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Background: Tadalafil, commonly prescribed for benign prostatic hyperplasia (BPH), may benefit patients with Type 2 diabetes mellitus (T2DM) for glycemic markers and complications. However, the association between the long‐term use of tadalafil and the incidence of T2DM has not been investigated. Methods: We emulated a target trial of tadalafil use (5 mg/day) and the risk of T2DM using a population‐based claims database in Japan. Patients who initiated tadalafil or alpha‐blockers for BPH and had no history of diabetes diagnosis, no dispensing of glucose‐lowering drugs, and no history of hemoglobin A1c levels of ≥6.5% (47–48 mmol/mol) were included. The primary outcome was the incidence of T2DM. Pooled logistic regression was used to estimate adjusted risk ratios (RRs) and 5‐year cumulative incidence differences (CIDs). Results: A total of 5180 participants initiated tadalafil treatment and were compared with 20,049 patients who initiated alpha‐blockers. The median follow‐up time for each arm was 27.2 months (interquartile range [IQR], 12.0–47.9) in tadalafil users and 31.3 months (IQR, 13.7–57.2) in alpha‐blocker users. The incidence rates of T2DM in tadalafil and alpha‐blocker users were 5.4 (95% confidence interval [CI], 4.0–7.2) and 8.8 (95% CI, 7.8–9.8) per 1000‐person years, respectively. Initiation of tadalafil was associated with a reduced risk of T2DM (RR, 0.47; 95% CI, 0.39–0.62; 5‐year CID, −0.031; 95% CI, −0.040 to −0.019). Conclusion: The incidence of T2DM was lower in men with BPH treated with tadalafil than in those treated with alpha‐blockers. Thus, tadalafil may be more beneficial than alpha‐blockers in preventing T2DM. [ABSTRACT FROM AUTHOR]

Objectives Patients and Methods Results Conclusion To define the natural distensibility of the human ureter and evaluate the impact of other possibly favourable factors on ureteric distensibility.A total of 101 patients undergoing ureteroscopic stone removal or percutaneous nephrolithotomy underwent ureteric sizing using sequential passage of 37‐cm urethral dilators in 2‐F increments while attached to a unique force sensor. Insertion forces were limited to 6 N. After 6 N was attained, an appropriately sized ureteric access sheath was passed. At the conclusion of each procedure, Post‐Ureteroscopic Lesion Scale score was determined.Urethral dilators were passed in 61% of patients at ≤14 F; 39% of patients accepted urethral dilators of ≥16 F. The mean dilator size was 14 F. Multivariate logistic regression analysis revealed that preprocedural ureteric stenting and antibiotic use favoured passage of 16‐F dilators (odds ratio [OR] 5.16, 95% confidence interval [CI] 1.70–15.62 [P = 0.004] and OR 5.15, 95% CI 1.743–15.243 [P = 0.003], respectively). Neither tamsulosin nor prior urinary tract infection had an impact on ureteric size (OR 0.765, 95% CI 0.281–2.084 [P = 0.601], OR 1.049, 95% CI 0.269–4.089 [P = 0.945], respectively).Using continuous insertion force monitoring and a 6‐N threshold, the majority of unstented adult human ureters within our patient population safely accommodated a 14‐F dilator. Safe passage of a 16‐F dilator at the 6‐N threshold was more likely among patients with a preexisting indwelling ureteric stent or patients who were treated with antibiotics within a week of the procedure. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the effect of tamsulosin combined with ginger moxibustion on lower urinary tract symptoms in elderly patients with prostatic hyperplasia. It provides basis and new way for the research and treatment of BPH. A total of 80 elderly patients with BPH and lower urinary tract symptoms admitted from March 2021 to July 2022 in our hospital were selected for the study. The patients were separated into ginger moxibustion group (G) with 40 patients and combined group (J) with 40 patients. Among them, the patients in Group G were only treated with ginger, while oral tamsulosin sustained release capsule combined with ginger was used in Group J. The course of treatment of both groups is 1 month, and the treatment is in progress. The changes of IPSS, QOL, residual urine volume, bladder volume, TCM symptom score and SF-36 score of patients in Group G and Group J were compared. Compared with Group G, the total IPSS score, SSS score, QOL score, bladder residual urine volume and TCM symptom score of Group J were lower (P<0.05) after treatment. The MFR, SF-36 score and the treatment efficiency in Group J were higher (P<0.05). Compared with simple ginger moxibustion, tamsulosin combined with ginger moxibustion can effectively improve the lower urinary tract symptoms of elderly patients with benign prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

