RESUMO
OBJECTIVE: To investigate the efficacy and safety of vibegron add-on therapy in men with persistent storage symptoms receiving α-1 blockers or PDE5 inhibitor for benign prostatic hyperplasia and then determine the independent factors affecting the efficacy of vibegron. METHODS: Vibegron 50 mg was administered for 12 weeks to 42 patients (72.0 ± 8.2 years) with persistent storage symptoms who had taken α-1 blockers (22 patients) or PDE5 inhibitor (20 patients). The primary endpoint was change in the overactive Bladder (OAB) Symptom Score from baseline to end of treatment. The secondary endpoints were changes in each question of several questionnaires, maximum flow rate and residual urine volume. Finally, independent factors affecting the efficacy of vibegron were investigated. RESULTS: Total OAB Symptom Score was significantly decreased (6.21 ± 3.12 vs 4.38 ± 2.46; P < .001). Although each score of several questionnaires, especially for storage symptoms, improved significantly, no significant improvement was found in stress incontinence, straining, bladder pain and urethral pain in the Core Lower Urinary Tract Symptom score. Maximum flow rate and residual urine volume did not change, and no patient discontinued vibegron because of adverse events. Multiple regression analysis showed that OAB Symptom Score, Core Lower Urinary Tract Symptom score, prostate volume and monotherapy with α-1 blocker were independent factors affecting the efficacy of vibegron. CONCLUSION: Add-on therapy of vibegron to monotherapy with α-1 blockers or PDE5 inhibitor for patients with benign prostatic hyperplasia and persistent storage symptoms was effective and safe.
Assuntos
Hiperplasia Prostática/tratamento farmacológico , Pirimidinonas/uso terapêutico , Pirrolidinas/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Antagonistas Adrenérgicos alfa/uso terapêutico , Idoso , Quimioterapia Combinada , Humanos , Masculino , Inibidores da Fosfodiesterase 5/uso terapêutico , Estudos Prospectivos , Hiperplasia Prostática/complicações , UrodinâmicaRESUMO
OBJECTIVES: To investigate the efficacy of tadalafil for patients with benign prostatic hyperplasia and chronic prostatitis/chronic pelvic pain syndrome. METHODS: Tadalafil 5 mg was given each morning for 12 weeks to patients diagnosed as having either moderate or severe lower urinary tract symptoms. Voiding symptoms were compared between patients with a high (≥4; high group) and low (<4; low group) pain subscore of the National Institutes of Health Chronic Prostatitis Symptom Index before and after tadalafil administration. The correlation between changes in the Chronic Prostatitis Symptom Index and the International Prostate Symptom Score during treatment was also investigated. RESULTS: At baseline, the pain subscore of the Chronic Prostatitis Symptom Index was high (≥4) in 24 of 74 (32.4%) patients. The International Prostate Symptom Score in the group with a high pain subscore was significantly higher than that in the group with a low pain subscore. International Prostate Symptom Score, National Institutes of Health Chronic Prostatitis Symptom Index total score and pain subscore were all significantly improved after treatment. The change in the Chronic Prostatitis Symptom Index total score correlated positively with the change in the International Prostate Symptom Score. The decrease in the International Prostate Symptom Score was significantly greater in the group with high versus low pain subscore. CONCLUSIONS: Tadalafil is sufficiently effective in the treatment of patients with benign prostatic hyperplasia and severe chronic prostatitis/chronic pelvic pain syndrome.
Assuntos
Inibidores da Fosfodiesterase 5/uso terapêutico , Hiperplasia Prostática/tratamento farmacológico , Prostatite/tratamento farmacológico , Tadalafila/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Prostatite/complicações , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
Multiple tumors in the liver, kidney, and on the posterior side of the urinary bladder were accidentally found when a diabetic woman visited the hospital. She refused to undergo surgery; therefore, she was only observed for 2 months. Subsequently, she was found unconscious at home and diagnosed with urinary infection, sepsis, and hyperglycemic hyperosmolar non-ketotic coma. The case followed a fulminant course, and she soon died. Postmortem computed tomography revealed emphysematous pyelonephritis (EPN), a rare, life-threatening infection. This case highlights the importance of carefully managing infection in diabetic patients, and it may contribute to clarifying the pathogenesis of EPN.
