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Introduction: Surgery in patients with large prostates due to benign prostatic hyperplasia (BPH) results in severe dysuria manifesting as frequent or urgent need to urinate and urinary incontinence. Traditionally, these conditions are treated with alpha blockers. Recently, alpha-blockers and the anticholinergic combination have been used showing additional advantages. This study aimed to investigate the comparative effectiveness of monotherapy versus combination therapy in the treatment of postoperative dysuria in BPH patients with large prostates undergoing transurethral surgery., Materials and Methods: From September 2016 to March 2017, 94 BPH patients with prostates greater than 100 cc underwent transurethral surgery at the Department of Urology of D.D. Pletnev Clinical Hospital; 22 patients had exclusion criteria. In the postoperative period, 36 patients received 0.4 mg of modified release tamsulosin (Omnik) for a month, and 36 patients were administered controlled release tablets tamsulosin 0.4 mg + solifenacin 6 mg (Vezomni) as fixed-dose combination therapy. At one month postoperatively, patients were asked to rate their symptoms on a visual analogue scale and fill out I-PSS and QoL questionnaires. Preoperative parameters of the groups were: visual analogue scale scores were 5.1 and 5.2, I-PSS scores were 24 and 24.2, QoL scores were 4.5 in both groups. Prostate volumes were 114 and 118 cc; maximum urinary flow rates were 7.7 vs. 7.5 ml/sec, residual urine volumes were 110 vs. 105 ml, respectively., Results: Visual analogue scale scores were 6.5 versus 9.2 points, I-PSS scores were 16.3 versus 12.1. The patients of the second group had greater mean micturition volume (150 versus 240 ml); other variables did not differ statistically significantly between the groups. Adverse reactions were mild, and drugs were not discontinued in any case., Conclusion: In BPH patients with dysuria after transurethral resection of large prostates, Vezomni administration results in a better quality of life due to an improvement in urgency and nocturia.

Introuction. One of the risk factors for LUTS is an infravesical obstruction, which is most often caused by benign prostatic hyperplasia (BPH). BPH symptoms are formed due to three components: static (mechanical), dynamic, and impaired functional capacity of the bladder. Medical treatment with 1-blockers decreases the outflow obstruction. 5-alpha reductase inhibitors are used to inhibit the static component of BPH., Aim: To investigate the effectiveness of various modifications of medical therapy of BPH using -blockers and 5-reductase inhibitors and combinations thereof., Materials and Methods: The study comprised 90 BPH patients who were divided into three groups, with each group containing 30 people. Patients of group I, II and III received monotherapy with -blockers, a combination of 5-reductase and -blockers, and fixed-dose combination drug Duodart, respectively. Evaluation of the treatment effectiveness included filling out voiding diaries, completing the I-PSS and QL questionnaires, uroflowmetry, transrectal ultrasonography of the prostate and estimation of the incidence of adverse effects. Also, compliance with the treatment was evaluated, and the number of patients who had episodes of acute urinary retention and required surgical treatment during the 12 month treatment course was registered., Results: Compared to monotherapy, combination therapy with -blockers and 5-reductase inhibitors more effectively reduces the LUTS, increases Qmax and prevents the disease progression, which manifests in a lower incidence of AUR and fewer surgical interventions in groups II and III. However, the combination therapy can be associated with some side effects. Patients who received fixed-dose combination drug Duodart had a greater compliance rate than patients on the combination of drugs, which, in our opinion, is associated with fewer cases of AUR and surgical interventions., Conclusion: The use of Duodart in patients with BPH effectively alleviates LUTS and reduces the risk of the disease progression, which manifests itself in a reduced number of complications and thereby contributes to improving the quality of life of patients.

Objectives: To evaluate the therapeutic effects of tamsulosin on recurrent urinary tract infections in women with dysfunctional voiding., Methods: A total of 155 women with recurrent urinary tract infections and dysfunctional voiding were included and randomly assigned to the following groups: uroflowmetry biofeedback (group 1), α1-adrenoceptor antagonists (group 2), uroflowmetry biofeedback combined with α1-adrenoceptor antagonists (group 3) and no treatment (group 4). Patients were evaluated by the American Urological Association Symptom Index at 3, 6 and 12 months. Urodynamics was carried out in patients of groups 1, 2, and 3 at 3, 6 and 12 months, whereas urodynamics was only carried out at 12 months in group 4. All patients were followed up for 1 year with monthly urine cultures., Results: The incidence of storage and emptying symptoms decreased significantly at 3, 6 and 12 months. Mean flow rate, flow time and voiding volume increased significantly (with a better outcome in patients of group 3), whereas post-void residual urine decreased. Mean opening detrusor pressure and detrusor pressure at maximum flow decreased significantly (with a better outcome in patients of group 3). Mean urethral closure pressure and maximum urethral closure pressure decreased significantly with a more significant decrease for patients in group 3. The prevalence of urinary tract infection decreased significantly in all groups after treatment, and this decrease remained stable during the follow up., Conclusions: In women with dysfunctional voiding and recurrent urinary tract infection, tamsulosin associated with uroflowmetry biofeedback might be an effective and safe treatment option for improving urinary symptoms and quality of life., (© 2014 The Japanese Urological Association.)

The retrospective evaluation of efficacy and safety of tamsulosin omnik (0.4 mg once a day) for 8 years in 17 patients with BPH and LUTS was performed. At the time of appointment of tamsulosin, mean age of patients was 61.9 years (range, 51 to 69 years). Efficacy of tamsulosin was evaluated based on the change of obstructive and irritative symptoms according to items of I-PSS scale, maximum urinary flow rate, residual urine volume and prostate volume. The study found that factors for favorable prognosis against the background of use of tamsulosin include moderate LUTS, small- or medium-sized BPH, maximum urinary flow rate of not less than 9 ml/s, and residual urine volume not more than 100 ml.

Background: Storage symptoms are often undertreated in men with lower urinary tract symptoms (LUTS)., Objective: To evaluate the combination of an antimuscarinic (solifenacin) with an α-blocker (tamsulosin) versus tamsulosin alone in the treatment of men with LUTS., Design, Setting, and Participants: A double-blind, 12-wk, phase 2 study in 937 men with LUTS (≥ 3 mo, total International Prostate Symptom Score [IPSS] ≥ 13, and maximum urinary flow rate 4.0-15.0 ml/s)., Intervention: Eight treatment groups: tamsulosin oral controlled absorption system (OCAS) 0.4 mg; solifenacin 3, 6, or 9 mg; solifenacin 3, 6 or 9 mg plus tamsulosin OCAS 0.4 mg; or placebo., Outcome Measurements and Statistical Analysis: The primary efficacy end point was change from baseline in total IPSS. Secondary end points included micturition diary and quality-of-life (QoL) parameters. Post hoc subgroup analyses were performed by severity of baseline storage symptoms, with statistical comparisons presented only for tamsulosin OCAS alone versus combination therapy, due to the small sample size of the solifenacin monotherapy and placebo subgroups., Results and Limitations: Combination therapy was associated with significant improvements in micturition frequency and voided volume versus tamsulosin OCAS alone in the total study population; improvements in total IPSS were not significant. Statistically significant improvements in urgency episodes, micturition frequency, total urgency score, voided volume, IPSS storage subscore, IPSS-QoL index, and Patient Perception of Bladder Condition were observed in a subpopulation of men with two or more urgency episodes per 24h (Patient Perception of Intensity of Urgency Scale grade 3 or 4) and eight or more micturitions per 24h at baseline (storage symptoms subgroup) with combination therapy versus tamsulosin OCAS alone (p ≤ 0.05 for the dose-response slope, all variables). Combination therapy was well tolerated, and adverse events were consistent with the safety profiles of both compounds., Conclusions: Solifenacin plus tamsulosin OCAS did not significantly improve IPSS in the total study population but offered significant efficacy and QoL benefits over tamsulosin OCAS monotherapy in men with both voiding and storage symptoms at baseline. Combination therapy was well tolerated., Trial Registration: Clinical Trials.gov Identifier: NCT00510406., (Copyright © 2013 European Association of Urology. All rights reserved.)