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

Background: Impaired glucose and energy metabolism has been suggested as a pathogenic mechanism underlying Parkinson's disease (PD). In recent cohorts, phosphoglycerate kinase 1 activators (PGK1a) have been associated with a lower incidence of PD when compared with other antiprostatic agents that do not activate PGK1. Objective: We aimed to perform a systematic review and meta-analysis comparing the incidence of PD in patients taking PGK1a versus tamsulosin. Methods: We searched PubMed, Embase, and Cochrane Library for studies comparing PGK1a vs. tamsulosin in adults and elderly. The primary outcome was the incidence of PD. We computed hazard ratios (HR) for binary endpoints, with 95% confidence intervals (CIs). Statistical analysis was performed using Review Manager 5.4 and R (version 4.3.1). Results: A total of 678,433 participants from four cohort studies were included, of whom 287,080 (42.3%) received PGK1a. Mean age ranged from 62 to 74.7 years and nearly all patients were male. Patients taking PGK1a had a lower incidence of PD (PGK1a 1.04% vs. tamsulosin 1.31%; HR 0.80; 95% CI 0.71–0.90; p < 0.01). This result remained consistent in a sensitivity analysis excluding patients of age 60 years old or younger (PGK1a 1.21% vs. tamsulosin 1.42%; HR 0.82; 95% CI 0.71–0.95; p < 0.01). Conclusions: Glycolysis-enhancing drugs are associated with a lower incidence of PD when compared with tamsulosin in adults and elderly individuals with prostatic disease in use of alpha-blockers. Our findings support the notion of glycolysis as a potential neuroprotective mechanism in PD. Future investigations with randomized controlled trials are needed. Plain Language Summary: It has been suggested that impairment in glucose and energy metabolism is one of the mechanisms underlying the development of Parkinson's disease. In recent studies, medications traditionally prescribed for prostate diseases, called phosphoglycerate kinase 1 activators (PGK1a), have been associated with a lower incidence of Parkinson's disease when compared to other medications for the same purpose that do not activate the same energetic pathway. Therefore, we thoroughly reviewed the literature and combined the results of studies that compared both medications (PGK1a versus another medication that does not activate this energetic pathway, called tamsulosin), evaluating the incidence of Parkinson's disease in both groups. We included a total of 678,433 individuals, of whom 42.3% received PGK1a and 57.7% received tamsulosin. In our analysis, patients taking PGK1a had a lower incidence of Parkinson's disease when compared to the other group, even when we excluded patients younger than 60 years of age. As a result, our findings support the notion that the increase of energy metabolism is a potential neuroprotective mechanism in Parkinson's disease and future investigations are needed. [ABSTRACT FROM AUTHOR]

