, and 28.6%, respectively) exhibited the need for ureteral dilation compared to those in group D (61.8%). In addition, the duration of surgery for groups A, B, and C was less than that for group D. Preoperative silodosin and Tadalafil administration in patients undergoing ureteroscopic for ureteral stones improves the access of large size duretero scope and reduced the need for ureteral dilatation with less surgical duration and minimal adverse events. [ABSTRACT FROM AUTHOR]

Introduction: At present, the geriatric population has formed a large clientele for medical services, with an increased incidence of lifestyle diseases. Approach to lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) is an upcoming challenge, especially with management showing a paradigm shift toward medical management. This study was basically designed to study the outcome of medical management of BPH on Indian population following the recommendations based on recent guidelines on medical management of BPH. Materials and Methods: With a calculated sample size of 131 based on the prevalence of BPH, a total of 170 patients were enrolled, and their complete profile with clinical examination, imaging and International Prostatic Symptom Score details were taken as per proforma and were followed up while on medical management and assessed on a cross-sectional basis at regular intervals. Results: The mean age in the study group was 64.61 years. We recorded that all patients had some formal education. These patients were prescribed α-1ablockers as monotherapy or combination therapy as per the protocol of the study. They showed improvement while on medical management with significant improvement. Adverse reactions of medical management were not significant enough to warrant discontinuation of therapy. Forty-one patients out of 170 underwent surgery for no response or worsening quality of life. This group was further analyzed which revealed that comorbid condition, prostate size, and body mass index had no association with the outcome. Conclusion: There is sufficient evidence to support the paradigm shift in the management of BPH. The present guideline is to initiate medical management with monotherapy for patients with BPH and prostate size 30 g. Surgery is advised for patients who do not respond to medical therapy and for the subgroup of patients with absolute indication for surgery in BPH.

Objective: To evaluate whether alpha blockers facilitate the navigation of the ureteroscope through the ureteric orifice, if administered preoperatively, based on the role of alpha blockers, mainly tamsulosin, in medical expulsive therapy of ureteric calculus. Methods: A prospective, case-control study of 174 patients who underwent ureteroscopic stone removal for lower or mid ureteral calculi between November 2014 and March 2016 was carried out. We included patients >14 years of age who were planned for ureteroscopic stone removal. We divided the patients into two groups, including those who were not prescribed alpha blockers prior to surgery (Group A: no alpha blocker) and those patients who were started on alpha blockers, tamsulosin 0.4 mg, 3 days prior to surgery (Group B: alpha blocker). We excluded patients with stone size >1 cm, spontaneous stone passage prior to surgery, unable to perform ureteroscopy (URS), and previous history of ureteroscopic intervention. Results: Our study included 124 patients, among whom 60 patients were prescribed alpha blockers preoperatively (Group B). The mean age of the study population was 37.62+9.74 (15–64 years) and the mean stone burden was 38.92+8.21 (15.94–58.12 mm2). The difference in rate of ureteroscope negotiation through the ureteric orifice between Groups A and B was not statistically significant (p=0.57). Conclusions: In URS, preoperative administration of alpha blockers failed to improve technical ease and lower complication rate. Further large group, multi-centre studies are required todiscover a definitive role of alpha blockers prior to URS.

Abstract A new, sensitive and simple field amplified sample injection (FASI) combined with micellar electrokinetic chromatography (MEKC) was developed for the analysis of terazosin (TER), alfuzosin (ALF), tamsulosin (TAM), doxazosin (DOX) and silodosin (SIL). The separation was achieved with Tris buffer (30 mM, pH 9.2) containing 30 mM SDS and 8% butanol, applying a voltage of 28 kV at 25 °C. Under the optimal conditions, the sensitivity of FASI-MEKC was improved 25.3–58.7 times as compared with the direct MEKC. The method was linear over concentration ranges of 50.0–2000.0 ng/mL for TER, DOX and SIL and 40.0–1200.0 ng/mL for ALF and TAM, with limits of detection of 9.04, 9.75, 5.21, 3.06 and 8.29 ng/mL in a respective order. The validated method was successfully applied for analysis of the five alpha blockers in dosage forms with good repeatability and recovery. Furthermore, the content uniformity testing of terazosin in its tablets as a model example was performed. The new method was also applied successfully to spiked human plasma which proved promising for the detection of these drugs in real samples. Highlights • First FASI-MECK method for separation of five alpha blockers • The method has high sensitivity with good accuracy and precision. • It was successfully applied for dosage forms and content uniformity testing. • Application to human plasma with good recovery and minimal matrix effect [ABSTRACT FROM AUTHOR]