In men of middle and older age group, urination disorders and erectile dysfunction are often combined. The role of phosphodiesterase type 5 inhibitors in the treatment of these patients remains uninvestigated. Prospective study included 38 patients with urination disorders and erectile dysfunction. The average age of the patients was 63.6 +/- 5.3 years. During first three months of observation, all patients have received alpha-adrenoblocker doxazosin at a dose of 4 mg once daily per os, the next three months--phosphodiesterase type 5 inhibitor udenafil at a dose of 50 mg once daily per os was added to doxazosin. 3 months after treatment, majority of patients reported improvement of urination. The statistically significant changes in BP and heart rate were not recorded, indicating a satisfactory tolerability and safety of doxazosin. Against the background of combined treatment during next 3 months, progressive improvement of erectile function (IIEF score 12.8 +/- 3.4 vs 18.4 +/- 3.7; p < 0.05), and regression of urination disorders, according to IPSS score (13.4 +/- 1.2 vs 11.2 +/- 1.7; p < 0.05) were observed. Uroflowmetric indicators were not significantly changed. Based on experimental and clinical studies, it was suggested that the dysregulation of NO--cGMP system, pathological activation of Rho-kinase pathways, hyperactivity of autonomic innervation, atherosclerosis and impaired blood flow in the pelvic organs are the common pathophysiological mechanisms for LUTS and erectile dysfunction. The clinical efficacy of phosphodiesterase type 5 inhibitors in the treatment of patients with these diseases is explained by its effects on these mechanisms.

The article presents the results of the study aimed to the evaluation the efficacy of combination therapy with alpha1-blocker (tamsulosin) and phosphodiesterase type 5 inhibitor (sildenafil) in patients with urination disorders and erectile dysfunction (ED). A pilot observational study involving 60 men aged from 50 and 80 years divided into 3 groups of 20 people was performed. Group 1 of patients received sildenafil 25 mg daily (dynamico), Group 2--tamsulosin 0.4 mg daily (Omnic-Ocas), and Group 3--tamsulosin 0.4 mg (Omnic-Ocas) and sildenafil 25 mg (dynamico) daily. The visits were carried out at the stage of screening, further--every 10 days (a total number--4 visits). Combination therapy of urination disorders and ED contributed to the significant improvement in uroflowmetry, the stopping of complaints according to the IPSS and IIEF-15 questionnaires, and improving the quality of life (according to the QoL questionnaire). Combination therapy significantly decreased obstructive and irritative symptoms, increased the maximum urine flow rate within the period of observation, as well as significantly decreased the residual urine volume, more pronounced when compared with monotherapy. Significant positive effect on erectile component and all components of the overall satisfaction in the sexual sphere were registered, that as a consequence led to the positive impact on the quality of life in patients treated with PDE5 inhibitor. Given the high prevalence of urinary disorders and erectile dysfunction, combined therapy with alpha1-blockers and PDE5 inhibitors in this case should be a promising area for drug therapy.

Objective: To comprehensively analyze the 5-year outcomes of tamsulosin treatment for patients with benign prostatic hyperplasia., Methods: Tamsulosin (0.2 mg/day) was given to 112 patients who had International Prostate Symptom Scores ≥8. They were prospectively followed for 5 years with periodic evaluation. If tamsulosin had to be discontinued, the reason was determined. Treatment failure was considered in the case of disease progression (postvoid residual urine volume ≥200 mL, acute urinary retention, febrile urinary tract infection or hydronephrosis as a result of bladder outlet obstruction), conversion to other α1-blockers or need for surgery. An intention-to-treat analysis was carried out., Results: A total of 34 patients (30.4%) continued the same medication for the overall study period, whereas 78 patients (69.6%) discontinued the medication. International Prostate Symptom Scores, Benign Prostatic Hyperplasia Problem Index and Quality of Life Index were significantly improved over the 5-year period. Treatment failure was observed in 21 patients (18.8%). Baseline prostate volume and postvoid residual urine volume were independent factors to predicting treatment failure. A total of 21 patients (18.8%) discontinued tamsulosin because of an improvement of symptoms. They were younger and had lower prostate-specific antigen levels than the remaining 91 patients. Their symptoms were stable even 1 year after termination of therapy., Conclusions: Long-term efficacy of tamsulosin was observed, although only a small portion of patients continued the treatment. α1-blocker monotherapy might be not appropriate for achieving a good long-term outcome in patients with a large prostate volume and a large amount of postvoid residual urine volume. Persistent improvement of symptoms, even after termination of tamsulosin, was observed in young patients with low prostate-specific antigen levels., (© 2012 The Japanese Urological Association.)

Purpose: Lower urinary tract symptoms (LUTS) affect countless individuals worldwide with an increased prevalence among those≥60 years of age. As the world's population ages, the prevalence of LUTS will continue to increase, diminishing the quality of life of many men and women. For men, alpha-1-adrenergic receptor (α1-AR) blockers are used as first-line therapy to mitigate bothersome LUTS, but for women with LUTS, few treatments have been adequately studied. However, new research has emerged evaluating the use of tamsulosin and other α1-AR blockers in female LUTS. Thus, the purpose of this review is to evaluate clinical trials using tamsulosin for the treatment of LUTS in women to determine if tamsulosin is an appropriate treatment option., Methods: A comprehensive search of the MEDLINE (1966-May 2012) and EMBASE (1980-May 2012) databases was performed. Additional articles were retrieved by manual review of the references cited in publications from the database search. Five published clinical trials and two abstracts were identified., Results: All seven trials presented in this review demonstrated statistically significant primary outcomes with use of tamsulosin in female LUTS, especially in women with predominant voiding dysfunction. Such efficacy measures included a reduction in urinary symptoms as well as improvements in quality of life and sleep quality. Tamsulosin was found to be safe and well tolerated in all studies reviewed., Conclusion: Consistent positive findings across multiple clinical studies suggest that in women with LUTS, particularly those with voiding dysfunction, tamsulosin may be an effective and safe treatment option.

This study was conducted to determine whether mirodenafil 100 mg, when administered on demand to patients with benign prostatic hyperplasia (BPH) who are receiving α1-blocker therapy, is safe with regard to the cardiovascular system and whether it improves lower urinary tract symptoms (LUTS) and sexual function. The study involved 121 LUTS/BPH patients who had been treated for at least 3 months with α1-blockers before being administered with mirodenafil 100 mg on demand. Before the start of mirodenafil administration, the blood pressure, heart rate, international prostate symptom score (IPSS)/quality of life (QoL), peak urine flow rate (Qmax), post-voiding residual urine volume (PVR), and international index of erectile function-5 (IIEF-5) of each patient were measured. At 4 and 8 weeks after commencing mirodenafil administration, the blood pressure and heart rate were measured again, any adverse effects of mirodenafil were assessed, and sexual function and voiding symptoms were re-evaluated. Of the 121 patients, 73 (60.3%) completed the 8-week clinical trial. Significant changes in blood pressure and heart rate were not observed during the study. Significant improvements in the IIEF-5 and the IPSS/QoL, but not the Qmax or PVR, were observed. The results of this study suggest that the administration of mirodenafil 100 mg on demand may induce few hypotensive interactions and may be acceptably effective with regard to improving LUTS and sexual function.

