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Background: Alpha blockers (ABs) are frequently prescribed to patients with chronic kidney disease (CKD), which is often complicated by refractory hypertension (HT). Although there have been several reports on the association between AB use and the risk of fractures, their conclusions have not yet been drawn. Therefore, this study aimed to investigate the association between AB use and the risk of fractures in patients with CKD. Method: This population-based cohort study used patient data obtained between April 2008 and August 2021 from a large-scale Japanese medical claims database. Consecutive patients with CKD who were newly prescribed ABs or non-AB antihypertensive drugs were included; males and females were analysed separately. The AB group was then divided into AB for HT and voiding dysfunction (VD) groups according to the drug approval in Japan. The primary outcome was the first hospitalisation due to fracture, and the variables were evaluated with weighted Cox proportional hazard model using overlap weights. Results: A total of 65,012, 4,723, and 10,958 males constituted the non-AB, AB for HT (doxazosin), and AB for VD (naftopidil, silodosin, tamsulosin, or urapidil) groups, respectively. A total of 31,887, 2,409, and 965 females constituted the non-AB, AB for HT (doxazosin or guanabenz), and AB for VD (urapidil) groups, respectively. In males, hazard ratio (HR) for primary outcome was not increased in the non-AB and AB for VD groups compared with the AB for HT group (HR, 0.70; 95% confidence interval [CI], 0.38–1.28 and HR, 1.33; 95% CI, 0.67–2.66, in the non-AB and AB for VD groups, respectively). Whereas, in females, although HR for the primary outcome was not increased in the non-AB group (HR, 1.06; 95% CI, 0.56–1.99), it was significantly increased in the AB for VD group (HR, 2.28; 95% CI, 1.01–5.16) compared with the AB for HT group. Conclusion: AB use in patients with CKD did not increase the risk of fractures when used for the treatment of HT; however, it increased the risk of fractures when used for the treatment of VD in females. These results suggest that ABs should be used with caution in these patients. [ABSTRACT FROM AUTHOR]

Abstract Background Alpha blockers (ABs) are frequently prescribed to patients with chronic kidney disease (CKD), which is often complicated by refractory hypertension (HT). Although there have been several reports on the association between AB use and the risk of fractures, their conclusions have not yet been drawn. Therefore, this study aimed to investigate the association between AB use and the risk of fractures in patients with CKD. Method This population-based cohort study used patient data obtained between April 2008 and August 2021 from a large-scale Japanese medical claims database. Consecutive patients with CKD who were newly prescribed ABs or non-AB antihypertensive drugs were included; males and females were analysed separately. The AB group was then divided into AB for HT and voiding dysfunction (VD) groups according to the drug approval in Japan. The primary outcome was the first hospitalisation due to fracture, and the variables were evaluated with weighted Cox proportional hazard model using overlap weights. Results A total of 65,012, 4,723, and 10,958 males constituted the non-AB, AB for HT (doxazosin), and AB for VD (naftopidil, silodosin, tamsulosin, or urapidil) groups, respectively. A total of 31,887, 2,409, and 965 females constituted the non-AB, AB for HT (doxazosin or guanabenz), and AB for VD (urapidil) groups, respectively. In males, hazard ratio (HR) for primary outcome was not increased in the non-AB and AB for VD groups compared with the AB for HT group (HR, 0.70; 95% confidence interval [CI], 0.38–1.28 and HR, 1.33; 95% CI, 0.67–2.66, in the non-AB and AB for VD groups, respectively). Whereas, in females, although HR for the primary outcome was not increased in the non-AB group (HR, 1.06; 95% CI, 0.56–1.99), it was significantly increased in the AB for VD group (HR, 2.28; 95% CI, 1.01–5.16) compared with the AB for HT group. Conclusion AB use in patients with CKD did not increase the risk of fractures when used for the treatment of HT; however, it increased the risk of fractures when used for the treatment of VD in females. These results suggest that ABs should be used with caution in these patients.