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

Aim: the efficacy and safety of combined therapy with anticholinergics and alpha blockers in comparison with alpha blockers monotherapy among patients with BPH. Methods: We conducted a single blinded RCT and 80 patients with BPH who referred to Ali-ebn-abitaleb, Zahedan were included. One group received 0.4 mg/d Tamsulosin in addition to Tolterodine and the other group received the same doses of Tamsulosin in addition to placebo. Both groups were evaluated before and 6 months after treatment with special attention to clinical symptoms, life quality improvement and treatment satisfaction. SPSS was applied for data analysis. Results: There is no significant difference between these two groups of patients’ demographics and basic indices such as PVR, PSA and the volume of prostate. IPSS was significantly improved among patients who received Toltrodine (p=0.0008) whereas both groups showed same score before treatment. Conclusion: It seems that combined therapy with anticholinergics and alpha blockers is a safe and efficient regimen among patients with BPH, either as primary or alternative treatment after the failure of conventional treatments.

FederAnziani Senior Italia and SIU – Italian Society of Urology – have decided to work together to draft a document focussing on Benign Prostatic Hyperplasia (BPH), and to stress the importance of adherence with pharmacological treatment in this setting, from both a scientific and a patient standpoint. Starting from a literature search, the two associations analysed to what extent an increase in treatment adherence amongst these patients influences hospital savings and to what extent therapy persistence levels are affected by monotherapy rather than free drug combinations. These estimates were performed only on patients taking medicinal products belonging to the 5 α-reductase inhibitors (5ARI) class that, although not indispensable, are the compounds that bring the greatest benefits, especially in the elderly and for which we know that every additional 30 days of therapy reduced the likelihood of acute urinary retention (AUR) and surgery by 14% and 11% respectively *. The results show that the use of fixed combination therapy would involve an increase in persistence due to the lower rate of patients abandoning treatment over time. Each 30 day-increment of 5ARI therapy, i.e. for an expenditure of 10.6 million euros extra per year for 5ARI medication, savings of approximately 24.3 million euros in hospital costs could be achieved.

Aim: the efficacy and safety of combined therapy with anticholinergics and alpha blockers in comparison with alpha blockers monotherapy among patients with BPH. Methods: We conducted a single blinded RCT and 80 patients with BPH who referred to Ali-ebn-abitaleb, Zahedan were included. One group received 0.4 mg/d Tamsulosin in addition to Tolterodine and the other group received the same doses of Tamsulosin in addition to placebo. Both groups were evaluated before and 6 months after treatment with special attention to clinical symptoms, life quality improvement and treatment satisfaction. SPSS was applied for data analysis. Results: There is no significant difference between these two groups of patients’ demographics and basic indices such as PVR, PSA and the volume of prostate. IPSS was significantly improved among patients who received Toltrodine (p=0.0008) whereas both groups showed same score before treatment. Conclusion: It seems that combined therapy with anticholinergics and alpha blockers is a safe and efficient regimen among patients with BPH, either as primary or alternative treatment after the failure of conventional treatments.

Benign prostatic hyperplasia is a common condition. It can cause problems with urine storage and voiding, and the severity of symptoms may be unrelated to the size of the prostate. When drug treatment is required, benign prostatic hyperplasia can be managed with monotherapy or combination therapy. Most patients are managed with selective alpha blockers. Patients with larger prostate volumes may benefit from a 5-alpha-reductase inhibitor, usually in combination with an alpha blocker. [ABSTRACT FROM AUTHOR]

