Trends in the use of antimuscarinics and alpha-adrenergic blockers in women with lower urinary tract symptoms in Taiwan: A nationwide, population-based study, 2007-2012.

BACKGROUND: We aim to examine the trend in the use of antimuscarinics and off-label alpha-adrenergic blockers for treatment of lower urinary tract symptoms (LUTS) in a Taiwanese Women Cohort between 2007 and 2012. METHODS: This population-based National Health Insurance Research Database (NHIRD) was used to examine the trends in the use of antimuscarinics or off-label alpha-adrenergic blockers in Taiwan. A sample of 1,000,000 individuals randomly drawn from the whole population of 23 million individuals who were registered in the NHI in 2005. From 2007 through 2012, women aged over 18 years whose claim record contained prescriptions of either of the two drugs for treatment of any of the LUTS-related diagnoses were identified and analyzed. The annual usage of the two drug classes were calculated by defined daily dose (DDD). RESULTS: From 2007-2012, there was a 0.80 fold (69676.8 to 125104.3) increase in DDD of antimuscarinics in our cohort. The overall healthcare seeking prevalence of LUTS was 7.33% in 2007 and 12.38% in 2012, in a rising trend. The prevalence of antimuscarinics-treated LUTS in our cohort increased from 2.53 in 2007 to 3.41 per 1000 women in 2012. The prevalence of LUTS treated by antimuscarinics increased especially for those older than 60 years during the study period. CONCLUSIONS: This 6-year observational study provided the epidemiologic information of clinically significant LUTS of Asian female population. Moreover, there was a rising trend in the use of antimuscarinics and off-label alpha-adrenergic blockers in the population-based cohort.

Successful treatment with pollen extract of hematospermia in patients with xanthogranolomatous prostatitis.

INTRODUCTION: The aim of this study was to report our experience in the management of hematospermia observed in 16 patients suffering from xanthogranulomatous prostatitis. METHODS: Recurrent episodes of hematospermia were the onset symptom in all patients, and in 25% of patients it was combined with fever. All patients reported PSA value elevation and the digital rectal examination (DRE) revealed an increase of the gland size and of its consistency in all cases. In all patients, the hematospermia was treated with the oral administration of two tablets of pollen extract in a single (1 g) dose daily for 30 days. RESULTS: Sixteen patients were observed between 2008 and 2016, referring hematospermia, progressive lower urinary tract symptoms (LUTS), and serum PSA level increase. To exclude the prostate cancer presence all patients were submitted to transperineal TRUS guided biopsy. In all the patients complete resolution of hematospermia was achieved treatment with pollen extract. All patients were subsequently treated for LUTS (alpha-adrenergic blockers), but none reported any significant improvement of symptoms. Basing on these pieces of evidence, after 90 days of alpha-blockers therapy, all patients underwent bipolar TURP. Histological examination of resected prostatic tissue revealed in all patients the diagnosis of xanthogranulomatous prostatitis. CONCLUSIONS: Patients with xanthogranulomatous prostatitis especially experience irritative symptoms, sometimes combined with fever or hematospermia. Hematospermia as the onset symptom has not been reported so far. The administration of the pollen extract for 30 days was associated with a complete resolution of hematospermia.

Systemic Comorbidity Burden Using the ACTIONS Phenotype Predicts Urologic Medication Discontinuation Following Transurethral Resection of the Prostate.

OBJECTIVE: To assess the impact of systemic comorbidities on a validated health phenotype score (ACTIONS: Anxiety, Cardiovascular, Testosterone, Insulin/diabetes, Obesity, Neurologic, Sleep apnea) on outcomes of transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH) for symptoms and medication discontinuation. MATERIALS AND METHODS: Comorbidities of men undergoing TURP for BPH from 2004 to 2015 were assessed with the validated ACTIONS phenotype totaling a score from 0 to 2 for each domain (Anxiety, Cardiovascular, Testosterone, Insulin/diabetes, Obesity, Neurologic, Sleep apnea). BPH medication discontinuation, change in International Prostate Symptom Score, postvoid residual, and patient satisfaction were assessed. Descriptive and comparative statistics were calculated with significance set at P <.05. RESULTS: The 319 men had a median age of 74.0 (interquartile range 67-78). Mean ACTIONS score was significantly lower in men who discontinued alpha-blockers or 5-alpha reductase inhibitors compared to those who did not (3.37 ± 2.14vs 4.79 ± 2.75, P <.0001). ACTIONS score <4 was significantly associated with medication discontinuation (P = .0014). Lower scores in Testosterone (P = .04), Neurologic (P = .003), and Sleep apnea (P = .04) domains were significantly associated with medication discontinuation. Total ACTIONS score was not independently associated with changes in International Prostate Symptom Score or postvoid residual. CONCLUSION: Lower ACTIONS score was associated with BPH medication discontinuation after TURP, suggesting men with lower comorbidity burdens do better after the procedure. The ACTIONS phenotype score is easily calculated and may aid the preoperative counseling of men undergoing TURP for BPH.