Alpha-1 adrenergic receptor (α1-AR) antagonists are commonly used for management of benign prostatic hyperplasia or hypertension. Some studies have shown a potential link between α1-AR antagonist use and cognitive impairment. Given the conflicting data surrounding α1-AR antagonists association with cognitive dysfunction, we aim to systematically review the association of cognitive dysfunction with α1-AR antagonist use to aid clinician decision both with medication initiation and continuation. A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched Ovid Cochrane, Ovid Embase, Ovid MEDLINE, Scopus, and Web of Science on March 7, 2023, with an update run on January 22, 2024. The primary outcome was cognitive dysfunction. We used Cochrane risk of bias for randomized controlled trials (RCTs) and MINORS (Methodological Index for Non-Randomized Studies) criteria for non-RCTs to evaluate study quality. This study was registered with PROSPERO (CRD42024505751). We identified 7 studies for our systematic review (3 RCTs, 4 non-RCTs). Tamsulosin was the most studied medication (6 of 7 studies). Tamsulosin was associated with no cognitive dysfunction in 2 RCTs, increased risk for dementia in 2 non-RCTs, no change in cognition in 1 non-RCT, and decreased risk for dementia in 1 non-RCT. Among 3 non-RCTs analyzing alfuzosin, it was associated with decreased risk of or no association with dementia in 2 studies and increased risk for dementia in 1 study. Doxazosin, prazosin, and terazosin were neutral or showed a negative risk for dementia. Our systematic review did not show a convincing causal association between α1-AR antagonists, including tamsulosin, and cognitive dysfunction. Considering the existing literature, it is appropriate to use α1-AR antagonists without concern for cognitive dysfunction. Future research, through robust study designs considering the multifactorial nature of cognitive dysfunction, is required to further evaluate this association.

Abstract Benign prostatic hyperplasia (BPH) may decrease patient quality of life and often leads to acute urinary retention and surgical intervention. While effective treatments are available, many BPH patients do not respond or develop resistance to treatment. To understand molecular determinants of clinical symptom persistence after initiating BPH treatment, we investigated gene expression profiles before and after treatments in the prostate transitional zone of 108 participants in the Medical Therapy of Prostatic Symptoms (MTOPS) Trial. Unsupervised clustering revealed molecular subgroups characterized by expression changes in a large set of genes associated with resistance to finasteride, a 5α-reductase inhibitor. Pathway analyses within this gene cluster found finasteride administration induced changes in fatty acid metabolism, amino acid metabolism, immune response, steroid hormone metabolism, and kinase activity within the transitional zone. We found that patients without this transcriptional response were highly likely to develop clinical progression, which is expected in 13.2% of finasteride-treated patients. Importantly, a patient’s transcriptional response to finasteride was associated with their pre-treatment kinase expression. Further, we identified novel expression signatures of finasteride resistance among the transcriptionally responded patients. These patients showed different gene expression profiles at baseline and increased prostate transitional zone volume compared to the patients who responded to the treatment. Our work suggests molecular mechanisms of clinical resistance to finasteride treatment that could be potentially helpful for personalized BPH treatment as well as new drug development to increase patient drug response.

Alpha-1 adrenergic receptor (α1-AR) antagonists are commonly used for management of benign prostatic hyperplasia or hypertension. Some studies have shown a potential link between α1-AR antagonist use and cognitive impairment. Given the conflicting data surrounding α1-AR antagonists association with cognitive dysfunction, we aim to systematically review the association of cognitive dysfunction with α1-AR antagonist use to aid clinician decision both with medication initiation and continuation. A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched Ovid Cochrane, Ovid Embase, Ovid MEDLINE, Scopus, and Web of Science on March 7, 2023, with an update run on January 22, 2024. The primary outcome was cognitive dysfunction. We used Cochrane risk of bias for randomized controlled trials (RCTs) and MINORS (Methodological Index for Non-Randomized Studies) criteria for non-RCTs to evaluate study quality. This study was registered with PROSPERO (CRD42024505751). We identified 7 studies for our systematic review (3 RCTs, 4 non-RCTs). Tamsulosin was the most studied medication (6 of 7 studies). Tamsulosin was associated with no cognitive dysfunction in 2 RCTs, increased risk for dementia in 2 non-RCTs, no change in cognition in 1 non-RCT, and decreased risk for dementia in 1 non-RCT. Among 3 non-RCTs analyzing alfuzosin, it was associated with decreased risk of or no association with dementia in 2 studies and increased risk for dementia in 1 study. Doxazosin, prazosin, and terazosin were neutral or showed a negative risk for dementia. Our systematic review did not show a convincing causal association between α1-AR antagonists, including tamsulosin, and cognitive dysfunction. Considering the existing literature, it is appropriate to use α1-AR antagonists without concern for cognitive dysfunction. Future research, through robust study designs considering the multifactorial nature of cognitive dysfunction, is required to further evaluate this association. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Premature ejaculation (PE) occurs in 31% of productive men aged 18-59 years, leading to disappointment and avoidance of sexual relations. The current guideline of treatment for PE is Dapoxetine, which possesses several adverse effects causing the limitation of long-term use. Silodosin, an alpha-1 blocker, has been proposed as a new option for treating PE due to its minimal side effects. Therefore, our study aims to assess the efficacy of silodosin in treating PE. Materials and Methods: This systematic review and meta-analysis was in accordance with Cochrane Handbook guidelines. Comprehensive literature search was conducted in several databases including PubMed, ScienceDirect, and Cochrane Central Register of Controlled Trials. The studies were included if they met the following criteria: (1) Involving premature ejaculation patients; (2) Intervention using silodosin; (3) Comparing placebo or other therapies for PE (4) Outcome includes the Intravaginal Ejaculation Latency Time (IELT) and reported adverse events related to the therapy. Study quality was assessed using Cochrane risk-of-bias criteria. Statistical analysis in this study was performed using Review Manager 5.4 Results: A total of four studies were included in this meta-analysis. Our study showed that patients who received silodosin had a significantly longer IELT compared to control (MD: 132.54, 95% CI 51.51-213.57, p

