PurposeWe evaluated and compared the efficacy of tamsulosin and alfuzosin in the medical treatment of symptomatic, uncomplicated distal ureteral stones.Materials and MethodsA total of 87 patients with distal ureteral stones of ≤10 mm were randomly divided into 3 groups. Group I patients (n=29) received 0.4 mg tamsulosin daily, group II patients (n=30) received 10 mg alfuzosin daily, and group III patients (n=28) were not given tamsulosin or alfuzosin. Patients in all groups received Diclofenac sodium regularly for 1 week and then on demand. Follow-up was done on a weekly basis for 30 days.ResultsThe mean stone size was comparable in the 3 groups (4.97±2.24, 5.47±2.13, and 5.39±1.81 mm, respectively). The stone expulsion rate was 86.2%, 76.6%, and 50% in groups I, II, and III, respectively. The difference in groups I and II with respect to group III was significant (p=0.0028 and 0.035). The mean expulsion time for groups I to III was 7.52±7.06, 8.26±7.34, and 13.90±6.99 days, respectively. The expulsion time was significantly shorter in groups I and II than in group III (p=0.0097 and 0.026). Patients taking tamsulosin and alfuzosin had fewer pain attacks than did group III patients (1.24±0.57 vs. 1.43±0.67 vs. 1.75±1.17). Only 3 cases of drug side effects, 2 in group I and 1 in group II, were recorded.ConclusionsThe use of tamsulosin or alfuzosin for the medical treatment of lower ureteric stones proved to be safe and effective. Moreover, tamsulosin did not have any significant benefits over alfuzosin.

Purpose. We evaluated the effectiveness and safety of tamsulosin, solifenacin, and combination of both in reducing double-J stent-related lower urinary symptoms. Materials and Methods. A total of 338 patients with double-J ureteral stenting were randomly divided, postoperatively, into 4 groups. In group I (n = 84), no treatment was given (control group), group II (n = 85) received tamsulosin 0.4 mg daily, group III (n = 84) received solifenacin 10 mg daily, and group IV (n = 85) received a combination of both medications. Before insertion and 2 weeks after, all patients completed the International Prostate Symptom Score (IPSS), quality of life component of the IPSS (IPSS/Qol), Overactive Bladder Questionnaire (OAB-q), and Visual Analogue Pain Scale (VAPS) questionnaire. Results. The demographics and preoperative questionnaires scores of all groups were comparable. There were statistically significant differences in all scores in favour of groups II, III, and IV as compared to control group (P value < 0.005). Group IV showed statistically significant differences in total IPSS, QoL score, and OAB-q score as compared to groups II and III (P value < 0.001). Conclusions. Combined therapy of tamsulosin and solifenacin significantly alleviated lower urinary symptoms associated with double-J stents as compared to either medication alone.

The addition of low-dose oral desmopressin therapy to an α-blocker tamsulosin provides effective treatment for nocturia in patients with LUTS/BPH.

ObjectiveTo evaluate the outcome of the expectant management of ureteric stones and to determine the factors predictive of the spontaneous passage of stones.Patients and methodsWe retrospectively reviewed the medical records of patients who had ureteric stones of ⩽10 mm and who were treated conservatively at our institutions during the period 2008–2013. The stone-passage rate and time, and different clinical, laboratory and radiological variables, were analysed.ResultsIn all, 163 patients with ureteric stones were enrolled in the study, of whom 127 (77.9%) passed their stones spontaneously, with a mean (SD) passage time of 24.0 (8.09) days. The cumulative stone-passage rate was 1.6%, 15%, 41.7%, 72.4%, 89.8% and 98.4% at 7, 14, 21, 28, 35 and 42 days from the first presentation, respectively. Patients with a high pain-scale score, stones of ⩽5 mm, a lower ureteric stone, a high white blood cell count and those with absent computed tomography (CT) findings of perinephric fat stranding (PFS) and tissue-rim sign (TRS) had a higher likelihood of spontaneous stone passage. Patients with stones of ⩽5 mm, stones in the lower ureter and those with no PFS had a shorter spontaneous passage time. In a multivariate analysis the absence of PFS and TRS were the only significant predictors for spontaneous stone passage (P < 0.001 and 0.002, respectively).ConclusionsThe spontaneous ureteric stone-passage rate and time varies with different factors. The absence of CT findings of PFS and TRS are significant predictors for stone passage, and should be considered when choosing the expectant management.

