Comparison of Different Alpha-blocker Combinations in Male Hypertensives with Refractory Lower Urinary Tract Symptoms

Lee, Keon-Cheol; Kim, Jong Gu; Cho, Sung Yong; Jeon, Joon Sung; Cho, In Rae

doi:10.5534/kja.2011.29.3.242

Korean J Androl

2011

DOI: 10.5534/kja.2011.29.3.242

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Comparison of Different Alpha-blocker Combinations in Male Hypertensives with Refractory Lower Urinary Tract Symptoms

Keon-Cheol Lee

Jong Gu Kim²,

Sung Yong Cho

et al.

Abstract: Results:The 269 patients (71.9%) were followed for at least 1 year (D group n=84, DT group n=115, and DF group n=70). The clinical parameters before and after initial 4 mg/day doxazosin were not different among the 3 groups. IPSS improvement after 3 months and maximal flow rate (Qmax) improvement after 3 and 12 months were significantly higher in the D and DT groups than the DF group (p＜0.05). Sitting systolic and diastolic BP of the D group decreased larger than those of the other 2 groups (p＜0.05). At least … Show more

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Cited by 3 publications

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Evaluation of Alpha 1 Adrenoceptor Antagonist Dose Increase Therapy: An Essential Strategy for Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

Watanabe

Yamaguchi²,

Κakizaki

et al. 2020

Current Urology

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Introduction: There have been a number of reports on dose increase therapy (DI-T) with the alpha 1 adrenoceptor antagonists (α1-blockers) naftopidil and tamsulosin for lower urinary tract symptoms associated with benign prostatic hyperplasia. Methods and Results: The reports on DI-T (naftopidil 75 mg/d, tamsulosin 0.4 mg/d) in non-responders to low-dose initial therapy (LI-T, naftopidil 50 mg/d, tamsulosin 0.2 mg/d) were summarized. In each study, a non-responder was defined as a patient without sufficient improvements on the International Prostate Symptom Score (IPSS), IPSS Quality of Life, maximum flow rate of urine, or treatment satisfaction. These reports showed that 22.4-76.1% of patients were non-responders to LI-T, indicating that a novel treatment strategy for such patients is important. Moreover, 22.5-90.0% of non-responders to LI-T showed a response to DI-T, which achieved the same level of efficacy as low-dose maintenance therapy. Specifically, the improvements of the IPSS voiding symptom sub-score and maximum flow rate of urine were superior. The predictive factors for non-response to α1-blockers LI-T were insufficient improvement of subjective symptoms and objective findings during LI-T. These patients require high-dose initial therapy or DI-T at an early stage, since adverse events associated with naftopidil and tamsulosin do not show a dose-response relationship. Conclusions: DI-T with α1-blockers has high potential as an essential treatment strategy for lower urinary tract symptoms associated with benign prostatic hyperplasia.

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Evaluation of Alpha 1 Adrenoceptor Antagonist Dose Increase Therapy: An Essential Strategy for Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

Watanabe

Yamaguchi²,

Κakizaki

et al. 2020

Current Urology

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Clinical Significance of Transrectal Ultrasonography and Efficacy of Dutasteride Treatment in Patients with Hemospermia

et al. 2011

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Purpose: The aims of this study were to investigate the clinical significance of transrectal ultrasonography (TRUS) and the efficacy of dutasteride (5α-reductase inhibitor) in patients with hemospermia. Materials and Methods: From January 2005 to December 2008, 60 patients with hemospermia were enrolled in the study. All patients underwent a digital rectal examination and TRUS; serum prostate specific antigen was also measured. The management of hemospermia was one of the following: watchful waiting, dutasteride treatment, or antibiotics with dutasteride. Results: Thirty-four patients (56.7%) had positive findings on TRUS. There were 16 cases (26.7%) of prostate calcification, 13 cases (21.7%) of ejaculatory duct cyst, 3 cases (5%) of ejaculatory duct calcification, a case of seminal vesicle inflammation, and a case of ejaculatory duct dilation. Dutasteride treatment resulted in improvement of symptoms in 87.9% (29/33) of the cases, whereas treatment with antibiotics or antibiotics with dutasteride resulted in a 100% (6/6) success rate. However, among 14 watchful waiting patients, only 3 patients (21.4%) showed an improvement of symptoms. Conclusions: This study showed that TRUS is an easy and effective method for the assessment of hemospermia, and also revealed that dutasteride could be a useful agent in the treatment of hemospermia.

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Experience of Combination Therapy with Alpha Adrenergic Receptor Antagonist and Anticholinergic Agent in Patients with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: 12 Month Follow-up

Seo

Kim

2011

Korean J Androl

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= Abstract =Purpose: Through more than 12 months of follow-up, the efficacy and safety of combination therapy with alpha adrenergic receptor antagonist and anticholinergic agent was investigated retrospectively. Materials and Methods:This study retrospectively analyzed the data of 84 patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) who were managed with an alpha adrenergic receptor antagonist and anticholinergic agent for at least 12 months between Jan 2007 and Dec 2010. On patients' first visit to our department, we obtained the patients' demographic data and information about the prostate total volume, serum prostate specific antigen (sPSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR) of each patient. After 12 months, changes in the above factors and the side-effects of anticholinergic agents were investigated. Results:The mean age of the patients was 66.1 years and the total observation period after drug administration was an average 20 months; the total sPSA and prostatic volume of patients was 1.8±0.8 ng/dl and 37.3±9.5 g, respectively. Qmax in uroflowmetry was improved after 12 months of medication (changed from 9.0±3.4 to 13.8±4.5 ml/sec; p＜0.001). PVR was increased from 35±22.2 ml to 49.3±37 ml (p＜0.001), but the change was not clinically significant, and no acute urinary retention occurred. The total IPSS score decreased from 21.4±5.1 to 13.3±4.6 (p ＜0.001), the storage score of IPSS decreased from 9.8±2.4 to 5.6±2 (p＜0.001), and the voiding score was decreased from 11.6±3.7 to 7.7±3.2 (p＜0.001). The QoL with IPSS was improved from 4.2±0.8 to 2.8±0.7 (p＜0.001). During the 12 months there were 34 patients (56 cases) of adverse events. However, no serious adverse events were reported. Conclusions:Combination therapy with alpha adrenergic receptor antagonist and anticholinergic agent was safe and made an improvement in LUTS in patients with BPH and storage symptoms.

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Comparison of Different Alpha-blocker Combinations in Male Hypertensives with Refractory Lower Urinary Tract Symptoms

Cited by 3 publications

References 27 publications

Evaluation of Alpha 1 Adrenoceptor Antagonist Dose Increase Therapy: An Essential Strategy for Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

Evaluation of Alpha 1 Adrenoceptor Antagonist Dose Increase Therapy: An Essential Strategy for Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

Clinical Significance of Transrectal Ultrasonography and Efficacy of Dutasteride Treatment in Patients with Hemospermia

Experience of Combination Therapy with Alpha Adrenergic Receptor Antagonist and Anticholinergic Agent in Patients with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: 12 Month Follow-up

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