Background: A 23% relative risk reduction (RRR) in prostate cancer (PCa) was shown in men receiving dutasteride in the 4-yr Reduction by Dutasteride of Prostate Cancer Events study, in whom biopsies were protocol dependent., Objective: Our aim was to explore PCa risk reduction in men with benign prostatic hyperplasia (BPH) from the Combination of Avodart and Tamsulosin (CombAT) study, in which biopsies were undertaken for cause., Design, Setting, and Participants: CombAT was a 4-yr randomized double-blind parallel group study in 4844 men ≥50 yr of age with clinically diagnosed moderate to severe BPH, International Prostate Symptom Score ≥12, prostate volume ≥30 ml, and serum prostate-specific antigen (PSA) 1.5-10 ng/ml. Men underwent annual PSA measurement and digital rectal examination (DRE), and prostate biopsies were performed for cause., Intervention: All patients took tamsulosin 0.4 mg/d, dutasteride 0.5 mg/d, or a combination of both., Measurements: The primary end point was incidence of PCa. Secondary end points included postbaseline prostate biopsy rates and Gleason score of cancers., Results and Limitations: Dutasteride (alone or in combination with tamsulosin) was associated with a 40% RRR of PCa diagnosis compared with tamsulosin monotherapy (95% confidence interval, 16-57%; p=0.002) and a 40% reduction in the likelihood of biopsy. There were similar reductions in low- and high-grade Gleason score cancers. The biopsy rate in the groups receiving dutasteride trended toward a higher diagnostic yield (combination: 29%, dutasteride: 28%, tamsulosin: 24%). One limitation was the lack of a standardized approach to PCa diagnosis and grading., Conclusions: Dutasteride, alone or in combination with tamsulosin, significantly reduced the relative risk of PCa diagnosis in men with BPH undergoing annual DRE and PSA screening. Consistent with the increased usefulness of PSA for PCa detection, men receiving dutasteride had a numerically lower biopsy rate and higher yield of PCa on biopsy., Trial Registration: Clinicaltrials.gov identifier: NCT00090103 (http://www.clinicaltrials.gov/ct2/show/NCT00090103)., (Copyright © 2010. Published by Elsevier B.V.)

Introduction: Dysfunctional voiding syndrome in children is characterized by a pattern of dysfunctional bladder emptying due to an active contraction of the external sphincter during micturition. Diagnosis is based on electromyographic and flowmetry results. The treatment is focused on relaxing the external sphincter during micturition where biofeedback is the treatment of choice. By the moment there are still centres without this possibility, alpha blockers are an alternative., Objective: To determine the efficacy of alpha blockers as an alternative to biofeedback as a therapeutic possibility., Material and Methods: We included a total of 17 children with dysfunctional voiding syndrome and carried out a retrospective study. We registered age, symptoms at diagnosis, presence of associated urologic problems, flowmetry results pre and post-treatment, type of treatment used and its effectiveness comparing patients treated with alpha blockers and those who are starting to deal with biofeedback., Results: There were 12 girls and 5 boys. The mean age at diagnosis was 4.9 years old, 88% of these children related enuresis, diurnal urinary incontinence and urgency, 57% of them had also urinary infections, 63% constipation, 36% had psychosocial problems. Ten patients were treated with alpha-antagonists: 6 with Tamsulosin and 4 with Doxazosin. They followed this treatment an average of 5.8 months, range between 2 and 12 months. Five patients were treated with biofeedback. All cases had an abnormal pelvic electromyography. Patients treated with alpha-blockers achieved a 70% of electromyographic improvement with a 70% of recurrence. In children treated with biofeedback we got improvement in 80% with no recurrence. After alpha blocker therapy, maximum flow rates and average flow values were better but not statistically significant, this difference was significant with biofeedback. A patient treated with Tamsulosin left treatment due to hypotension, 2 patients left Doxazosin because of dizziness., Conclusions: Alpha-blockers are effective in the treatment of dysfunctional voiding syndrome with a high percentage of recurrence. They can be an alternative to biofeedback but this one is the effective and definitive treatment.

Objectives: To compare the efficacy and safety of silodosin and tamsulosin in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) by a randomized crossover method., Methods: BPH patients with the complaint of LUTS were included in this study, and were randomly divided into two groups: a silodosin-preceding group (4 weeks of twice-daily administration of silodosin at 4 mg, followed by 4 weeks of once-daily administration of tamsulosin at 0.2 mg) or a tamsulosin-preceding group (4 weeks' administration of tamsulosin, followed by 4 weeks' administration of silodosin). No drug withdrawal period was provided when switching the drug., Results: In the first treatment period, both drugs significantly improved the International Prostate Symptom Score total score, but the improvement by silodosin was significantly superior to that by tamsulosin. After crossover treatment, significant improvement was observed only with silodosin treatment. Moreover, intergroup comparison of changes revealed that silodosin showed significant improvement of straining and nocturia with first and crossover treatments, respectively, compared with tamsulosin. Silodosin also significantly improved quality of life (QOL) score in both treatment periods, while tamsulosin significantly improved QOL score only in the first treatment period. The most frequent adverse drug reaction was ejaculatory disorder with silodosin; however, the incidence of dizziness with silodosin was similar to that with tamsulosin., Conclusions: In BPH/LUTS patients, silodosin exhibits excellent efficacy in improving subjective symptoms in both initial and crossover treatment, and it appears to improve the QOL of patients., (© 2010 The Japanese Urological Association.)

We determined the clinical efficacy of a loading dose of tamsulosin (0.2-0.3 mg) in patients with benign prostate hyperplasia (BPH). Tamsulosin was administered at a dose of 0.3 mg to 26 patients with BPH and moderate or severe urinary disturbance, as determined on the basis of the international prostate symptom score (I-PSS) and quality of life (QOL) severity. The I-PSS and QOL index were calculated before and at the end of the 12-week administration period. The total I-PSS and QOL index were significantly decreased at 12 weeks compared with the baseline (p=0.003, and p=0.011, respectively). Significant differences were observed in the changes in 3 I-PSS items (stream, p=0.042 ; nocturia, p=0.012 ; urgency, p=0.003). On the basis of these findings, we conclude that the administration of 0.3 mg tamsulosin to patients with BPH improves the scores of objective indexes, and may specifically ameliorate urinary storage symptoms.