[Interest of a systematic assessment of the treatment of the lower urinary tract symptoms in the management of benign prostatic hypertrophy in general practice (1380 patients) - Study EVALURO]. / Intérêt d'une évaluation systématique du traitement des symptômes du bas appareil urinaire dans la prise en charge d'une hypertrophie bénigne de la prostate en médecine générale (1380 patients) ­ Étude EVALURO.

OBJECTIVE: To evaluate the efficacy of a modification or initiation of treatment by a α-blocker in patients already medically treated for BPH-related LUTS, with persistent urinary symptoms. METHODS: This is a prospective observational study among general practitioners in France. Included patients were over 60 years of age with BPH-related LUTS who had been medically treated for at least 6 months. A treatment by an α-blocker was initiated or modified if the PGI-I (Patient Global Impression of Improvement) did not objective any improvement under treatment and the IPSS (International Prostate Symptom Score) was≥8. Patients were followed up between 1 and 3 months after inclusion. The primary endpoint was the frequency of unsatisfactory progression of patients, assessed by persistence of urinary symptoms under treatment (IPSS≥8 and PGI-I unchanged or worsened). Progress of LUTS (IPSS and PGI-I) following modification of treatment with α-blocker was also assessed at the follow-up visit. RESULTS: Three hundred and fifty-three physicians included 1449 patients between February 2, 2016 and March 9, 2017 (1380 patients were analyzed): the average age was 70.0±6.9 years ; the duration of the LUTS was 4.1±4.2 years; at inclusion, they received mainly plants (n=744; 53.9%) and α-blockers (n=463; 33.6%); the mean IPSS score was 16.4±6.7, it was not correlated with duration of SBAU; the mean PGi-I was 2.6±1.2. In total, 48.8% (612/1255) of patients had a non-satisfactory evaluation of the LUTS; 42.8% (591/1380) of patients had a modification of treatment according to the protocol: 385 (65.6%) had an initiation of a α-blocker, 202 (34.4%) had a modification of treatment by α-blocker (4 missing data). The α-blocker was monotherapy for 484 (81.9%) patients. At the follow-up visit (1 to 3 months), the average IPSS score was 7.7±4.8, significantly lower (18.7±6.1 at inclusion); the average PGI-I of 1.2±0.7 was significantly lower (3.5±0.8 at inclusion); the quality of life (Q8-IPSS) was significantly improved. For the 345 patients under plant extracts having changed for one α-blocker, as well as for the 67 patients under α-blocker having changed for another α-blocker, the 3 scores had decreased significantly. CONCLUSION: A systematic evaluation of medical treatment for BPH showed that 48.8% of patients medically treated for at least 6 months were not improved. A modification of treatment by an α-blocker (initiation or modification) can then significantly improve the LUTS.

The efficacy and safety of arotinolol combined with a different calcium channel blocker in the treatment of Chinese patients with essential hypertension: a one-year follow-up study.