Introduction: The use of a ureteral access sheath (UAS) during ureteroscopy (URS) has been associated with the risk for ureteral injuries. Preoperative administration of α1-blockers presents a potential mitigator of such lesions by inducing ureteral relaxation, which may also contribute to improving other surgical outcomes. Methods: A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases for studies comparing preoperative α1-blockers administration vs its non-use in adult patients without pre-stenting undergoing URS. Binary outcomes were evaluated using risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was measured with the Cochran's Q test, I2 statistics, and prediction intervals (PIs). A DerSimonian and Laird random-effects model was utilized for all outcomes. Results: Eleven studies encompassing 1074 patients undergoing URS were included, of whom 522 (48.60%) received α1-blockers before the procedure. Preoperative α1-blockers were associated with a reduction in significant ureteral injuries (RR 0.30; 95% CI 0.17–0.53; I2 = 6%; PI 0.10–0.88) and an increase in mean successful UAS insertion (OR 2.14; 95% CI 1.08–4.23; I2 = 23%; PI 0.51–8.93). In patients undergoing exclusively ureteroscopy lithotripsy (URSL), the medications also reduced total complications (RR 0.62; 95% CI 0.46–0.84; I2 = 0%) and complications graded Clavien–Dindo III or higher (RR 0.16; 95% CI 0.04–0.69; I2 = 0%), but no significant difference between groups was found in the stone-free rate (RR 1.10; 95% CI 0.86–1.40; I2 = 91%; PI 0.47–2.59). Conclusion: Preoperative α1-blockers were linked to a decrease in significant ureteral injuries with UAS use and fewer complications during URSL procedures. However, their impact on the successful insertion of a UAS remains uncertain. Consideration of administering preoperative α1-blockers in non-stented adult patients undergoing URS with UAS is advisable. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate postoperative pupil distortion following small pupil cataract surgeries performed using B-HEX and Malyugin rings (MR). A randomized control trial was conducted from June 2020 to June 2023 at a tertiary eye-care hospital. The study consisted of 64 participants for cataract surgery with small pupil. There were two groups, one undergoing surgery with the use of B-HEX pupil expander and other with MR intraoperatively and the rest of the surgery was proceeded as per the convention. Areas of preoperative and postoperative images was calculated, put into an online software and pupil distortion was calculated in percentage. Two-tailed t-test was used to see the difference between the two groups. Mean age at presentation was 70.5 ± 10.12 years. Most common cause for small pupil was tamsulosin therapy. Mean size of small-pupil was 3.0 ± 1.1 mm. With the application of two rings, mean pupillary area preoperatively was 4178.23 ± 1589.46 and postoperatively was 6100.44 ± 2658.28 following the use of MR, respectively and 30,002.93 ± 13,193.40 preoperatively and 37,648.26 ± 15,207.01 postoperatively following the use of B-Hex ring respectively. Comparing baseline area from pupillary area at 1-month follow-up, a significant increase was noted for both the rings. Also, MR caused significantly more pupillary distortion compared to B-HEX ring (p < 0.05). MR causes significantly more pupillary distortion in the postoperative period compared to B-HEX ring. Though, both the rings cause pupillary distortion, these devices expand the surgical area adequately, ease the procedure, decrease risk of complications achieving good functional visual outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Alpha-1 adrenergic receptor antagonists (α1-ARAs) are frequently used in treatment of Hypertension and symptomatic benign prostatic hypertrophy (BPH). Numerous studies have demonstrated the association between α1-ARAs like Tamsulosin and increased surgical risks for patients undergoing cataract surgery. This study aims to identify and study the effects of α1-ARAs on iris parameters and the subsequent operative challenges encountered during cataract surgery. Methods A cross-sectional, prospective study involving 30 patients on α1-ARAs planned for cataract surgery and equal number of age and sex matched controls were subjected to evaluation of changes on iris parameters and subsequent challenges in cataract surgery. Results The study group had statistically significant lesser pupil diameter. Iris thickness at sphincter muscle region (SMR) was similar between groups (P = 0.53). Significantly lower values of iris thickness at dilator muscle region (DMR) found in treated subjects (P =

Benign prostatic hyperplasia (BPH) is a chronic disorder that inflicts severe symptoms on middle-aged men. The current study compared the effects of tadalafil and tamsulosin on urological parameters after 3 and 6 months of therapy. A retrospective case–control study was conducted, in which 100 patients with moderately severe BPH were divided into two groups based on their treatment: 50 patients were given tamsulosin 0.4 mg/day and group 50 patients were administered tadalafil 5 mg daily. All patients continued therapy for approximately 6 months, and their urological parameters were assessed at baseline and after 3 and 6 months. There was no significant difference in the overall effect on the International Prostate Symptom Score at the end of the study using two-way ANOVA analysis (P = 0.448). The intercourse number was significantly improved by tadalafil compared to tamsulosin (P < 0.001). The prostatic-specific antigen, postvoiding residual, and prostatic volumes were not significantly different between tadalafil and tamsulosin (P = 0.198, 0.163, and 0.183, respectively). In conclusion, tadalafil, 5 mg once daily, appears to have similar efficacy to tamsulosin, with significant improvement in the patient’s erectile function. Tadalafil can be used for 6 months for moderate-to-severe lower urinary tract symptoms.