Purpose: Primary bladder neck dysfunction is a nonneurogenic voiding disorder frequently overlooked in pediatrics. The diagnosis classically is made by videourodynamics but can also be made with noninvasive uroflow studies with pelvic floor electromyography. We report our long-term results using alpha-blocker therapy in patients with primary bladder neck dysfunction., Materials and Methods: We reviewed 51 neurologically normal children (mean age 11.6 years, range 3.5 to 17.8) meeting criteria for primary bladder neck dysfunction who underwent alpha-blocker therapy for at least 1 year. All patients were symptomatic with abnormal flow parameters and an electromyogram lag time of 6 seconds or more on initial uroflow/electromyography. Pretreatment and on-treatment uroflow/electromyogram studies were performed in all patients. Average and maximum uroflow rates, electromyogram lag times and post-void residual volumes were compared., Results: After a mean followup of 46.2 months (range 12 to 124) mean average and maximum uroflow rates improved from 7.0 to 12.4 cc per second and from 12.4 to 20.3 cc per second, respectively, while mean electromyogram lag time decreased from 30.8 to 5.8 seconds (all p <0.01). Of the patients 85% reported subjective symptomatic relief. A total of 15 patients (29%) stopped alpha-blocker therapy for various reasons, none related to side effects. Repeat off-treatment uroflow/electromyogram studies showed that measured parameters reverted to pretreatment values (all p <0.05). Eight of these 15 patients eventually resumed alpha-blocker therapy, while only 3 remained asymptomatic off of the alpha-blocker., Conclusions: alpha-Blocker therapy continues to benefit children with primary bladder neck dysfunction even after 3 years of treatment. Few patients can come off of alpha-blocker therapy without returning to their pretreatment state, suggesting the condition is likely chronic in most patients., (Copyright 2010 American Urological Association. Published by Elsevier Inc. All rights reserved.)

The study of efficacy and safety of tamsulosin in therapy of stent-related symptoms has demonstrated that tamsulosin relieves stent-related irritative symptoms and improves quality of life. Further prospective trials are needed to finally assess tamsulosin efficacy.

We evaluated the therapeutic effects of tamsulosin for women with non-neurogenic voiding dysfunction. Women who had voiding dysfunctions for at least 3 months were included. Inclusion criteria were age > or =18 yr, International Prostate Symptom Score (IPSS) of > or =15, and maximum flow rate (Q(max)) of > or =12 mL/sec and/or postvoid residuals (PVR) of > or =150 mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram as having no or mild obstruction (group A) or moderate or severe obstruction (group B). After 8 weeks of treatment, treatment outcomes and adverse effects were evaluated. One hundred and six patients were evaluable (70 in group A, 36 in group B). After treatments, mean IPSS, bother scores, Q(max), PVR, diurnal and nocturnal micturition frequencies and scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS-SF) were changed significantly. Eighty-nine patients (84%) reported that the treatment was beneficial. The proportion of patients reported that their bladder symptoms caused "moderate to many severe problems" were significantly decreased. No significant difference were observed between the groups in terms of IPSS, bother score, Q(max), PVR, micturition frequency, and BFLUTS-SF changes. Adverse effects related to medication were dizziness (n=3), de novo stress urinary incontinence (SUI) (n=3), aggravation of underlying SUI (n=1), fatigue (n=1). Tamsulosin was found to be effective in female patients with voiding dysfunction regardless of obstruction grade.

Purpose: A number of therapies for dysfunctional voiding in children have been proposed after conservative measures have failed. Prior studies have shown significant improvement in lower urinary tract symptoms with alpha1-adrenergic antagonists. Nonselective alpha1-adrenergic antagonists can result in systemic vasodilatation and hypotension. We examined the effects of tamsulosin, a uroselective alpha1A-adrenergic antagonist, on blood pressure, as well as its safety and efficacy in the treatment of dysfunctional voiding in a pediatric population., Materials and Methods: A total of 23 children without anatomical or neurogenic abnormalities presented with lower urinary tract symptoms refractory to conservative measures. All children had increased post-void residual urine or abnormal uroflowmetry in the absence of pelvic floor activity suggestive of bladder neck dysfunction. All patients were administered tamsulosin daily. Voiding diaries, blood pressure, uroflowmetry studies and patterns along with assessment of post-void residual urine were obtained before and after beginning tamsulosin in all children., Results: Median duration of tamsulosin therapy was 7 months, and patient followup was 20 months. The number of voiding and incontinent episodes significantly decreased during treatment compared to baseline (p <0.05). Mean blood pressures before and during tamsulosin treatment were 98/55 mm Hg and 110/61 mm Hg, respectively. Significant increases in average and maximum urinary flow rates along with reduction in post-void residual urine were observed during tamsulosin therapy compared to baseline values (p <0.01). A 50% reduction in the number of abnormal uroflow patterns was observed with tamsulosin therapy., Conclusions: Tamsulosin demonstrated no clinically significant effect on blood pressure, while proving to be a safe and effective treatment option for lower urinary tract symptoms in a select pediatric population.

Introduction: To investigate the incidence of ejaculatory disorders caused by naftopidil and tamsulosin in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH)., Materials and Methods: Ninety-five patients with LUTS/BPH who had International Prostate Symptom Scores (IPSS) of 8 or more were randomly assigned to receive naftopidil (50 mg/day, n = 48) or tamsulosin (0.2 mg/day, n = 47). Before and 12 weeks after treatment, a questionnaire was used to evaluate ejaculation., Results: Among men who had sexual activity during the 12 weeks, the proportion who reported an abnormal feeling on ejaculation was higher in the tamsulosin group (16.7%) than in the naftopidil group (7.4%), although the difference was not significant (p = 0.402). The proportion of men who reported reduced ejaculatory volume after treatment was significantly higher in the tamsulosin group (96.0%) than in the naftopidil group (73.1%, p = 0.0496). On the other hand, the improvements in IPSS and the quality of life index were significantly higher in the tamsulosin group than in the naftopidil group., Conclusions: Tamsulosin may cause a higher incidence of ejaculatory disorders than naftopidil, although the efficacy of 0.2 mg tamsulosin may be better than that of 50 mg naftopidil., (Copyright 2009 S. Karger AG, Basel.)

Objective: To evaluate the effect of tamsulosin in improving symptoms in, and quality of life of, patients with indwelling double-J ureteral stents., Patients and Methods: This prospective study lasted from January 2005 to February 2007. All the patients with symptomatic lower ureteral stones with <15 mm diameter were enrolled in this prospective study, and were prospectively randomized (programs Plus 1.0 and Plus 2.10; S-Plus, Taiwan) into two groups. There was a total of 146 patients with insertion of a double-J ureteral stent after ureteroscopic stone removal. In group 1, 71 patients were enrolled and they received placebo for 2 weeks. Group 2 included 75 patients who received 0.4 mg of tamsulosin, once daily for 2 weeks. All patients completed a 10-cm linear visual analogue scale (VAS) for evaluating pain and voiding flank pain, and irritative domain of the International Prostate Symptom Scale (IPSS) before double-J stent removal 2 weeks later., Results: The mean VAS for pain was 4.01 in group 1, 1.52 in group 2, and for voiding flank pain it was 3.3 in group 1 and 1.93 in group 2. The mean score of frequency in IPSS was 3.7 in group 1 and 1.55 in group 2. The mean score of urgency in IPSS was 3.82 in group 1 and 1.43 in group 2. The mean score of nocturia in IPSS was 2.01 in group 1 and 0.65 in group 2. The mean score of quality of life in IPSS was 4.21 in group 1 and 1.6 in group 2. All p values are <0.0001 with statistical significances., Conclusions: Tamsulosin improved a subset of stent-related urinary symptoms, pain, voiding flank pain and quality of life., (Copyright 2009 S. Karger AG, Basel.)