Introduction: Benign prostatic hyperplasia (BPH) is commonly treated with 5-alpha-reductase inhibitor/alpha blocker combination therapy or with alpha blocker monotherapy. However, in China, the characteristics of BPH patients receiving 5-alpha-reductase inhibitor/alpha blocker combination therapy or alpha blocker monotherapy remain largely unknown. Therefore, this study compared the characteristics of BPH patients receiving either the 5-alpha-reductase inhibitor finasteride in combination with an alpha blocker or an alpha blocker as monotherapy in clinical practice in China.Methods: Data were obtained from a large electronic medical record database from four tertiary hospitals in major cities in China (2009-2016). BPH patients aged ≥ 50 years with ≥ 1 alpha blocker fill on/after the first BPH diagnosis were selected. Patients were further classified as receiving combination therapy (≥ 1 overlapping day of supply for finasteride and an alpha blocker) or alpha blocker monotherapy (did not receive any 5-alpha-reductase inhibitor). Patient characteristics, visit type (in- vs. outpatient) at treatment initiation, and comorbidities were evaluated during the 6-month baseline period and compared between the two groups using two sample t tests and chi-square tests/Fisher's exact tests.Results: A total of 2666 and 2738 patients received combination therapy and monotherapy, respectively. The combination group was older (70.3 vs. 67.3 years, p < 0.0001) and had more patients initiated in an inpatient setting (46.0% vs. 26.4%, p < 0.0001). Compared with the monotherapy group, the combination group had more comorbidities, such as hypertension (48.3% vs. 35.6%, p < 0.0001), cardiovascular disease (65.3% vs. 48.0%, p < 0.0001), and diabetes (21.1% vs. 15.7%, p < 0.0001), and a higher Charlson comorbidity index (0.9 vs. 0.7, p < 0.0001).Conclusion: Chinese BPH patients using finasteride/alpha blocker combination therapy were older and had a higher comorbidity burden than those using alpha blocker monotherapy. These findings provide Chinese healthcare decision-makers with a better understanding of the patient characteristics generally associated with BPH combination therapy vs. alpha blocker monotherapy.Funding: Merck Sharp and Dohme (China) Co., Ltd., Shanghai, China. [ABSTRACT FROM AUTHOR]

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

Objective: The aim of this study is to evaluate the risk for hip fracture associated with adverse drug reactions caused by α1‐adrenergic (alpha) blockers to treat female voiding dysfunction. Methods: Information from the Health Insurance Review and Assessment Service database from January 1, 2008 to December 31, 2012 was used. Hip fracture women patients who received a prescription for an alpha blocker due to voiding dysfunction were the cases. A 30‐day hazard period after administration of an alpha blocker was set. The 30‐day control period was defined as 360 days before administration. The standardized incidence ratio and hazard ratio for the risk of hip bone fracture as related to alpha blocker use were analyzed. Results: The study cohort included 287 383 subjects having a mean age of 65.1 ± 9.7 years in the study cohort. A total of 170 and 79 hip fracture cases were diagnosed in the hazard period and control period, respectively. The incidence of newly diagnosed hip fractures per 100 000 person‐years was 763.4 in the hazard period and 348.5 in the control period. The hazard ratio for hip fracture after use of an alpha blocker was 2.19 (95% confidence interval, 1.74–2.77). Conclusions: Alpha blockers to treat voiding dysfunction may have association with the risk for hip fracture in elderly women. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of tadalafil compared with four alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive treatment for ureteral stones in male adults. Materials and methods: Male adults who were admitted to urology clinic with flank pain and diagnosed with non complicated < 10 mm ureteral stone on non-contrast computed tomography (NCCT) between June 2014-September 2015 were retrospectively evaluated. A total of 273 patients with ureteral stone were divided into five groups. Alfuzosin 10 mg/daily, doxazosin 8 mg/daily, tamsulosin 0.4 mg/daily, silodosin 8 mg/daily and tadalafil 5 mg/daily for 6 weeks were prescribed respectively. Stone localization, diameter, volume and Hounsfield units were noted as NCCT findings. The patients were divided into the two groups based on their stone localization as distal and mid-proximal stones. These two groups were evaluated separately. Expulsion rate were noted at the end of 6 weeks. NCCT and treatment findings were compared between five drug groups in distal and mid-proximal stones separately. Results: Age was higher in tadalafil group in distal stones (p = 0.032). Expulsion rate was found 78.1% for alfuzosin, 75.7% for doxazosin, 76.5% for tamsulosin, 88.6% for silodosin and 90% for tadalafil in distal (p = 0.44) and 21.7%, 30%, 30%, 30% and 54.5% in mid-proximal stones (p = 0.034) respectively. Conclusions: Expulsion rate was higher in silodosin and tadalafil for distal ureteral stones but the difference didn't meet statistical significance. However the expulsion rate was significantly higher in tadalafil than in the other groups for mid-proximal ureteral stones. The result of this study showed that tadalafil may increases ureteric stone expulsion. [ABSTRACT FROM AUTHOR]