Abstract Objectives This work aims to determine the efficacy and safety of preoperative alpha‐blocker therapy on ureteroscopy (URS) outcomes. Methods In this systematic review and meta‐analysis of randomised trials of URS with or without preoperative alpha‐blocker therapy, outcomes included the need for ureteral dilatation, stone access failure, procedure time, residual stone rate, hospital stay, and complications. Residual stone rates were reported with and without adjustments for spontaneous stone passage, medication noncompliance, or adverse events leading to patient withdrawal. Data were analysed using random‐effects meta‐analysis and meta‐regression. Certainty of evidence was assessed using the GRADE criteria. Results Among 15 randomised trials with 1653 patients, URS was effective and safe with a stone‐free rate of 81.2% and rare (2.3%) serious complications. The addition of preoperative alpha‐blockers reduced the need for ureteral dilatation (risk ratio [RR] = 0.48; 95% CI = 0.30 to 0.75; p = 0.002), access failure rate (RR = 0.36; 95% CI = 0.23 to 0.57; p

"Purpose: This study investigated the effect of administering tamsulosin before surgery on the successful insertion of a 12/14 French (F) ureteral access sheath (UAS) during the procedure, as well as the impact of preoperative and postoperative tamsulosin use on symptoms related to the ureteral stent. Materials and Methods: This study was a randomized, single-center, double-blinded, placebo-controlled trial involving 200 patients who underwent unilateral retrograde intrarenal surgery. Patients received either tamsulosin (0.4 mg) or placebo 1 week before surgery until stent removal. Patients were randomly assigned to one of four groups. Group 1 received tamsulosin throughout the study period. Group 2 received tamsulosin before surgery and placebo after surgery. Group 3 received placebo before surgery and tamsulosin after surgery. Group 4 received placebo before and after surgery. The USSQ (Ureteral Stent Symptom Questionnaire) was completed between postoperative days 7 and 14 immediately before stent removal. Results: A total of 160 patients were included in this analysis. Their mean age was 55.0±11.0 years, and 48 patients (30.0%) were female. In the group that received preoperative tamsulosin, the success rate of 12/14F UAS deployment was significantly higher than that of the preoperative placebo group (88.0 vs. 75.3%, p=0.038). Preoperative and postoperative tamsulosin did not significantly alleviate symptoms related to the ureteral stent. Conclusions: Our results revealed that preoperative administration of tamsulosin improved the success of larger-sized UAS, whereas preoperative and postoperative tamsulosin use did not significantly alleviate symptoms related to ureteral stents."

Background: Urolithiasis is a common condition in daily urological practice. Medical Expulsive Therapy (MET) is non-invasive approach for removal of ureteric stone. In MET, alpha-blocker Tamsulosin is commonly used in treating urolithiasis but it does not address the pathology of inflammation presents in such condition. With addition of low dose Deflazacort as anti-inflammatory agent, there may have a potential to improve the pathology and outcome of the treatment. Aims and Objectives: This study aims to find the efficacy of low-dose deflazacort combined with tamsulosin in the MET for distal ureterolithiasis. Materials and Methods: This prospective randomized controlled trial was conducted from December 2022 to December 2023 in Rampurhat Government Medical College and Hospital. A total of 130 patients with ureteric stone ≤10 mm were randomized into two groups. Tamsulosin group received tamsulosin (0.4 mg once daily for 28 days). Deflazacort group received tamsulosin (0.4 mg once daily for 28 days) with deflazacort (12 mg once daily for 10 days). All subjects were reviewed on 14 days and 28 days. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic episodes, and hospitalization were recorded. Adverse effects of drugs were noted. Results: Among 130 patients randomized, 4 patients were lost to follow-up and 8 patients required early intervention. Deflazacort group had similar rate of stone expulsion (88% vs. 80%, P=0.548). There were significantly shorter expulsion time (10.15 days vs. 14.28 days, P

Abstract Background Inserting ureteral stents is a routine intervention that often results in problems. The cornerstone for treating stent-related symptoms is pharmacological therapy. This study was conducted to evaluate and to compare the effectiveness of mirabegron, tamsulosin, solifenacin and control in reducing double-J stent-related symptoms. Results Patients were evaluated preoperatively, one week after stent insertion and two weeks after the start of medications by the Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), overactive bladder questionnaire (OAB-q) and visual analogue pain scale (VAPS). Solifenacin and mirabegron groups had significantly lower sexual scores after the 1st and 2nd weeks post-operatively (PO) when compared with the control group. Mirabegron group had significantly lower sexual scores after 1st and 2nd weeks PO when compared with patients in tamsulosin and solifenacin groups. Patients in mirabegron group had significantly fewer additional problems after the 1st and 2nd weeks PO when compared with patients in the control and tamsulosin groups. Conclusions To sum up, mirabegron was found to be superior to solifenacin in lowering urinary symptoms scores, sexual performance scores and work performance scores at both first and second weeks post-operatively. Mirabegron is a good alternative choice for SRSs when tamsulosin or solifenacin is ineffective or not tolerated.