Objectives: In order to compare the clinical efficacy of naftopidil (Naf) and tamsulosin hydrochloride (Tam), which differ in their selectivity to alpha receptor subtypes, we performed a multi-center prospective randomized controlled study., Methods: Men complaining of lower urinary tract symptoms due to benign prostatic hypertrophy, were randomized into two treatment groups: one receiving 50 mg Naftopidil daily (Naf group, n = 31 pts), and one receiving 0.2 mg Tam once daily (Tam group, n = 28 pts). Baseline symptom scores were compared to those at 2 weeks and at the end of the observation period (6-8 weeks)., Results: In the Naf group at 2 weeks, the score of the daytime frequency significantly improved from 3.5 to 2.2 (P = 0.03), and the score of nocturia improved significantly from 3.5 to 2.2 (P = 0.0004), respectively. In the Tam group at 2 weeks, however, no significant improvement was noted in the increased score of daytime frequency (P = 0.1) or nocturia (P = 0.2). At 2 weeks, the storage symptom score of the frequency to the combined score of daytime frequencies and the score of nocturia was better in the Naf group (improved from 7.0 to 4.4, P = 0.0017) than in the Tam group (from 6.8 to 4.9, P = 0.08) (P < 0.05). At 6-8 weeks, the effects of the two drugs on lower urinary tract symptoms were comparable., Conclusions: Naf demonstrated a significant early response to improve storage symptoms at 2 weeks, including daytime frequency and nocturia, compared with Tam.

Objectives: To evaluate the efficacy of tolterodine extended release (ER), tamsulosin, and tolterodine ER plus tamsulosin in men with symptoms of overactive bladder and benign prostatic hyperplasia stratified by prostate-specific antigen (PSA) level., Methods: We performed a post hoc analysis of data from men >or=40 years old with frequency and urgency (with or without urge urinary incontinence), postvoid residual urine volume <200 mL, maximal urinary flow rate >5 mL/s, International Prostate Symptom Score (IPSS) of >or=12, and quality-of-life score of >or=3. They had been randomized to placebo, tolterodine ER (4 mg), tamsulosin (0.4 mg), or tolterodine ER plus tamsulosin for 12 weeks. The men were stratified by the median baseline PSA level (>or=1.3 vs <1.3 ng/mL). Assessments included changes in bladder diary variables and IPSSs. The men rated the urgency level of each micturition, and the frequency-urgency sum was defined as the total of these ratings., Results: The PSA level correlated significantly with prostate size. Men with a PSA level of >or=1.3 ng/mL receiving tolterodine ER plus tamsulosin showed significantly greater improvements in 24-hour frequency, daytime frequency, the frequency-urgency sum, total IPSS, and IPSS storage score compared with those receiving placebo. Tamsulosin significantly improved the IPSS voiding scores, but tolterodine ER was ineffective. In men with a PSA level <1.3 ng/mL, tolterodine ER alone and tolterodine ER plus tamsulosin significantly improved the 24-hour frequency, daytime frequency, frequency-urgency sum, and IPSS storage scores compared with those receiving placebo; tamsulosin alone was ineffective. No significant changes were found in the postvoid residual urine volume or maximal urinary flow rate in any group, and the acute urinary retention rates were low., Conclusions: The results of our study have shown that tolterodine ER was efficacious in men with lower urinary tract symptoms, including overactive bladder, who had lower PSA levels (<1.3 ng/mL).

Objectives: To prospectively evaluate the effectiveness of tamsulosin in treating women with voiding difficulty., Methods: Female patients presenting chronic, bothersome voiding symptoms, combined with subnormal uroflow were treated with 0.2 mg tamsulosin daily for six weeks. Outcome analyses included the International Prostate Symptom Score and uroflowmetry with post-void residual urine. Patients achieving a 50% or greater reduction in their voiding symptom score, combined with a 30% or greater increment in their maximal flow rate were regarded as having a good therapeutic response. Subgroup analysis was performed in patients classified as having bladder outlet obstruction, or detrusor underactivity based on pressure-flow study, excluding those with indwelling catheterization or intermittent self-catheterization as well as those with anatomic obstruction., Results: Ninety-seven patients met the study inclusion criteria and were enrolled. Significant improvements in voiding symptom score, storage symptom score, maximal flow rate, post-void residual urine and voiding efficiency were observed in all patients while on tamsulosin. A good therapeutic response was observed in 35.1% of patients. Of these, 33 were classified as having bladder outlet obstruction and 52 had detrusor underactivity. Although both groups experienced significant reduction in their voiding symptom scores, patients with bladder outlet obstruction were more likely to achieve a reduction of their voiding symptom score. The magnitude of improvement in uroflow parameters as well as the proportion of patients achieving a good therapeutic response (39.4% for bladder outlet obstruction vs 32.7% for detrusor underactivity, P = 0.69) were similar between the two groups. Adverse events were mild and tolerable., Conclusions: Tamsulosin has beneficial effects in a significant proportion of women with voiding difficulty.

Purpose: We investigated whether combination therapy with dutasteride and tamsulosin is more effective than either monotherapy alone for improving symptoms and long-term outcomes in men with moderate to severe lower urinary tract symptoms and prostatic enlargement (30 cc or greater). We report preplanned 2-year analyses., Materials and Methods: The CombAT study is an ongoing, multicenter, randomized, double-blind, parallel group study. Men 50 years or older with a clinical diagnosis of benign prostatic hyperplasia, International Prostate Symptom Score 12 points or greater, prostate volume 30 cc or greater, total serum prostate specific antigen 1.5 ng/ml or greater to 10 ng/ml or less and peak urinary flow greater than 5 to 15 ml per second or less with a minimum voided volume of 125 ml or greater were randomized to 0.5 mg dutasteride, 0.4 mg tamsulosin or the combination once daily for 4 years. Symptoms were assessed every 3 months and peak urinary flow was assessed every 6 months. The primary end point at 2 years was the change in International Prostate Symptom Score from baseline., Results: Combination therapy resulted in significantly greater improvements in symptoms vs dutasteride from month 3 and tamsulosin from month 9, and in benign prostatic hyperplasia related health status from months 3 and 12, respectively. There was a significantly greater improvement from baseline in peak urinary flow for combination therapy vs dutasteride and tamsulosin monotherapies from month 6. There was a significant increase in drug related adverse events with combination therapy vs monotherapies, although most did not result in the cessation of therapy., Conclusions: In men with moderate to severe lower urinary tract symptoms and prostate enlargement (30 cc or greater) combination therapy provides a significantly greater degree of benefit than tamsulosin or dutasteride monotherapy.

After the dosage form of tamsulosin hydrochloride was changed from a capsule to on orally disintegrating tablet (ODT, Harnal D), we often received patient complaints and noted an increase in noncompliance with medication regimens. The change in dosage form appeared to cause poor compliance by patients who had become accustomed to the light pink/white capsule over many years. Therefore, we carried out a questionnaire survey of patients taking the ODT form to determine the effects of changing the dosage form and the usefulness of the ODT. Most (92%) of respondents took the ODT with water. In addition, 16% missed taking the medicine after the change in dosage form. ODT is a dosage form that is easy to take for patient with dysphagia, or those on restricted water intake. However, it appears that elderly men and patients with visual disorders cannot distinguish the ODT from other medicines and this affects patient compliance. In conclusion, all pharmaceutical companies should consider the design of medications in terms of coloration, indications, or shape in anticipation of the aging society in future, so that patients can distinguish them. Furthermore, sufficient pharmaceutical care is needed to improve both compliance and safety management for the elderly.