BACKGROUND: Combined treatment of a calcium antagonist and α/ß-adrenoreceptor blocker is expected to offer some advantages in the management of hypertension; however, their antihypertensive efficacy and safety remain relatively under-explored. METHODS: The current study addresses the 24-h antihypertensive efficacy and safety of arotinolol combined with a different calcium channel blocker. One-hundred fifty-two patients were randomly divided into three groups: nifedipine, amlodipine and felodipine group. In each group, the antihypertensive treatment dose was 30 mg/d, 5 mg/d, 5 mg/d long acting nifedipine, amlodipine, felodipine plus 20 mg/d arotinolol, respectively. Blood pressure was measured in ABPM devices and mercury manometer. RESULTS: The result showed that the effective rate of one year antihypertensive treatment of arotinolol combined with nifedipine was 51 of 53, significantly effective (p < 0.05) among three combinations. It also showed that there was no statistical significant difference (p > 0.05) in controlled rate of morning peak blood pressure between treatment of arotinolol combined with amlodipine and arotinolol combined with nifedipine, but there was a significant difference (p < 0.01) in controlled rate of morning peak blood pressure between arotinolol combined with nifedipine vs. felodipine and arotinolol combined with amlodipine vs. felodipine. CONCLUSIONS: The therapy approached of arotinolol combined with nifedipine or amlodipine could be effective and well-tolerated, and they can be used as the better chosen antihypertensive drug.

Pharmacotherapy and herbal treatment of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is the most common tumor in aging men, and is associated with lower urinary tract symptoms (LUTS). Treatment options include watchful waiting, life-style modification, pharmacologic treatment, and surgery. Alpha-adrenergic receptor blockers (α-blockers) decrease LUTS and increase urinary flow rates in men with symptomatic BPH. 5-Alpha-reductase inhibitors (5-ARIs) decrease the production of dihydrotestosterone within the prostate, which results in decreased prostate volume. For patients with moderate to severe symptoms and a large prostate, combination therapy with α-blockers and 5-ARIs can further improve clinical efficacy of treatment. Numerous plant-based products (phytomedicines) are increasingly used as an alternative or complement the conventional medication. For some patients, phosphodiesterase-5 inhibitors (PDE5-Is) or antimuscarinic agents may be added. Here, we discuss the current pharmacotherapy of BPH.

Reversal of pulpal and soft tissue anesthesia by using phentolamine: a prospective randomized, single-blind study.

INTRODUCTION: Phentolamine mesylate has been reported to be an effective local anesthetic reversal agent for soft tissue but has not been studied regarding reversal of pulpal anesthesia. The authors conducted a prospective randomized, single-blind study comparing the reversal of pulpal and soft tissue anesthesia when phentolamine was administered at 30 minutes versus 60 minutes after the administration of an inferior alveolar nerve (IAN) block. METHODS: Ninety adult subjects received 2 sets of injections consisting of an IAN block followed by an injection of phentolamine at 30 minutes and a sham injection at 60 minutes or a sham injection given at 30 minutes and a phentolamine injection given at 60 minutes in 2 separate appointments. The authors used an electric pulp tester to test the first and second molars, premolars, and incisors for pulpal anesthesia in 4-minute cycles for 120 minutes. Lip and tongue soft tissue anesthesia was also monitored. RESULTS: Phentolamine significantly (P < .05) reduced duration of both pulpal and soft tissue anesthesia when administered at either 30 or 60 minutes after an IAN block. CONCLUSIONS: Phentolamine would be beneficial for patients who would like to experience a faster return to normal soft tissue function and sensation after the administration of local anesthesia. However, because pulpal anesthesia is also reversed fairly rapidly, phentolamine should be administered at the end of the dental appointment.

[Qianlieping capsule plus alpha-blocker for chronic non-bacterial prostatitis: analysis of 220 cases].

OBJECTIVE: To investigate the clinical effects of Qianlieping Capsule combined with alpha-receptor blocker tamsulosin on chronic non-bacterial prostatitis (CNBP). METHODS: We assigned 220 CNBP patients to three groups to receive oral Qianlieping Capsule (2.0 g tid) plus alpha-receptor blocker tamsulosin (0.2 mg qd) (n = 98), Qianlieping Capsule alone at 2.0 g tid (n = 66), and tamsulosin alone at 0.2 mg qd (n = 56) , respectively. After 6 weeks of medication, we assessed the therapeutic effects according to the NIH-CPSI scores and the number of small particles of lecithin (SPL) in the prostatic fluid after treatment. RESULTS: Qianlieping Capsule alone increased the number of SPL by 46.9% and reduced the NIH-CPSI score by 24.4%. Combination of Qianlieping and tamsulosin more significantly increased the number of SPL (61.4%) and decreased the NIH-CPSI score (42.3%) than tamsulosin alone (33.7% and 28.6%) (P < 0.01). CONCLUSION: Qianlieping Capsule chronic is effective for chronic non-bacterial prostatitis, and the combination of Qianlieping Capsule with tamsulosin produces even better effect than tamsulosin alone.