This prospective, experimental study aims to evaluate the association between administration of α-blocker, 5α-reductase inhibitor, or anxiolytic medications and intraoperative floppy iris syndrome (IFIS) using a rabbit animal model. A total of 31 Metis rabbits were distributed into four groups as follows: 10 rabbits given tamsulosin, 10 rabbits given finasteride, 5 rabbits who received lorazepam, and 6 treatment-naive animals in the control group. Dosing was calculated according to body surface area ratio of man to rabbit, with a dosing duration of 43 days for all groups. Phacoemulsification maneuvers were performed by a single surgeon, who was blinded to group allocation. Any intraoperative billowing of the iris was noted and subsequently graded from 0 to 3. Higher incidences of iris billowing were found in the tamsulosin-dosed animals [OR = 8.33 (CI 95% 0.63–110.09)], (p = 0.13), the finasteride group [OR = 11.6 (CI 95% 0.92–147.6)], (p = 0.11), and the lorazepam group [OR = 7.5 (CI 95% 0.45–122.8)], (p = 0.24), as opposed to the control. Administration of α-blocker tamsulosin, 5α-reductase inhibitor finasteride, or anxiolytic medication lorazepam induces altered intraoperative iris behavior. These results correspond with previous studies and further solidify the hypothesis that systemic medication, administered both long and short-term, influences surgical parameters in cataract surgery. The present study can become the basis for further clinical or experimental research. [ABSTRACT FROM AUTHOR]

Purpose: Although it is known that alpha-adrenergic receptor antagonists have positive effects on metabolic parameters such as glucose metabolism, lipid profile, and insulin sensitivity, it is unclear whether this is a class effect. Tamsulosin is reported to have adverse effects on glucose metabolism and insulin resistance, and this may be because of its lack of glycolysis-enhancing effect compared with other alpha-adrenergic receptor antagonists with glycolysis-enhancing effects such as doxazosin, terazosin, and alfuzosin. The aim of this study was to compare the effect of tamsulosin on metabolic parameters with another alpha-1 adrenergic receptor antagonist, doxazosin. Methods: In this prospective, observational, controlled, 12-week clinical study, a total of 60 male patients aged ≥ 40 years who were first started on tamsulosin (n = 30; 0.4 mg/day, oral; mean age, 59.20 ± 8.97 years) or doxazosin (n = 30; 4 or 8 mg/day, oral; mean age, 58.50 ± 8.93 years) for benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) were enrolled. The groups were compared according to the changes in anthropometric and biochemical parameters (glycemia, lipid profile, and insulin sensitivity) at the end of treatment. Results: In intragroup analyses, systolic blood pressure, diastolic blood pressure, total cholesterol, and HbA1c levels decreased significantly in the doxazosin group compared with baseline (p < 0.05 for all), while no significant change was observed in the tamsulosin group. In comparisons between groups, systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels showed a significant decrease in the doxazosin group compared with the tamsulosin group (percent change: − 6.68 ± 13.08 vs. 0.53 ± 11.02, p = 0.025; − 3.63 ± 9.56 vs. 4.02 ± 10.86, p = 0.005; and − 5.62 ± 18.18 vs. 5.24 ± 15.42, p = 0.015, respectively). Conclusion: Although these results do not support previous findings that tamsulosin has adverse effects on metabolic parameters, they suggest that doxazosin treatment may be a reason for preference in patients with BPH or LUTS accompanied by metabolic disorder. [ABSTRACT FROM AUTHOR]