Objective: We attempted to determine whether tamsulosin is an efficacious therapy for the treatment of lower urinary tract symptoms (LUTS) in women., Methods: A total of 140 women, aged 27-69 years old with LUTS entered a randomized double-blind study comparing tamsulosin (70) versus placebo (70) for 1 month. The outcome variables were mean change from baseline of International Prostate Symptom Score (IPSS), mean change from baseline of mean and maximum urinary flow rate and any adverse effects., Results: Mean change from baseline of IPSS (standard deviation, SD) were -5.6 (6.3) in the tamsulosin group and -2.6 (6.1) in the placebo group. The difference was statistically significant (p = 0.008). Mean change from baseline of mean urinary flow rate (SD) was 0.7 (2.7) mL/second in the tamsulosin group and -0.5 (2.6) mL/second in the placebo group. The difference was also statistically significant (p = 0.013). However, the difference in mean change from baseline of maximum urinary flow rate between the two groups was not statistically significant (p = 0.506). There were two patients in the tamsulosin group who experienced dizziness and asthenia. No other adverse effect was detected., Conclusion: Tamsulosin is more efficacious than placebo in the treatment of LUTS in women.

There is no consensus on the evaluated efficacy of individual alpha(1)-blockers in the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). This study compared the clinical benefits of tamsulosin hydrochloride with those of naftopidil in BPH. Men aged 54-84 years with a main complaint of BPH were randomly assigned to receive consecutive treatment with tamsulosin then naftopidil (T-N group, 25 patients), or naftopidil then tamsulosin hydrochloride (N-T group, 20 patients). The therapeutic effects were compared in a crossover design. Administration was continued for 28 days in each treatment period. Both groups showed similar improvements during the first treatment period. However, during the second treatment period after crossover, therapeutic effects were greater in the N-T group. Tamsulosin was more effective than naftopidil on intermittency, nocturia and quality of life scores. Tamsulosin and naftopidil have different efficacy profiles for LUTS associated with BPH., ((c) 2007 Prous Science.)

Objectives: To determine the prevalence of nocturnal polyuria (NP, defined as a nocturnal urine fraction exceeding one third of the daily urine output in elderly men) in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and clinical responsiveness to alpha-blocker therapy., Methods: Outpatients with LUTS suggestive of BPH were included. Patients filled out the International Prostate Symptom Score questionnaire and a 7-day voiding diary, and urinalysis, prostate-specific antigen measurement, uroflowmetry, and ultrasonography were performed. Patients with NP were given alpha-blocker therapy (tamsulosin 0.4 mg/day) for 6 weeks and then re-evaluated for NP and urinary symptoms., Results: A total of 58 outpatients were included in the study. Of these, 95% had NP. The mean frequency of nocturia was 2.73 +/- 1.44 per day. A significant correlation was found between NP and the duration of LUTS (r = 0.393, P = 0.035) and the amount of water intake within 3 hours before sleep (r = 0.731, P = 0.001). Of the patients with NP, 20 were given alpha-blocker therapy. After therapy, the peak urinary flow rate had increased significantly, but NP remained unchanged in 75% of the patients., Conclusions: NP is a common symptom accompanying LUTS suggestive of BPH. Our results showed that it is significantly related to the duration of LUTS and amount of water intake before sleep. NP cannot be treated with alpha-blocker therapy, although there is improvement in LUTS suggestive of BPH.

Objectives: To compare the efficacy of two alpha(1)-adrenoceptor antagonists, alpha(1A)-adrenoceptor-selective tamsulosin hydrochloride and alpha(1D)-adrenoceptor-selective naftopidil, in the treatment of lower urinary tract symptoms (LUTS) with benign prostatic hyperplasia (BPH)., Patients and Methods: Thirty-four patients (mean age 72.4 years, sd 4.3, range 66-79) with LUTS (International Prostate Symptom Score, IPSS >8) secondary to BPH were enrolled in a randomized crossover study. Seventeen patients were initially prescribed naftopidil 50 mg for 4 weeks, followed by tamsulosin 0.2 mg for 4 weeks (group A); another 17 were initially prescribed tamsulosin 0.2 mg, followed by naftopidil 50 mg (group B). Patients changed to the alternative treatment after a 1-week washout period. Efficacy criteria were improvement in LUTS (IPSS), quality of life (QoL), uroflowmetry, and pressure-flow study (PFS) values based on the treatment with each agent., Results: At baseline there were no significant differences between the groups in IPSS, QoL, uroflowmetry values or PFS values, except for the volume at maximum desire to void. After treatment with each agent, the IPSS and QoL were significantly improved and the reduction in bladder outlet obstruction confirmed by PFS. Naftopidil was significantly more effective than tamsulosin in relieving nocturia. The increases from baseline (before treatment) to the endpoint (after treatment with each agent) in the volume at first desire and maximum desire to void were significantly higher with naftopidil than with tamsulosin. Involuntary contractions disappeared in two patients with relief of nocturia with naftopidil, but not with tamsulosin. The decrease in other symptoms of the IPSS, QoL, increase in uroflowmetry values and changes in other PFS values were similar for both agents., Conclusions: The two agents provided similar efficacy in the treatment of LUTS with BPH. However, naftopidil was better than tamsulosin for nocturia. The disappearance of involuntary contraction and the greater increase in first-desire volume with naftopidil may be associated with the relief of nocturia. The alpha(1D)-adrenoceptor antagonist is effective in alleviating both voiding and storage symptoms. The alpha(1D)-adrenoceptor antagonist may be more effective than the alpha(1A)-adrenoceptor antagonist in LUTS with BPH.

Purpose: We assessed the impact of intermittent tamsulosin treatment on abnormal ejaculation., Materials and Methods: This prospective study was performed between January 2001 and December 2004. It included 405 patients who were at least 50 years old with lower urinary tract symptoms. This study was divided into 2 phases. In phase 1 patients received a 0.4 mg tamsulosin capsule daily after breakfast for at least 3 months. The second phase of this study was performed in the 30 patients with abnormal ejaculation. In this phase these patients received 0.4 mg tamsulosin once daily every other day. Patients were assessed at study entry and at study week 6., Results: Abnormal ejaculation was reported as retrograde ejaculation by 18 patients, as decreased volume by 7 and as absent ejaculate by 5. Ejaculatory function recovered during intermittent tamsulosin treatment in 12 patients with retrograde ejaculation and in 7 with decreased volume or absent ejaculate. As a result, 19 of 30 patients (63.3%) with abnormal ejaculation recovered. A significant improvement in retrograde ejaculation was found after intermittent tamsulosin treatment (p = 0.02). Although there were improvements in decreased volume or absent ejaculate at week 6 of intermittent treatment, these differences were not statistically significant (p = 0.42 and 0.61, respectively)., Conclusions: The results of the current study, which to our knowledge is the first report of the effect of intermittent tamsulosin treatment on abnormal ejaculation, show that this treatment modality is well tolerated and provides comparable improvements for abnormal ejaculation.