Possible mechanisms of action of the aqueous extract of Artocarpus altilis (breadfruit) leaves in producing hypotension in normotensive Sprague-Dawley rats.

CONTEXT AND OBJECTIVES: Artocarpus altilis (Parkinson) Fosberg (Moraceae) (breadfruit) leaves are used as an antihypertensive remedy. We investigated the possible mechanisms of action of its aqueous extract and its effect on cytochromes P450 (CYP) enzyme activities. MATERIALS AND METHODS: Intravenous administration of an aqueous leaf extract (20.88-146.18 mg/kg) of A. altilis on mean arterial pressure and heart rate were recorded via cannulation of the carotid artery on anaesthetized normotensive Sprague-Dawley rats. Recordings of the contractile activity of the aortic rings to the extract (0.71-4.26 mg/mL) were studied using standard organ bath techniques. Inhibitions of human CYP3A4 and CYP2D6 enzyme activities were evaluated by means of a fluorometric assay in 96 well plates using heterologously expressed microsomes. RESULTS: A. altilis caused significant (p < 0.05) hypotensive and bradycardiac responses unaffected by atropine (2 mg/kg) and mepyramine (5 mg/kg), but attenuated by propranolol (1 mg/kg) and N(G)-nitro-L-arginine methyl ester (5 mg/kg). The extract (0.71-4.26 mg/mL) significantly (p < 0.05) relaxed phenylephrine (10⁻9-10⁻4 M) and 80 mM KCl-induced contractions in endothelium intact and denuded aortic rings; and caused a significant (p < 0.05) rightward shift of the Ca²âº dose-response curves in Ca²âº-free Kreb's solution. Moderate inhibitions of cytochrome P450s (CYP3A4 and CYP2D6) enzyme activities with IC50 values of 0.695 ± 0.187 and 0.512 ± 0.131 mg/mL, respectively, were produced. CONCLUSION: A. altilis exhibits negative chronotropic and hypotensive effects through α-adrenoceptor and Ca²âº channel antagonism. Drug adversity effects are unlikely if the aqueous leaf extract is consumed with other medications reliant on CYP3A4 and CYP2D6 metabolism. This study thus provides scientific evidence for the use of the breadfruit in the treatment of hypertension.

[Impact of preoperative therapy with 5-α-reductase inhibitors in the treatment of benign prostatic hyperplasia]. / Impatto della terapia preoperatoria con inibitori dell'enzima 5-α reduttasi nel trattamento dell'iperplasia prostatica benigna.

Benign prostatic hyperplasia is considered a progressive disease intimately linked with aging. The long-term use of combination therapy with a 5-alpha-reductase inhibitor, together with an alpha blocker in men with moderate-severe symptoms, reduces the risk of clinical progression and BPH-related surgery. It is unclear what the impact is of preoperative therapy with 5-ARI in patients that undergo surgery. The aim of our study was to evaluate the impact of preoperative therapy with 5-alpha-reductase inhibitors on: a) indication on the type of surgery; b) surgical and functional outcomes; c) surgical complications. This is a prospective observational study. It will include all patients undergoing surgery by TURP or Open Prostatectomy in a period of 24 months. We expect results that demonstrate significant and favorable influence of pretreatment with 5-alpha-reductase inhibitors on certain outcomes. Therefore, therapy with 5-ARI could be considered as neoadjuvant to surgery, whatever this is.