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

Introduction: The application of double-J ureteral stents in urology is widespread, but their use is often accompanied by complications and bothersome symptoms, affecting patients' quality of life (QoL). While various medications have been tested for alleviating the symptoms associated with double-J stents, consensus on their effectiveness remains elusive. This study aims to investigate the effectiveness of tamsulosin, solifenacin, mirabegron, desloratadine, and combination therapy using a Romanian-adapted version of the Ureteral Stent Symptom Questionnaire (USSQ). Materials and Methods: A prospective, observational, randomised trial was conducted at the Urology and Renal Transplant Clinic of Dr. "C.I. Parhon" Clinical Hospital in Iasi between 1 January 2022 and 1 August 2023. Three hundred twenty seven patients who underwent their first double-J stent insertion were evaluated with the Romanian-adapted USSQ at baseline and 30 days post-insertion. Patients were randomly divided into six groups based on the prescribed medications: control, tamsulosin, mirabegron, solifenacin, desloratadine, and combination therapy. Results: The data suggest a significant reduction in symptoms in patients who received medication compared with the control group. Furthermore, the combined medication of solifenacin 10 mg and tamsulosin 0.4 mg was particularly effective in reducing pain with statistical significance compared to the control group (p = 0.001). The highest mean scores for urinary symptom severity were observed in the control group (12.37 ± 6.82), and the lowest was in the mirabegron group (9.94 ± 5.82). The individuals who received a daily dose of 50 mg of mirabegron saw the most notable influence on their job. Conclusions: While no single medication emerged as a "miracle drug" for managing symptoms related to double-J stent insertion, the combination therapy of solifenacin and tamsulosin is the most promising option for improving symptoms related to double-J stent insertion and QoL. Additional extensive research is required to validate these initial results. [ABSTRACT FROM AUTHOR]

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

Background: Urolithiasis is a common condition in daily urological practice. Medical Expulsive Therapy (MET) is non-invasive approach for removal of ureteric stone. In MET, alpha-blocker Tamsulosin is commonly used in treating urolithiasis but it does not address the pathology of inflammation presents in such condition. With addition of low dose Deflazacort as antiinflammatory agent, there may have a potential to improve the pathology and outcome of the treatment. Aims and Objectives: This study aims to find the efficacy of low-dose deflazacort combined with tamsulosin in the MET for distal ureterolithiasis. Materials and Methods: This prospective randomized controlled trial was conducted from December 2022 to December 2023 in Rampurhat Government Medical College and Hospital. A total of 130 patients with ureteric stone ≤10 mm were randomized into two groups. Tamsulosin group received tamsulosin (0.4 mg once daily for 28 days). Deflazacort group received tamsulosin (0.4 mg once daily for 28 days) with deflazacort (12 mg once daily for 10 days). All subjects were reviewed on 14 days and 28 days. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic episodes, and hospitalization were recorded. Adverse effects of drugs were noted. Results: Among 130 patients randomized, 4 patients were lost to follow-up and 8 patients required early intervention. Deflazacort group had similar rate of stone expulsion (88% vs. 80%, P=0.548). There were significantly shorter expulsion time (10.15 days vs. 14.28 days, P<0.001) and less number of colic episodes (33 episodes vs. 21 episodes, P=0.026) and less analgesic requirements (65% vs. 82.5%, P=0.022) in deflazacort group. No significant side effects were noted during the study. Conclusion: Low-dose deflazacort added to tamsulosin provides a significant advantage in ureteric stone expulsion without any extra side effects. With a comparable rate of stone passage, there are more rapid stone expulsion, low analgesic requirement, and less colic episodes when low-dose deflazacort is added to tamsulosin for ureteric stone ≤10 mm. [ABSTRACT FROM AUTHOR]

Background: Inserting ureteral stents is a routine intervention that often results in problems. The cornerstone for treating stent-related symptoms is pharmacological therapy. This study was conducted to evaluate and to compare the effectiveness of mirabegron, tamsulosin, solifenacin and control in reducing double-J stent-related symptoms. Results: Patients were evaluated preoperatively, one week after stent insertion and two weeks after the start of medications by the Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), overactive bladder questionnaire (OAB-q) and visual analogue pain scale (VAPS). Solifenacin and mirabegron groups had significantly lower sexual scores after the 1st and 2nd weeks post-operatively (PO) when compared with the control group. Mirabegron group had significantly lower sexual scores after 1st and 2nd weeks PO when compared with patients in tamsulosin and solifenacin groups. Patients in mirabegron group had significantly fewer additional problems after the 1st and 2nd weeks PO when compared with patients in the control and tamsulosin groups. Conclusions: To sum up, mirabegron was found to be superior to solifenacin in lowering urinary symptoms scores, sexual performance scores and work performance scores at both first and second weeks post-operatively. Mirabegron is a good alternative choice for SRSs when tamsulosin or solifenacin is ineffective or not tolerated. [ABSTRACT FROM AUTHOR]