Objectives: Since little investigation has been undertaken to determine if alpha1-blockers should be given continuously to sustain their efficacy, we conducted a pilot study to determine symptom change following discontinuation of tamsulosin after an initial improvement in symptoms in men with lower urinary tract symptoms (LUTS)., Patients and Methods: Thirty-three of 78 patients with mild-to-moderate prostate hyperplasia, who had symptom improvement according to the International Prostate Symptom Score (IPSS) to <10 or the quality of life (QOL) index to < or =3 after initial treatment with tamsulosin, were enrolled in this study. Subjective parameters (IPSS and QOL index) and objective parameters (maximum and mean urinary flow rates) were evaluated at baseline and after initial treatment, and 4, 8, 12 and 24 weeks after discontinuing tamsulosin., Results: The rates of successful discontinuation of tamsulosin were high throughout the follow-up period, i.e., 80.6% at 4 weeks, 80.6% at 8 weeks, 80.0% at 12 weeks, and 68.9% at 24 weeks. Temporary worsening in both subjective and objective parameters was observed only at 4 weeks; however, these parameters recovered to almost post-treatment levels at 24 weeks., Conclusion: The present study suggests that continuous treatment is not always needed to maintain urinary symptom relief in a specific subset of patients who felt symptom improvement after initial treatment with tamsulosin., (2006 S. Karger AG, Basel.)

Objective: To evaluate the efficacy and safety of two doses (10 and 15 mg) of alfuzosin once daily and tamsulosin (0.4 mg) once daily, compared with placebo, in men with benign prostatic hyperplasia (BPH)., Patients and Methods: In this randomized, double-blind, placebo-controlled, multicentre study, 625 patients were randomized to receive alfuzosin 10 or 15 mg once daily, tamsulosin 0.4 mg once daily (active reference), or matching placebo for 12 weeks, with no initial dose titration. The study was designed to compare each of the three active treatments with the placebo group. Primary outcome measures were mean changes from baseline in the International Prostate Symptom Score (IPSS) and peak urinary flow rate (Qmax) at 12 weeks, compared with placebo, using one-way analysis of variance. Because Qmax data were not normally distributed, median changes from baseline were also compared for Qmax. Pair-wise comparisons were conducted using the Dunnett correction for quantitative variables and Bonferroni-Holm correction for categorical variables, allowing for multiple treatment group comparisons., Results: Alfuzosin 10 mg significantly improved urinary tract symptoms compared with placebo, with a mean (sd) change from baseline in the IPSS of -6.5 (5.2) vs -4.6 (5.8) for placebo (adjusted P = 0.007); there was a trend toward a difference between alfuzosin 15 mg, with a mean (sd) change from baseline in IPSS of -6.0 (5.6), and placebo (adjusted P = 0.050). The mean change from baseline in IPSS with tamsulosin 0.4 mg, at -6.5 (5.6), vs placebo was also significant (adjusted P = 0.014). The median change from baseline in Qmax was significantly increased with both alfuzosin doses and with tamsulosin (all adjusted P = 0.02 vs placebo). Both doses of alfuzosin were well tolerated, with dizziness the most frequent adverse event (placebo, 4%; alfuzosin 10 mg, 6%; 15 mg, 7%; tamsulosin, 2%); the respective incidence rates of sexual function adverse events were 0%, 3%, 1% and 8%., Conclusion: Treatment with alfuzosin 10 mg significantly improved urinary symptoms and Qmax compared with placebo and was well tolerated. There were also significant improvements over placebo with the active reference, tamsulosin 0.4 mg. The incidence of sexual function adverse events was higher with tamsulosin than with placebo. The benefit-to-risk profile of alfuzosin 10 mg once daily appeared to be reduced with a higher dose (15 mg).

Objective: to assess the efficacy and tolerability of tamsulosin (0.4 mg MR o.d.)for 12 weeks in out-patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) at Italian urology centres., Material and Methods: Multicentre clinical trial in 261 patients aged > or =45 years, with a diagnosis of LUTS/BPH and total International Prostate Symptom Score (I-PSS) > or =8. Patients were given tamsulosin (0.4 mg MR o.d.) for 12 weeks and examined three times: at a screening visit (2 weeks before inclusion), at inclusion and at the end of treatment. Primary efficacy parameter: Total I-PSS score. Secondary efficacy parameters: obstructive and irritative I-PSS, I-PSS individual items, I-PSS responders, Maximum urinary flow rate (Qmax), Qmax responders. Tolerability was evaluated on the basis of AEs., Results: The total I-PSS diminished significantly by 33.1% (P = 0.0001). Both obstructive and irritative symptoms were significantly reduced by 35.4% and 30.3%, respectively (both P = 0.0001). All the 7 individual I-PSS items improved significantly (P = 0.0001), including quality of life. The mean +/-SD Qmax increased significantly by 11.1%. Seven patients (2.6%) reported 11 adverse events; hypotension was not documented as well as no cases of abnormal ejaculation were reported. All events resolved after discontinuation of treatment., Conclusion: Tamsulosin is effective and well tolerated. The low incidence or absence of documented hypotension is the main advantage of tamsulosin over the other non selective alpha blockers in the treatment of patients with LUTS/BPH within the setting of an Italian urology referral centre.

Purpose: We investigated in what is to our knowledge the first prospective study the safety and efficacy of intermittent tamsulosin therapy in patients with lower urinary tract symptoms., Materials and Methods: This study was performed between January 2001 and February 2003 in 140 patients. In phase 1 of this study patients received 1, 0.4 mg tamsulosin capsule daily for 3 months and were reevaluated after 3 months. At this assessment uroflowmetry, International Prostate Symptom Score and ultrasonographic estimation of residual urine were determined. In phase 2 responders to tamsulosin therapy were then randomized into 1 of 3 groups, namely group 1--continued 4 mg tamsulosin once daily every day, group 2--0.4 mg tamsulosin once daily every other day and group 3--discontinued tamsulosin. Efficacy assessments were done again at 4, 12 and 24 weeks., Results: There were no statistically differences among the patients in groups 1 and 2 at 6 months for International Prostate Symptom Score, maximum or average urine flow, or residual urine. Differences between patients in groups 1 and 3 were statistically significant at 6 months. Differences between patients in groups 2 and 3 were also statistically significant at 6 months for these parameters., Conclusions: Tamsulosin at a dose of 0.4 mg once daily and 0.4 mg once daily every other day for lower urinary tract symptoms provide comparable improvements in urinary flow and symptoms. Each treatment was well tolerated.

Purpose: Little has been reported on the occurrence of primary bladder neck dysfunction (PBND) in the pediatric patient, particularly as it relates to the use of alpha-blocker therapy, the mainstay of medical therapy in adults. Diagnosed on videourodynamics (VUDS), PBND is characterized by the constellation of prolonged opening time, incomplete bladder neck funneling, quiet pelvic floor electromyogram (EMG) during voiding and abnormal pressure flow parameters. We report the VUDS findings in PBND and our experience with alpha-blocker therapy in the pediatric and adolescent population., Materials and Methods: A total of 34 symptomatic patients met all VUDS criteria for PBND, and alpha-blocker therapy was initiated in 26. All patients were monitored with serial noninvasive uroflow studies with pelvic floor EMG (uroflow/EMG) before and after initiation of alpha-blocker therapy. Objective clinical response was assessed by measuring average and maximum uroflow rates, post-void residual urine volumes and pelvic floor EMG lag time, a correlate of opening time., Results: A total of 26 patients with PBND (20 males, 6 females) 5.5 to 20 years old at initiation of therapy (mean age 12.8 years) were treated with alpha-blockers. Mean average and maximum uroflow rates improved from 5.5 to 12.6 cc per second and from 10.3 to 19.7 cc per second, respectively, while mean EMG lag time decreased from 24.4 to 5.7 seconds and post-void residual urine volume from 98.9 to 8.9 cc (all p <0.001). Mean followup was 31 months, with all patients reporting significant symptomatic improvement. No patient experienced any major adverse side effects. The 8 patients with PBND who refused alpha-blocker therapy had no improvement symptomatically or urodynamically with time, and those who discontinued therapy had a return to pretreatment values., Conclusions: PBND is an often overlooked but significant cause of voiding dysfunction in children and adolescents. In our experience alpha-blockers are clinically effective therapy for PBND and have been reasonably well tolerated in our young patients for what may possibly be a lifelong problem.

