α1‐blocker tamsulosin as initial treatment for patients with benign prostatic hyperplasia: 5‐year outcome analysis of a prospective multicenter study

Abstract

Abbreviations & AcronymsObjective: To comprehensively analyze the 5-year outcomes of tamsulosin treatment for patients with benign prostatic hyperplasia. Methods: Tamsulosin (0.2 mg/day) was given to 112 patients who had International Prostate Symptom Scores Ն8. They were prospectively followed for 5 years with periodic evaluation. If tamsulosin had to be discontinued, the reason was determined. Treatment failure was considered in the case of disease progression (postvoid residual urine volume Ն200 mL, acute urinary retention, febrile urinary tract infection or hydronephrosis as a result of bladder outlet obstruction), conversion to other a1-blockers or need for surgery. An intention-to-treat analysis was carried out. Results: A total of 34 patients (30.4%) continued the same medication for the overall study period, whereas 78 patients (69.6%) discontinued the medication. International Prostate Symptom Scores, Benign Prostatic Hyperplasia Problem Index and Quality of Life Index were significantly improved over the 5-year period. Treatment failure was observed in 21 patients (18.8%). Baseline prostate volume and postvoid residual urine volume were independent factors to predicting treatment failure. A total of 21 patients (18.8%) discontinued tamsulosin because of an improvement of symptoms. They were younger and had lower prostate-specific antigen levels than the remaining 91 patients. Their symptoms were stable even 1 year after termination of therapy. Conclusions: Long-term efficacy of tamsulosin was observed, although only a small portion of patients continued the treatment. a1-blocker monotherapy might be not appropriate for achieving a good long-term outcome in patients with a large prostate volume and a large amount of postvoid residual urine volume. Persistent improvement of symptoms, even after termination of tamsulosin, was observed in young patients with low prostate-specific antigen levels.

Perioperative use of tamsulosin significantly decreases rates of urinary retention in men undergoing pelvic surgery

“…Alpha-1 blockers such as tamsulosin are routinely used for benign prostatic hypertrophy and UR [11]. They work by relaxing the detrusor muscles and facilitating bladder emptying.…”

The Persistence of Silodosin Monotherapy and the Reasons for Withdrawal from Treatment of Previously Untreated Japanese Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

“…Therefore, the continuation rates with α 1-adrenoceptor antagonists for LUTS/BPH have been prospectively studied. Masumori et al reported that the continuation rates for tamsulosin at 5 years and for naftopidil at 3 years were 30.4% and 21.4%, respectively [14, 15]. Yamanishi et al reported that the continuation rate for silodosin at 6 years was 25% [13].…”

“…Since 5 α -reductase inhibitors have been approved in Japan since 2009, all patients enrolled between 2007 and 2009 in this study were treated with silodosin monotherapy (4 mg) twice daily as its routine prescription in Japan. The scheduled number of the enrolled patients was 100 according to previous similar studies [14, 15]. Most patients were prescribed silodosin at one- or two-months intervals.…”

“…However, one-quarter of the reasons for withdrawal were not clear because these patients did not come back to the hospital. Masumori et al prospectively investigated the persistence of tamsulosin and naftopidil for the treatment of LUTS/BPH and reported the reasons for withdrawal, including those of the patients who did not come back to the hospital [14, 15]. …”

Additional correction of OAB symptoms by two anti-muscarinics for men over 50 years old with residual symptoms of moderate prostatic obstruction after treatment with Tamsulosin

“…But they are not always effective for treating symptoms of NAC [7]. If patients have strong concomitant symptoms of OAB, strategy of substitution of a1-blocker with anti-cholinergic agent, additional simultaneous prescription of anti-muscarinic drug and substitution of a1-blocker with other drug of the same group is used [8,9]. Sixth International Consultation On New Developments in Prostate Cancer and Prostate Diseases [10] and some special studies [11] adopted recommendations on combined administration of a1blocker and anti-cholinergic drugs as a rational therapy for obstruction of urethra in prostatic gland area associated with symptoms of OAB.…”