Purpose: The purpose of this American Urological Association (AUA) Guideline amendment is to provide a useful reference on the effective evidence-based management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH). Materials and Methods: The Minnesota Evidence Review Team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality (AHRQ) database to identify studies relevant to the management of BPH. The guideline was updated in 2023 to capture eligible literature published between September 2020 and October 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. Results: The BPH amendment resulted in changes to statements/supporting text on combination therapy, photoselective vaporization of the prostate (PVP), water vapor thermal therapy (WVTT), laser enucleation, and prostate artery embolization (PAE). A new statement on temporary implanted prostatic devices (TIPD) was added. In addition, statements on transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT) were removed and information regarding these legacy technologies was added to the background section. References and the accompanying treatment algorithms were updated to align with the updated text. Conclusion: This guideline seeks to improve clinicians' ability to evaluate and treat patients with BPH/LUTS based on currently available evidence. Future studies will be essential to further support these statements to improve patient care. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia is a relatively frequent condition in senior men, particularly those over 50, and is generally defined as a thickening of the prostate gland. Lower urinary tract discomfort might impact 30% of males over the age of 65 in total. This study aimed to evaluate the impact of 5 alpha-reductase inhibitors, alpha-blockers, or combination therapy on prostatic size. With this study, one hundred and four patients with benign prostatic hyperplasia have been recruited from a private clinic in Kirkuk City in the period between 2019 and 2021. A radiologist conducted ultrasound assessments to measure the volume of the prostate in centimetres (cm³) both before and, after starting treatment. The follow-up ultrasound was performed two years after initiating the treatment. Prostatic volume has a dramatic decrease in patients on 5 alphareductase inhibiter or combination therapy. This change was statistically significant as the pvalue was less than 0.05. On the other hand, patients on alpha-blocker therapy have a nonsignificant decrease in mean prostatic volume. In conclusion, 5 alpha reductase inhibiter when used alone or in combination with alpha blocker agents affects significantly prostatic size. [ABSTRACT FROM AUTHOR]

Atherosclerosis is characterized by the narrowing of the arterial lumen due to subendothelial lipid accumulation, with hypercholesterolemia being a major risk factor. Despite the recent advances in effective lipid-lowering therapies, atherosclerosis remains the leading cause of mortality globally, highlighting the need for additional therapeutic strategies. Accumulating evidence suggests that the sympathetic nervous system plays an important role in atherosclerosis. In this article, we reviewed the sympathetic innervation in the vasculature, norepinephrine synthesis and metabolism, sympathetic activity measurement, and common signaling pathways of sympathetic activation. The focus of this paper was to review the effectiveness of pharmacological antagonists or agonists of adrenoceptors (α1, α2, β1, β2, and β3) and renal denervation on atherosclerosis. All five types of adrenoceptors are present in arterial blood vessels. α1 blockers inhibit atherosclerosis but increase the risk of heart failure while α2 agonism may protect against atherosclerosis and newer generations of β blockers and β3 agonists are promising therapies against atherosclerosis; however, new randomized controlled trials are warranted to investigate the effectiveness of these therapies in atherosclerosis inhibition and cardiovascular risk reduction in the future. The role of renal denervation in atherosclerosis inhibition in humans is yet to be established. [ABSTRACT FROM AUTHOR]

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

Introduction: Alpha-1 adrenergic receptor antagonist (α1-ARA) are well established treatment for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS). Since BPH and erectile dysfunction (ED) are commonly concomitant conditions, the importance of addressing the potential role of α1-ARA in patients with ED is rising., Methods: We systemically reviewed literature for studies that assessed erectile function (EF) indices in relation to α1-ARA use. All types of comparisons were included., Results: Out of 1915 records, 21 articles have been included. All articles suffered high risk of bias. α1-ARA showed a significant improvement in EF in comparison to baseline and placebo. Some α1-ARA are more erectogenic than others. Combined therapy with phosphodiesterase-5 inhibitors improved EF better than either alone. Factors like associated lower urinary symptoms, dose, duration of therapy modify α1-ARA effects on EF., Conclusion: Αlpha1-ARAs have a potential role in improving EF in subjective and objective scales. However, the available evidence is extracted from studies on patients with other indications for α1-ARAs, particularly BPH-related LUTS. Further investigations should target patients with ED only to precisely identify their clinical utility.