Objective: Urolithiasis is a common urological diseases and affects the daily life of patients. Medical expulsive therapy has become acceptable for many parents. We conducted a meta-analysis to determine the efficacy and safety of tadalafil compared with tamsulosin for treating distal ureteral stones less than 10mm in length. Methods: Related studies were identified via searches of the PubMed, Embase, and Cochrane Library databases. All the articles that described the use of tadalafil and tamsulosin for treating distal ureteral stones were collected. Results: A total of 14 studies were included in our meta-analysis. Our results revealed that tadalafil enhanced expulsion rate [odds ratio (OR) = 0.68, 95% confidence interval (CI): 0.47 to 0.98, p = 0.04]; reduced expulsion time [mean difference (MD) = 1.22, 95% CI (0.13, 2.30), p = 0.03]; lowered analgesia use [MD = 38.66, 95% CI (7.56, 69.77), p = 0.01] and hospital visits [MD = 0.14, 95% CI (0.06, 0.22), p = 0.0006]. According to our subgroup analysis, either tadalafil 5 mg or 10 mg did not promote expulsion rate and accelerate expulsion time compared with tamsulosin. But patients receiving 5mg tadalafil decreased analgesia usage [MD = 101.04, 95% CI (67.56, 134.01), p < 0.00001]. Conclusion: Compared with tamsulosin, tadalafil demonstrates a higher expulsion rate and less expulsion time for patients with distal ureteral stones less than 10mm with a favorable safety profile. [ABSTRACT FROM AUTHOR]

Aim: This study aims to evaluate the effectiveness and safety of administering double-dose tamsulosin (0.8 mg) for treating patients with benign prostatic hyperplasia (BPH) who have not responded to the standard single dose of tamsulosin (0.4 mg) and are deemed unsuitable for transurethral resection (TUR) intervention. Materials and methods: Between November 2022 and July 2023, we prospectively analyzed 111 patients who were experiencing severe BPH symptoms. These patients received a double dose of tamsulosin for one month. We collected baseline characteristics such as age, body mass index, and underlying medical conditions. Various parameters including the International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) levels, prostate volume, peak urinary flow rate (Qmax), voided volume, and post-void residual volume were evaluated before and after treatment. Results: All 111 patients completed the study. The mean age, PSA level, and prostate volume were 63.12 ± 4.83 years, 3.42 ± 0.93 ng/ml, and 50.37 ± 19.23 ml, respectively. Of these patients, 93 showed improvement in Qmax, post-void residual volume, and IPSS score (p-value = 0.001). The total IPSS score and total Qmax improved from 24.03 ± 2.49 and 7.72 ± 1.64 ml/sec to 16.41 ± 3.84 and 12.08 ± 2.37 ml/sec, respectively. Conclusion: Double-dose 0.8mg tamsulosin as an alpha-blocker therapy appears to be a viable temporary management option for BPH patients who have not responded to the standard single dose 0.4mg tamsulosin and are not suitable candidates for TUR intervention. [ABSTRACT FROM AUTHOR]

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: Benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) commonly coexist in aging men. Tamsulosin and tadalafil are widely used for lower urinary tract symptoms (LUTS) and ED, respectively. A combination of these 2 drugs might be useful to design new management strategies, as treatment of LUTS might affect ED. Furthermore, the effect of tadalafil alone or in combination with tamsulosin on LUTS has not been widely studied, especially in our country. We conducted a study to compare the effects of tamsulosin, tadalafil, and a combination of tamsulosin and tadalafil in patients with LUTS with or without ED. Materials and methods: In this observational study, 81 men with LUTS due to BPH were included. Patients were divided into 3 groups of 27 patients each. Group A received tamsulosin 0.4 mg/d alone, group B tadalafil 5 mg/d alone, and group C combination therapy (tamsulosin and tadalafil both). All patients were evaluated for the International Prostate Symptom Score (IPSS), the International Index of Erectile Function 5 score, the maximum urinary flow rate, and postvoid residual urine volume. Results: IPSS improvement was seen in all groups (-50.90%, P < 0.05; -28.57%, P < 0.05; and -54.83%, P < 0.05, respectively). An improvement in International Index of Erectile Function 5 was also seen in all 3 groups (+39.28%, P < 0.05; +45.9%, P < 0.05; and +55.4%, P < 0.05, respectively). Maximum urinary flow rate and postvoid residual also showed improvement in all 3 groups (33.9%, P < 0.05; 29.92%, P < 0.05; and 39.71%, P < 0.05 and -60.60%, P < 0.05; -48.51%, P < 0.05; and -62.18%, P < 0.05, respectively). Conclusion: In patients with LUTS due to BPH, tadalafil and tamsulosin, either alone or in combination, significantly reduce LUTS. In addition, these drugs significantly enhance erectile function in males with LUTS, whether taken alone or in combination. We found no statistically significant improvement in either the IPSS or the ED scores when comparing the combination group to the tamsulosin-alone and the tadalafil-alone groups. [ABSTRACT FROM AUTHOR]