Assuntos
Complicações do Diabetes , Nefropatias Diabéticas/diagnóstico , Neoplasias Renais/diagnóstico , Pielonefrite/diagnóstico , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/etiologia , Nefropatias Diabéticas/complicações , Evolução Fatal , Feminino , Humanos , Neoplasias Renais/etiologia , Pessoa de Meia-Idade , Pielonefrite/etiologiaRESUMO
OBJECTIVE: This study evaluated the 5-year failure rate of naftopidil (NAF) or tamsulosin hydrochloride (TAM) in lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH/LUTS) and compared the prognostic factor of two alpha(1)-blockers. MATERIAL AND METHODS: A total of 131 patients with International Prostate Symptom Score (IPSS) >or= 8 or IPSS quality of life (IPSS-QOL) >or= 3 with BPH/LUTS receiving treatment with alpha(1)-blockers had been administered NAF or TAM, and failure rates were calculated for 5 years. Age, prostate volume (PV), acute urinary retention (AUR), overactive bladder (OAB), IPSS, IPSS-QOL and postvoiding residual volume (PVR) were evaluated as prognostic factors. RESULTS: No significant differences in failure rate were observed between the drugs. The failure rate was significantly high for patients with a PV >or= 35 ml, PVR >or= 30 ml, a history of AUR or complications of OAB symptoms. The failure rate for patients with a history of AUR was significantly higher than in those without AUR in the NAF group. By contrast, in the TAM group, it was significantly higher in patients who had OAB symptoms than in those without OAB. CONCLUSIONS: No significant differences were observed between the drugs for the failure rate. Each treatment had a unique factor for prognosis, such as history of AUR for NAF and complications of OAB for TAM. Therefore, it will be necessary to use the two alpha(1)-blockers properly, considering the patient's background.
Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Naftalenos/uso terapêutico , Piperazinas/uso terapêutico , Hiperplasia Prostática/complicações , Prostatismo/tratamento farmacológico , Prostatismo/etiologia , Sulfonamidas/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Estudos Retrospectivos , Tansulosina , Fatores de TempoRESUMO
AIM: The aim of this study was to compare the efficacy and safety of alpha1-adrenoceptor (alpha1-AR) antagonist monotherapy with combination therapy using alpha1-AR antagonist and anticholinergic agent for benign prostatic hyperplasia (BPH) with storage symptoms as the chief complaint. METHODS: In this prospective comparative study, either 25-75 mg/day of naftopidil monotherapy (monotherapy group) or combination therapy using 25-75 mg/day of naftopidil and an anticholinergic agent (10-20 mg/day of propiverine hydrochloride or 2-6 mg/day of oxybutynin hydrochloride; cotherapy group) were administered for 12 weeks to 101 BPH patients with storage symptoms. RESULTS: International prostate symptom score (IPSS) and quality of life (QOL) index improved significantly in both groups, with no marked differences between groups. Maximum flow rate (Qmax) and residual urine volume (RUV) tended to improve in both groups, again with no marked differences between groups. However, median post-therapeutic RUV was significantly worse for the cotherapy group (45.0 mL) than for the monotherapy group (13.5 mL; P = 0.0210). Ratio of patients with increased RUV was also significantly worse for cotherapy (22.9%) than for monotherapy (5.0%; P = 0.038). CONCLUSIONS: Although the anticholinergic dosage was low, the present results suggest that naftopidil monotherapy was as useful as combination therapy of naftopidil and an anticholinergic agent. Therefore, naftopidil is a useful agent as the first choice in BPH patients with storage symptoms.