Olulade Ayodele,1 Howard J Cabral,2,3 David McManus,4 Susan Jick1,5 1Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; 2Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; 3Biostatistics and Research Design Program, Boston University Clinical and Translational Science Institute, Boston, MA, USA; 4Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; 5Boston Collaborative Drug Surveillance Program, Lexington, MA, USACorrespondence: Susan JickBoston Collaborative Drug Surveillance Program, Lexington, MA, USATel +1 781 862-6660Email sjick@bu.eduBackground: Many men receive 5-alpha reductase inhibitors (5ARIs) for ongoing treatment of benign prostatic hyperplasia (BPH). The increased risk of cardiovascular complications with 5ARIs has been documented in BPH studies and the occurrence of cerebral venous thrombosis, presumably due to increased estrogen level following 5ARI use, was described in multiple case reports. The objective of this study was to determine if 5ARIs with or without alpha blockers (AB) were associated with an increased risk of venous thromboembolism (VTE) in males with BPH.Methods: We conducted a nested case–control study among a population of men ages 40– 79 who received at least one 5ARI or AB prescription for treatment of BPH between 1995 and 2015 in the UK-based Clinical Practice Research Datalink GOLD. Cases of incident VTE (pulmonary embolism [PE] or deep venous thrombosis [DVT]) and matched controls were identified from this population. We used descriptive analyses and conditional logistic regression to evaluate the risk of VTE in users of 5ARIs compared to users of ABs.Results: For 5ARI only users, the adjusted odds ratios (aORs), (95% CI) for VTE were 1.51 (0.98– 2.32) in current 5ARI users and 1.23 (0.70– 2.17) in recent/distant past, compared to AB only users. However, the aOR (95% CI) in men who had 50 or more current 5ARI prescriptions compared to users of ABs only was higher: 2.29 (1.14– 4.63). For 5ARI with AB use, the aORs, (95% CI) for VTE were 1.16 (0.64– 2.10) in current 5ARI+AB users and 1.93 (0.71– 5.25) in recent/distant past, compared to AB only users. The aOR (95% CI) in men who had 50 or more current 5ARI+AB prescriptions compared to users of ABs only was 1.65 (0.64– 4.26).Conclusion: Current use of 5ARI, particularly long-term use, is associated with an increased risk of incident idiopathic VTE compared to patients treated with AB use only.Keywords: 5ARI, BPH, VTE, alpha blocker

Pheochromocytoma in pregnancy is a life threatening condition and is very rare. Timely diagnosis, appropriate treatment and team management is necessary for decreasing maternal and fetal morbidity and mortality. A 24year old G2P1L1 with previous full term normal delivery with prior history of right adrenalectomy for right sided pheochromocytoma presented with symptoms of episodic headache, dizziness and sweating. She was diagnosed with left sided pheochromocytoma of 5cm x 2.7cm size during anomaly scan which later was confirmed by laboratory analysis. She was started on alpha-blocker and was carried till full term pregnancy with close monitoring and regular follow up. A healthy neonate was delivered by vaginal delivery with ventouse after induction of labour under epidural analgesia. Patient was stable during labour and post-partum period was uneventful. She was discharged on day 4 of the delivery with continuation of alpha-blocker.