Real-world use of Permixon® in benign prostatic hyperplasia--determining appropriate monotherapy and combination treatment.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a major health concern for aging men. The resulting lower urinary tract symptoms may have a profound effect on a patient's quality of life and it is recognized that patient acceptability of treatment is key to decreasing the human and economic burden of the condition. Alphaadrenergic antagonists (alpha-blockers), 5-alphareductase inhibitors (5-ARIs), and phytotherapy as monotherapy or in combination, form the mainstay of medical treatment. METHODS: The Adelphi Permixon Study, a cross-sectional study of representative consulting patients with BPH in two European countries, was undertaken to examine the reasons for choice of medication. Physicians completed patient record forms, and data were analyzed for clinical outcomes and their relationship with the choice of appropriate therapy. RESULTS: Patients receiving combination therapies for BPH are likely to be older and are more likely to be retired than those on monotherapy. Combination therapy is adopted in the real-world setting as first-line therapy on a not-infrequent basis. The analyses demonstrated an association between choice of Permixon® (Pierre Fabre Medicament, Castres, France) as appropriate monotherapy or in combination with alpha-blockers, and the following: BPH severity; treatment of general urinary symptoms, including storage and voiding symptoms; improvement of urinary flow rate; lack of a risk of sexual problems; and reduction of inflammation. Permixon combination with an alpha-blocker is associated with benefits in terms of speed of onset of action, reduction of inflammation, and a positive benefit regarding sexual problems when compared with use of alpha-blocker monotherapy. CONCLUSION: In the real clinical world, Permixon is considered an appropriate treatment for BPH as both monotherapy and in combination with alpha-blockers. Prescribing Permixon in combination with alpha-blockers can be demonstrated to provide benefits beyond use of either therapy alone.

[Efficacy of magnetolaser therapy of patients with an inflammatory form of chronic abacterial prostatitis].

To assess efficacy of magnetolaser therapy (KAP-ELM-01 Andro-Gin unit) in the treatment of inflammatory chronic abacterial prostatitis (ICAP), 68 ICAP patients were divided into 2 groups. Group 1 patients (n = 33) received standard therapy. Group 2 patients received standard therapy plus magnetolaser (ML) therapy. The effect was assessed by the symptoms scale and indices of kallirrein-kinin system. After treatment pain relieved by 36,9%, on the average, in group 1 and by 63.1% in group 2. Lower urinary tract symptoms regressed insignificantly in both groups: by 4.8% and 7.1%, respectively. Quality of life improved by 27.6 and 65.5%, respectively. Kallikrein activity in prostatic secretion remained high in both groups. A 21.7% rise (p < 0.05) of prokallikrein level was seen after treatment only in group 2. Activity of KKS inhibitors (alpha2-MG and alphal-PI) in prostatic secretion normalized in group 2. Total activity of serin proteinases lowered in both groups (p < 0.05). High activity of alphal-PI (8.21 + 1.97 U/ml) persisted in group 1. Thus, standard treatment of ICAP does not result in biochemical normalization of prostatic secretion. ML therapy is more effective.

Administration-time-dependent effects of blood pressure-lowering medications: basis for the chronotherapy of hypertension.

There is growing interest on how to best tailor blood pressure (BP)-lowering medications according to the circadian (24 h) BP pattern of individual patients, that is, chronotherapy. Significant and clinically meaningful treatment-time differences in the beneficial and/or adverse effects of at least six different classes of hypertension medications are now known. Generally, calcium channel blockers are more effective with bedtime than morning dosing, and in the case of dihydropyridine derivatives bedtime dosing significantly reduces the risk of edema. Scheduling angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors at bedtime, as opposed to awakening, increases the proportion of patients with properly controlled BP, enhances the sleep-time relative BP decline towards a normal dipping pattern and best reduces urinary albumin excretion, a marker of functional renal status. The chronotherapy of conventional BP-lowering medications entails their correct scheduling with reference to the body's circadian rhythms, not only to achieve control of daytime and night-time systolic and diastolic BP but to normalize the dipping status of the 24 h pattern. Chronotherapy constitutes a cost-effective strategy for enhancing BP control during both nocturnal sleep and daytime activity and for potentially reducing the risk of cardiovascular disease and end-organ injury of the blood vessels and tissue of the heart, brain, kidney, eye and other organs.

[Using setegis (terasosine) in early postoperative period after transurethral prostate resection].