Little is known about alpha blocker use in young children, particularly in those with lower urinary tract obstruction (LUTO). Therefore, we aimed to assess the safety and tolerability of selective alpha-blockers in children under 3 years of age with LUTO. A prospectively-collected database captured 93 patients born between 12/2005 and 01/2023. Assessed data included baseline characteristics, ultrasound features, blood pressure (BP), side effects and creatinine values. Primary outcome was side effects or discontinuation of alpha-blockers. Secondary outcomes were BP parameters, growth, and kidney function. Data are shown as median with interquartile range (IQR), Odds Ratio (OR) with 95% CI and mean value with standard deviation (SD). A total of 33 patients less than 3 years of age were started on alpha-blockers at 16.8 ± 11.8 months and followed for 48.9 ± 40.5 months. At last follow-up, no significant effect on systolic/diastolic BP percentiles (p > 0.9 and p > 0.9), creatinine levels (p > 0.9). Weight percentiles increased to the last follow-up (37.8 ± 33.2 vs. 53.6 ± 32.9, p = 0.0133) while height percentiles increased from 28 to 100 days to last follow-up (12.9 ± 18.3 vs. 39.6 ± 35.2, p=0.001). Four patients discontinued alpha-blockers; however, no side-effects were reported during the study period. No severe clinical or systemic side effects were observed, demonstrating safety and tolerability in young children with LUTO. Although alpha-blockers did not significantly improve kidney function in short term follow-up, and failure to thrive was not observed in these children. Additional studies with more patients are required to assess the optimal dosing and timing leading to maximal benefits for these infants. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and the safety of Tamsulosin 0.4 mg/day and 0.8 mg/day in patients suffering from lower urinary tract symptoms due to benign prostatic obstruction. Patients and Methods: A prospective interventional, double-blinded, controlled study was carried out on 93 patients who met the criteria and divided randomly into two groups: group A for Tamsulosin 0.4 mg/day and group B for Tamsulosin 0.8 mg/day. International prostate symptom score, post void residual urine volume, and maximum flow rate of urine were assessed before and after 4 weeks of treatment. Results: Both study groups showed a significant reduction in storage sub-score but only frequency was significantly reduced in group B (P < 0.001). On the other hand, Tamsulosin 0.8 mg was superior to Tamsulosin 0.4 mg regarding voiding sub-score except for straining (P = 0.325). Accordingly, the total international prostate symptom score was significantly improved in group B versus group A (P < 0.001). Furthermore, maximum flow rate and post-void residual urine volume were notably improved in Group B as compared to Group A (P < 0.001). Of all adverse events only dizziness was noted to be statistically significant in Group B versus Group A (P < 0.001). Conclusion: Tamsulosin 0.8 mg has shown better outcomes in treating patients who suffer from lower urinary tract symptoms due to benign prostatic enlargement than Tamsulosin 0.4 mg, and besides that, it is well tolerated. Trial registration number: M S 292/2020, SID: 373, date: 22/4/2020. [ABSTRACT FROM AUTHOR]

Introduction: Distal ureterolithiasis, characterized by stones in the lower ureter, poses significant challenges in clinical management. Medical expulsive therapy (MET) using Tamsulosin is a common non-invasive treatment, but its efficacy can be limited, especially for stones larger than 5 mm. Deflazacort, a corticosteroid with anti-inflammatory properties, may enhance the effectiveness of Tamsulosin by reducing ureteral inflammation and facilitating stone passage. Methods: This prospective, randomized controlled trial enrolled 80 patients with distal ureteral stones