Acute urinary retention is a common clinical presentation in emergency departments in the UK and is responsible for over 30 000 hospital admissions annually. Awareness of the latest advice and guidelines regarding its presentation, investigation and management is paramount to improve patient outcomes and reduce morbidity. Immediate management of acute urinary retention relies on timely bladder decompression by catheterisation. Knowledge of the routes and types of catheterisation, including the associated risks, complications and contraindications, is essential to allow rapid and early intervention, thus preventing further complications. Differences in the presentation of patients with acute urinary retention reflect varying aetiologies, the knowledge of which determines long-term management and prognosis. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVE: Urinary system stone disease is a common entity. Small renal stones are preferably treated using Extracarporeal Shock Wave Lithotripsy (ESWL) technique. Passage of stone fragments result in pain, hematuria and urinary tract obstruction. This can be avoided by the use selective α-1 receptor antagonists like Tamsulosin. However, their efficacy remains a matter of debate. In this study the role of selective α-1 blocker was evaluated in facilitating spontaneous expulsion of renal stone fragments after ESWL. The objective of our study was to find out the Efficacy of Tamsulosin (Selective α-1 blocker) in facilitating the transit of stone fragments (4-7mm) after ESWL. Follow up X-ray KUB was used to confirm the stone clearance. Efficacy was measured in terms of stone expulsion rate. METHODOLOGY: It was randomized controlled trial including 150 patients coming to outpatient department of Urology Lahore General Hospital, Lahore from January 25, 2010­ to July 25, 2010. Total 150 patients with renal stones broken down into fragments (4-7mm) after ESWL were enrolled using non-probability purposive sampling technique. Patients were categorized into group A and B. Patients of group A received cap. Tamsulosin 0.4mg along with Tab. Diclofenac sodium 50mg. Whereas, patients belonging to group B received only diclofenac sodium 50 mg twice daily. Patients underwent ESWL every three weeks, in case of non-fragmentation, to the maximum of 4 sessions. All the patients were followed with X Ray KUB for stone clearance. The data of all patients was incorporated into pre designed Performa. Statistical evaluation of clinical variables done in terms of efficacy i.e. stone clearance. RESULTS: Stone clearance rate of patients in group A was 86.6% as compared to only 76% in group B. Usage of selective α-1 blockers in group A enhanced the stone clearance rate as compared to group B. However this difference was statistically insignificant (p-value-0.094). CONCLUSION: There was increased stone clearance in alpha one blocker group but not statistically significant. Further studies with larger sample size are required to evaluate the role of Selective α-1 blockers (Tamsulosin) after ESWL.

Introduction: Endoscopic stent placement is an eminent procedure in urological practice and it substantially helps in reducing severe symptoms of ureteral obstruction. However, there may be few adverse events which may significantly affect the Quality of Life (QoL) of patients. These include stent related pain, sexual dysfunction, and Lower Urinary Tract Symptoms (LUTS). Appropriate therapy will reduce LUTS and improve QoL. Aim: To assess the effect of silodosin and deflazacort combination, when compared to silodosin alone, in improving symptoms and QoL in patients with indwelling Double J (DJ) ureteral stents. Materials and Methods: A randomised, controlled trial was conducted at the Department of Urology of a Tertiary Care Hospital, in Eastern India between August 2018 and December 2018; in patients with insertion of DJ stent after ureteroscopy and percutaneous stone removal. Patients were randomised into; Group A, silodosin (8 mg) once daily for two weeks and Group B, silodosin (8 mg) and deflazacort (30 mg) once daily for two weeks. Outcomes including pain, voiding flank pain, storage symptoms (frequency, urgency, nocturia), QoL were determined. Student’s t-test was used for comparison of Visual Analogue Scale (VAS) and International Prostate Symptom Scale (IPSS) scores. Results: Total 144 patients were analysed in the study and were divided into group A (n=72) and group B (n=72). The mean age was 50.93 and 50.91 years; with 60 and 58 males in Group A and B, respectively. The mean VAS for pain was 1.05 and 2.01 for group B and A (p