Objectives: To assess the efficacy of adjunctive tamsulosin therapy in improving the success rate of laser-assisted semi-rigid ureteroscopy (URS) for removing proximal ureteral stones. Patients and Methods: This prospective study included 165 patients with proximal ureteral stones ≥10 mm. The patients were randomly assigned to a tamsulosin group (Group I, n = 81) receiving tamsulosin 0.4 mg daily for 1 week pre-URS and a control group (Group II, n = 84) without tamsulosin therapy. Treatment consisted of URS using a semi-rigid ureteroscope (7.5 Fr), followed by intracorporeal holmium: YAG laser lithotripsy. The patients were followed up regularly for 8 weeks after URS. Results: The operative time was 43.4 and 49.6 min in Groups I and II, respectively (p < 0.001). Scope to stone access rate was 93.8 and 82.1% in patients of Groups I and II, respectively (p = 0.022). The stone-free rate was significantly higher in Group I compared to Group II (74/81; 91.4% vs. 67/84; 79.8%; p = 0.035). The complication rate was significantly lower in Group I compared to Group II (17.3 vs. 38.1%, p = 0.003). Only minor complications were encountered and were managed conservatively. Conclusions: Tamsulosin therapy prior to semi-rigid URS improved ureteroscopic access to proximal ureteral stones, thus leading to an increased success rate and low morbidity.

This hospital-based, prospective study was conducted to evaluate the relationship between body mass index (BMI) and various semen parameters in infertile men. A total of 439 men presented for infertility evaluation were assessed by basic infertility evaluation measures including semen analysis and BMI calculation. The main outcome measure was the relationship between BMI groups [BMI: 18.5-24.9 kg/m (normal weight), 25-29.9 kg/m (overweight) and ≥30 kg/m (obese)] and different semen parameters [volume, concentration, motility and morphology]. The mean BMI was 29.67 ± 5.89. Most of patients (82.91%) were overweight or obese. The 3 BMI groups were comparable in semen parameters (P > 0.05). BMI had a negative correlation with various semen parameters. However, this correlation was significant only with sperm concentration (P = 0.035). We concluded that sperm concentration was the only semen parameter which showed significant reduction with higher BMI in infertile men.

In a prospective manner, we studied the effect of varicocelectomy on premature ejaculation and testicular hormonal function in patients with varicocele. Microsurgical subinguinal varicocelectomy was carried out in 73 patients with clinical varicocele associated with premature ejaculation (group 1) and compared with 56 patients without operative intervention (group 2; control). The primary efficacy variable was the mean change in the Premature Ejaculation Diagnostic Tool. The changes in International Index of Erectile Function questionnaire, total serum testosterone and testicular size were also assessed. In group 1, the Premature Ejaculation Diagnostic Tool decreased significantly after varicocelectomy, from 15.56 to 11.37 (P < 0.001), indicating improvement of premature ejaculation. Thirty patients (41.1%) showed improvement of premature ejaculation compared to 5.3% in the control group (P < 0.001). In group I, but not in group II, testosterone levels and International Index of Erectile Function values increased significantly when compared with pre-operative values (P< 0.001 and 0.040 respectively). Testicular size increased after varicocelectomy, but this increase was nonsignificant till the end of study (P = 0.054). We concluded that varicocelectomy is clearly related to improvement of premature ejaculation and testicular hormonal function in varicocele patients.

Objective:To improve the clearance of lower caliceal stones (LCSs) after shock wave lithotripsy (SWL) using a combination of intra-operative forced diuresis and inversion therapy.Materials and Methods:One hundred and fifty-seven consecutive patients with symptomatic, single LCSs of 5–20 mm size were prospectively randomized into two groups. The first (study group, SG) underwent SWL at the time of the maximum diuresis with the patient in the Trendelenburg position with an angle of 30 degree, while the second group (control group, CG) underwent standard SWL. After the last SWL session, patients were followed-up regularly using plain abdominal X-ray and renal ultrasound. The primary endpoint of the study was the stone-free rate (SFR) at 12 weeks.Results:A total of 141 patients completed the study treatment protocol and follow-up: 69 patients in SG and 72 patients in CG. Both groups were comparable in baseline data. SG showed significantly higher SFR at all follow-up time points. At week 12, 78.3% of SG were rendered stone free, whereas only 61.1% were stone free in CG (P = 0.030). Also, there was a significantly higher SFR for larger stones (>10 mm) and stones with higher attenuation value (>500 Hounsfield units) in SG than CG. Mild non-significant complications were reported in both groups.Conclusion:SWL with intraoperative forced diuresis and inversion seems to be an effective measure with minimal extra cost to improve LCS clearance post-SWL.