Purpose: There are 2 main medical preparations available for lower urinary tract symptoms resulting from benign prostatic hyperplasia (BPH). Choosing between an alpha-blocker and a 5alpha-reductase inhibitor requires trade-offs between their attributes or characteristics. We investigated the relative importance of and trade-offs between the attributes of the 5alpha-reductase inhibitor dutasteride and alpha-blockers in community dwelling men using a validated technique., Materials and Methods: A discrete choice experiment was administered to 211 men older than 40 years who were randomly selected from the general United Kingdom population. Attributes investigated in the discrete choice experiment were time to symptom improvement, sexual and nonsexual side effects, the risks of acute urinary retention (AUR) and surgery, cost and prostate size decrease. Using regression analysis the relative importance of these attributes, the trade-offs that men are willing to make between these attributes and the willingness to pay for each attribute were estimated., Results: All attributes were important to respondents. The most important attribute was side effects. The least preferred side effects was impotence, followed by decreased libido and dizziness. Respondents were willing to wait 13, 2 and 8 months longer for symptom improvement in exchange for decreased prostate size, and the risks of AUR and surgery, respectively. Men reporting moderate symptoms were less concerned about sexual side effects, time to symptom improvement and the risk of AUR compared with men reporting mild symptoms., Conclusions: Given the attribute levels of BPH medical treatment, overall community dwelling men preferred the 5alpha-reductase inhibitor over alpha-blockers. In the interests of shared decision making it is important to consider the importance of eliciting the preferences of patients with BPH.

The article is devoted to the main principles of prophylaxis of urination disorders and infective-and-inflammatory complications after the serious operations and trauma. The authors consider that surgeons, urologists and reanimators should take into account the risk of urinary bladder long catheterization. To prevent such complications it is recommended to use the selective alpha1A/D-adrenoblocker tamsulosin. It will allow the prevention of ischuria development, restoration of adequate urination in the early postoperative period with evident economical profit of such measure.

Background: The aim of the study presented here was to stratify drug therapy for patients with benign prostatic hyperplasia (BPH) displaying various voiding symptoms., Methods: Two different alpha1-adrenoceptor antagonists; tamsulosin hydrochloride (Tam) and naftopidil (Naf ), were administered to 96 patients with BPH for 8 weeks in a crossover study., Results: With the administration of both drugs, the International Prostate Symptom Score (I-PSS) significantly decreased and the maximum urinary flow significantly increased. Whereas Naf monotherapy decreased the I-PSS for storage symptoms, Tam monotherapy decreased the I-PSS for voiding symptoms. In both the Naf-to-Tam and Tam-to-Naf groups, crossover was effective when the initial drug was judged subjectively and objectively to have been ineffective. Compliance was acceptable with both drugs., Conclusion: Our results show that either Naf or Tam can be used to treat patients on the basis of objective and subjective assessment of voiding symptoms. Our findings should be helpful for patient guidance and treatment of BPH.

Background: The therapeutic role of alpha-blockers in the treatment of voiding disorders due to benign prostatic hyperplasia has been extensively examined. To investigate a possible effect of alpha1-blocker on urodynamic voiding parameters in patients with neurogenic bladder, we conducted a clinical trial using tamsulosin., Methods: Twenty-four patients (14 men and 10 women) ranging from 24 to 82 years of age (mean age 61 years) with neurogenic bladder were analyzed. Urodynamic studies were performed before and after treatment with 0.4 mg tamsulosin daily for 4 weeks., Results: On uroflowmetry, the average flow rate (from 4.6 +/- 3.3 to 6.7 +/- 3.0 mL/s, P = 0.04), maximum flow rate (from 9.4 +/- 6.8 to 14.1 +/- 7.0 mL/s, P = 0.016) and residual urine rate (from 46 +/- 29 to 32 +/- 21%, P = 0.02) improved significantly. In patients with detrusor contraction during voiding, detrusor opening pressure and detrusor pressure at maximum flow decreased significantly from 69.0 +/- 36.2 to 49.2 +/- 26.4 cmH2O (P = 0.046) and from 66.7 +/- 34.6 to 53.6 +/- 26.5 cmH2O (P = 0.007), respectively. On the other hand, in patients with detrusor areflexia, vesical opening pressure (from 78.2 +/- 23.4 to 61.6 +/- 25.2 cmH2O), or vesical pressure at maximum flow (from 68.6 +/- 23.2 to 62.9 +/- 25.2 cmH2O) did not change significantly after treatment., Conclusion: Tamsulosin reduces functional urethral resistance during voiding and improves flow rate in patients with neurogenic bladder. It has more beneficial urodynamic effects in patients with detrusor contraction during voiding than in patients with detrusor areflexia.

Purpose: We evaluated the long-term (up to 6 years) safety and efficacy of the selective alpha 1A-adrenoceptor antagonist tamsulosin in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia., Materials and Methods: A total of 609 patients were enrolled in a 4-year multicenter open label extension study. Subjects entered the study after completion of a 1-year open label trial that included patients who previously completed up to 57 weeks of double-blind, placebo controlled studies. Maintenance doses (0.4 or 2 x 0.4 mg daily) established in the 1-year study were continued. Efficacy and safety were assessed every 3 months. Primary efficacy evaluations were changes from baseline maximum urine flow rate and total American Urological Association symptom index, and the responder rates for those 2 end points. Secondary end points were changes in American Urological Association subset scores, Boyarsky symptom scores, average urine flow rate, post-void residual urine volume, quality of life index and investigator global assessment., Results: Of the 609 patients who entered the 4-year extension study 159 had a 2-year or greater prior experience with tamsulosin, yielding a potential 6-year experience on the medication. Of this 159 patient subset 109 completed the whole 6 years. Initial rapid improvements from baseline in primary and secondary end points were maintained each year throughout the duration of the study. Tamsulosin was well tolerated, confirming the safety profile demonstrated in earlier studies. Orthostatic hypotension was observed in 1.3% of the patients., Conclusions: This study demonstrates the sustained efficacy, safety and excellent long-term tolerability of tamsulosin for up to 6 years in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia.

In this multicentre, double-blind study, patients with LUTS/BPH were randomised to 26 weeks with finasteride 5 mg once daily (n=204) or tamsulosin 0.4 mg once daily (n=199). Double-blind treatment was continued for another 26 weeks (total treatment duration: 1 y). The primary efficacy parameter was the difference in mean change in total Symptom Problem Index (SPI) from baseline to end point at week-26 in the intention-to-treat (ITT) and per protocol (PP) populations. Tamsulosin induced a greater improvement in total SPI (-5.2 points or -37%) compared to finasteride (-4.5 points or -31%) at week-26 (P=0.055 in ITT and P=0.032 in PP). Tamsulosin improved urinary symptoms (particularly the more bothersome storage symptoms) and flow more quickly than finasteride. The difference was statistically significant for the SPI from week-1 (reduction, respectively, -2.5 vs -1.8 points, P=0.043) to week-18 and for Qmax from week-1 (increase, respectively, 2.3 vs 0.7 ml/s, P=0.0007) to week-12. Both treatments were well tolerated with a comparable incidence of adverse events, including urinary retention.