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

Objective: The present study systematically reviewed the safety of combined treatment with an alpha blocker and phosphodiesterase-5 inhibitor. Materials and methods: The study was performed according to the PRISMA statement. The included studies were randomized controlled trials that included at least one group on alpha-blocker monotherapy and one group on a combined treatment with an alpha blocker and phosphodiesterase-5 inhibitor. The primary endpoints were the hemodynamic effects of the two groups, specifically the clinically significant changes and a positive orthostatic test. The secondary endpoints were the adverse events of the two treatment modalities. Results: A total of 6687 studies were screened, and 19 randomized controlled trials were eligible for the meta-analysis. The combined treatment more often produced a clinically significant hemodynamic change with an MD of 4.73 (CI 1.25, 17.94; I2 = 0%; p = 0.02), but the positive orthostatic test was similar between the groups with an MD of 1.64 (CI 0.36, 7.47; I2 = 50%; p = 0.52). The meta-analysis of adverse events favored alpha-blocker monotherapy with an OD of 0.5 (CI 0.32, 0.78; I2 = 44%; p = 0.002). However, if we consider only the adverse events due to hypotension, the result was similar between the two groups with an OD of 0.97 (CI 0.58, 1.64; I2 = 0%; p = 0.92). Conclusion: The combined treatment may produce a clinically significant hemodynamic change. The combination of alpha blocker and phosphodiesterase-5 inhibitor was safe because it did not increase the rate of adverse events due to hypotension. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of erectile dysfunction (ED) is higher in patients with lower urinary tract symptoms (LUTS). Phosphodiesterase 5 inhibitors (PDE5is) can improve both ED and LUTS and therefore is useful for these patients. Our aim of this study is to evaluate whether combination therapy of alpha blockers and PDE5i is more effective than alpha-blockers monotherapy for the treatment of LUTS. Materials and Methods: A systematic review and meta-analysis were undertaken to assess the difference between the combination therapy and alpha-blockers monotherapy by searching published randomized controlled trials from electronic databases PubMed, Embase, and the Cochrane Library up to April 2018. Results: A total of 13 randomized controlled studies with 1173 patients were included in our meta-analysis. Compared with alpha-blocker monotherapy, the combination therapy obtained a significantly better improvement in International Prostate Symptom Score (IPSS) (1.73, 95% confidence interval [CI]: 1.1–2.35), voiding subscore (0.99, 95% CI: 0.54–1.44), storage subscore (0.57, 95% CI: 0.03–1.1), peak flow rate (0.69 cc/s, 95% CI: 0.27–1.1), and erectile function (EF) symptom score. Meta-regression showed that baseline IPSS, baseline peak flow rate, baseline prostate volume, age, baseline EF symptom score, and dosage of PDE5is were not associated with the difference in IPSS improvement. Conclusion: A combination of alpha blockers and PDE5is has better therapeutic effects than alpha-blocker monotherapy on LUTS related to benign prostate hyperplasia. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic stent placement is an eminent procedure in urological practice and it substantially helps in reducing severe symptoms of ureteral obstruction. However, there may be few adverse events which may significantly affect the Quality of Life (QoL) of patients. These include stent related pain, sexual dysfunction, and Lower Urinary Tract Symptoms (LUTS). Appropriate therapy will reduce LUTS and improve QoL. Aim: To assess the effect of silodosin and deflazacort combination, when compared to silodosin alone, in improving symptoms and QoL in patients with indwelling Double J (DJ) ureteral stents. Materials and Methods: A randomised, controlled trial was conducted at the Department of Urology of a Tertiary Care Hospital, in Eastern India between August 2018 and December 2018; in patients with insertion of DJ stent after ureteroscopy and percutaneous stone removal. Patients were randomised into; Group A, silodosin (8 mg) once daily for two weeks and Group B, silodosin (8 mg) and deflazacort (30 mg) once daily for two weeks. Outcomes including pain, voiding flank pain, storage symptoms (frequency, urgency, nocturia), QoL were determined. Student's t-test was used for comparison of Visual Analogue Scale (VAS) and International Prostate Symptom Scale (IPSS) scores. Results: Total 144 patients were analysed in the study and were divided into group A (n=72) and group B (n=72). The mean age was 50.93 and 50.91 years; with 60 and 58 males in Group A and B, respectively. The mean VAS for pain was 1.05 and 2.01 for group B and A (p<0.05), respectively; similarly, voiding flank pain was also significantly lower in group B (1.56) than group A (2.80) (p<0.05). Mean score for frequency and urgency were significantly lower in group B (2.16 and 1.64) than group A (3.08 and 2.85); while, score for nocturia were similar between both the groups (p=0.87). The QoL score was significantly better in group B than in group A (1.44 vs. 2.81: p<0.05). Conclusion: Combination therapy with silodosin and deflazacort, instead of monotherapy with silodosin alone, was safe and effective in alleviating stent related LUTS and improving QoL. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine whether male patients taking pre-operative selective alpha-1 adrenergic blocking agents have a lower likelihood of developing post-operative urinary retention (POUR) and a shorter length of hospitalization following lower extremity arthroplasty.Methods: A retrospective cohort study was conducted of patients who underwent primary or revision total hip or knee arthroplasty, or unicompartmental knee arthroplasty at an academic institution from January 2002 to May 2014. A cohort of male patients aged 35 and older who were taking a selective alpha-1 blocker prior to surgery (N = 229) were compared with a control group (N = 330) not taking one of these medications. Propensity score-matched logistic regression was performed to isolate the effect of taking a selective alpha-1 blocker on POUR.Results: When evaluating for the outcome of POUR while controlling for age, hypertension, benign prostatic hyperplasia, urinary tract infections, type of anaesthesia, and procedure, those patients taking an alpha-1 blocker had a 12.1% decreased relative risk (95% CI 3.4 to 20.8%; p = 0.007) of developing POUR compared with patients not taking these medications. Mean length of stay was 3.8 days (95% CI 3.6 to 4.1) in the cohort taking selective alpha-1 blockers compared with 4.7 days (95% CI 4.4 to 4.9) for the control cohort.Conclusions: After controlling for known risk factors for the development of POUR, the use of selective alpha-1 blockers pre-operatively reduces the risk of developing urinary retention after lower extremity arthroplasty and is associated with a 1-day decreased length of stay. [ABSTRACT FROM AUTHOR]

We conducted a review of evaluation erection function by assessing the expression level of nitrate oxidase in rats with neck bladder obstruction and got alpha blocker treatment. Abnormal condition of erectile dysfunction marked byitheiinability toihaveianierectioniorimaintainiiian erectioniduringiintercourse. Many factors can cause this condition. One of them is due to the low synthesis of nitric oxide. Because nitric oxide is the main mediator during erection process. Thus, nitric oxide values and erectile function are considered to have a direct relationship. While alpha blockers or alpha adrenoceptor antagonistsiplayiiiiaiiirole niiithe contraction of smooth muscle from several urinary tract organs, such as the prostate and bladder. In the case of urinary tract obstruction, alpha blockers are used as treatment. The presence of a blockade inithese receptorsiwili causeirelaxationiofithe bladderineckismoothimusclesiiiand smooth the urine flow. The uses of alpha blockers can improve erectile function. However, not all study results showes the significant differences in nitric oxide expression between before and after alpha blocker use. This may be influenced by many factors, including the type and dose of alpha blockers used. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of alpha blocker treatment on the placement of ureteral access sheaths (UAS) during retrograde intrarenal surgery (RIRS). Material and methods: This study was a retrospective analysis of prospectively collected data. Patients who underwent RIRS due to renal stones between November 2015 and December 2017 were seperated into two groups. Age, gender, body mass index (BMI), stone size, laterality, hydronephrosis degree, and renal stone density were recorded. Tamsulosin (0.4 mg/day) was prescribed to the study group (n=25) 2 weeks before the operation. The control group (n=25) underwent the operation without any additional treatment. All the operations were performed using a 7.5 Fr flexible ureteroscope and 9.5/11.5 Fr (Cook, Blooming, USA) UAS. Results: Two patients in the study group were excluded from the study as they suffered from dizziness and retrograde ejaculation. No statistically significant difference was found between the patients in the study group (n=23) and control group (n=25) in terms of age, gender, BMI, stone size, laterality, hydronephrosis, and renal stone density (p=0.470, p=0.536, p=0.456, p=0.102, p=0.555, p=0.732, and p=0.317, respectively). The UAS could be successfully placed on the first attempt in 15 (65.2%) patients in the study group and 11 (44%) patients in the control group during the first attempt itself. Even though the successful UAS placement rate was higher in the study group, no statistically significant values were observed (p=0.141). Conclusion: The data obtained from the present study showed that the use of alpha blockers prior to RIRS did not improve the UAS placement rates. It is considered that studies conducted on more patients might be able to achieve significant values. [ABSTRACT FROM AUTHOR]

Objectives: To assess the safety and efficacy of bromelain plus tamsulosin versus tamsulosin alone as medical expulsive therapy (MET) for promoting spontaneous stone passage (SSP) of symptomatic distal ureter stones. Patients and Methods: One-hundred-fourteen patients with a 4–10 mm distal ureteral stone were enrolled (Group A). Patients self-administered daily bromelain with tamsulosin for 30 days or until SSP or intervention was mandatory. Patients were compared to those from a control group taking tamsulosin as MET (Group B) and matched for the following factors: sex, age ±10%, stone diameter. A logistic regression model evaluated bromelain and the ureteral stone diameter as explanatory variables. Results: SSP rates were 87.7 vs. 75.4% for group A vs. group B respectively (p = 0.016); with no difference observed for the time to self-reported stone expulsion (11.68 vs. 11.57 days; p = 0.91). Considering larger stones (> 5 mm), the SSP rate was 83.3% in group A and 61% in group B (p < 0.01). With each millimeter increment of stone diameter, the probability of SSP decreased by 59.1% (p < 0.0001), while it increased of 3.3 when bromelain was present. Only 3 cases of tamsulosin-related adverse events were recorded. Conclusion: The association of bromelain and tamsulosin as MET increases the probability of SSP of symptomatic distal ureteral stones, with no bromelain-related side effects recorded. [ABSTRACT FROM AUTHOR]

Background: Ureteral stent placement is a routine urological procedure. However, patients inserted with ureteral stent exhibited increased urinary symptoms that compromise patients’ quality of life. Objective: To assess the efficacy of alpha blockers (Alfuzosin) in the management of ureteral stent related urinary symptoms. Methods: Total of 60 patients after ureteral stent insertion was randomly divided into two equal groups; 30 in alfuzosin group and the remaining 30 in control group. Urinary symptoms questionnaire was filled after two weeks and results were statistically analyzed. Results: Urinary symptoms like urgency, frequency and flank pain were significantly less in the alfuzosin group when compared with control group. Conclusion: Alpha blocker (Alfuzosin) was found to be effective in reducing ureteral stent related urinary symptoms. Journal of Gandaki Medical College Vol. 10, No. 1, 2017, page: 28-30

Background: Fixed Drug Eruption (FDE) is a drug reaction involving the skin and less commonly the mucosal membranes. Tamsulosin is an alpha‐1 adrenergic receptor blocker used to treat benign prostatic hyperplasia. Dizziness and headache are among its most common side effects (Singapore Med J, 2018;59:336). Although cutaneous drug eruption has been reported with other alpha‐1 adrenergic receptor blockers. Aims: Drug rash due to Tamsulosin is relatively uncommon (Singapore Med J, 2018;59:336). In this case we report an incidence of fixed drug eruption due to Tamsulosin. Patients: A 54 year old male, with benign prostatic hyperplasia was referred to our office for evaluation of certain eruptions, having developed his hyper‐pigmented patches after 2 weeks of using oral 0.4 mg Tamsulosin per day. Based on the clinical course and the skin biopsy we diagnosed the condition as Tamsulosin associated fixed drug eruption. The most important therapeutic measure was discontinuing Tamsulosin medication. Following this, his eruptions improved remarkably in a few days without complications. Results: According to previous findings, there has been no case report on fixed drug eruption caused by Tamsulosin. Conclusion: Our case is a relatively mild form of fixed drug eruption. Therefore it should be kept in mind that a severe cutaneous drug eruption might occur after Tamsulosin administration. [ABSTRACT FROM AUTHOR]

The use of beta-adrenoceptor antagonists for treatment of tachydysrhythmias secondary to sympathomimetic agents is controversial due to concerns of "unopposed alpha receptor stimulation." Labetalol is a dual alpha 1 and beta1/beta 2 adrenoceptor antagonist. We report the case of a 33-year-old male who developed rapid atrial fibrillation with a ventricular rate of 151 beats per minute in the setting of methamphetamine use. He received intravenous labetalol 10 mg on five occasions over a 6.5 h period, which slowed his ventricular rate and eventually resulted in restoration of sinus rhythm. Administration of labetolol did not produce a clinically significant rise in blood pressure. Combination alpha and beta blockade using labetalol may be an effective and safe treatment option in patients with methamphetamine associated supraventricular tachydysrhythmias. [ABSTRACT FROM AUTHOR]

Introduction: Levobupivacaine is the s-isomer of racemic Bupivacaine. It is less cardio, neurotoxic and equally potent local anaesthetic compared to its racemate. It is known to cause less Depression of myocardial contractility. Dexmeditomidine when used via epidural route has synergistic effect with local anaesthetics. Majority of patients presenting for vascular surgery are elderly and have associated co-morbidities like diabetes, hypertension, and coronary artery disease. We intend to study safety and efficacy of epidural Levoupivacaine and Dexmedetomidine in this group of patients. Materials and Methods: Sixty adult patients undergoing lower limb vascular surgery under lumbar epidural anaesthesia were randomly allocated to three groups. All groups were preloaded with 10ml/kg of crystalloid solution. B group was scheduled to receive 15 ml of racemic Bupivacaine, L-group was scheduled to receive 15ml of Levobupivacaine and LD-group received 15ml of Levobupivacaine with 0.5 mics/kg Dexmeditomedine. Time to onset of sensory block to T-10, maximum sensory level achieved, Bromage scale, time to two segment regression, time to total regression, sedation level achieved and patients assessment of quality of anaesthesia were assessed. Haemodynamic parameters were monitored throughout study period. Adverse effects were noted and treated appropriately. Results: Baseline parameters were comparable among all the groups. Time to onset of sensory block to T-10 and maximum level of block achieved, was comparable among the groups. Time to two segment regression and time to total regression was significantly prolonged in LD group compared to other two groups. There was significant bradycardia noted in LD group which required treatment. Conclusion: Levobupivacaine can be safely used in elderly high risk patients undergoing vascular surgery. Addition of dexmedetomidine prolongs the duration of anaesthesia and postoperative analgesia.