TUR of the prostatic gland for prostatic adenoma was made in 93 patients aged 54-81 years (mean age 64.4 +/- 7.5 years). The patients were divided into two groups. Patients of group 1 (n = 31) received no alpha-adrenoblockers, those of group 2 (n = 62) received terasosine in pre- and postoperative period. Group 2 patients demonstrated significant improvement in clinical parameters, postoperative hospital stay for them decreased by 11.3%, side effects were insignificant, their residual urine early after operation was 26.3 +/- 8.6 cm3 while 4 weeks after TUR it was 16.3 +/- 6.9 cm3. Thus, terasosine (setegis) can be recommended for use in early postoperative period after TUR of the prostate for prostatic adenoma as an effective and safe drug improving postoperative outcome.

[One-week effects of Tamsulosin on benign prostatic hyperplasia assessed with a daily symptom score].

The early effects of Tamsulosin within one week of administration on lower urinary tract symptoms in patients with benign prostatic hyperplasia (BPH) were investigated. Patients with newly diagnosed BPH were randomized into a Tamsulosin group and a Eviprostat group. Changes in subjective symptoms daily for 7 days after the start of administration and in the 4th week (8 times in total) were evaluated using seven symptoms in the International Prostate Symptom Score (IPSS) and the quality of life (QOL) index entered in a self-scoring diary kept by the patients daily. In the Tamsulosin group, the IPSS total score showed significant improvements. Significant improvements were observed in the incomplete emptying and frequency scores from the day after the start of administration, in the intermittence and straining scores from day 2, in the urgency and weak stream scores from day 3 and in the nocturia score from day 5. The QOL index significantly improved on day 7. In comparison with Eviprostat, Tamsulosin showed a stronger improvement tendency in the total IPSS, voiding symptoms score and incomplete emptying score and the difference was significant. The difference between the two groups was especially marked for the intermittence and weak stream scores and Tamsulosin showed significantly better early effects. Tamsulosin also showed significantly better early effects than Eviprostat in the QOL index. In conclusion, it was clear that Tamsulosin caused significant improvement in lower urinary tract symptoms associated with BPH as a whole from a very early stage within one week after administration.

[Medication combined with local hyperthermia: a desirable therapy for chronic prostatitis pain symptoms].

OBJECTIVE: To compare the effect of the combined therapy of medication with local hyperthermia with that of the simple local hyperthermia therapy in the treatment of pain symptoms of chronic prostatitis (CP). METHODS: Seventy-six CP patients aged 18-48 (mean 29.2 +/- 3.8) years, with the disease course of 3.5-180 (mean 8.0 +/- 1.2) months and NIH-CPSI pain score > or = 14, were equally randomized into a treatment group and a control. The former was treated by applying the CRS-2280E extraorgan short-wave capacitance field hyperthermia system to the prostate once an hour every other day for 7 times, combined with anal administration of 1 Qianliean suppository and oral doxazosin 4 mg before bedtime every night for 2 weeks, while the latter underwent simple local hyperthermia. All the patients were scored on NIH-CPSI and the therapeutic results were compared between the two groups. RESULTS: The pre- and post-treatment NIH-CPSI scores were (23.9 +/- 3.8) and (5.2 +/- 3.1) (P < 0.01) in the treatment goup and (24.5 +/- 4.3) and (11.6 +/- 3.4) (P < 0.01) in the control; the pre- and post-treatment scores on NIH-CPSI pain symptoms were (16.5 +/- 1.9) and (3.1 +/- 2.2) (P < 0.01) in the former and (15.9 +/- 1.7) and (8.2 +/- 2.0) (P < 0.01) in the latter. The total score on NIH-CPSI and that on NIH-CPSI pain symptoms were both significantly higher in the treatment group than in the control (P < 0.01). Within the treatment group, the score on NIH-CPSI pain symptoms was even more significantly improved in patients with the first attacks than in those already treated by other means (P < 0.01). No adverse effects were observed in either of the groups. CONCLUSION: Both the combined therapy of medication with local hyperthermia and simple local hyperthermia are effective, safe and tolerable in the treatment of CP pain symptoms, and the former is even more desirable, particularly for those with the first attacks of the symptoms.

Low dose tamsulosin for stone expulsion after extracorporeal shock wave lithotripsy: efficacy in Japanese male patients with ureteral stone.

OBJECTIVE: We evaluated the efficacy of low dose tamsulosin after extracorporeal shock wave lithotripsy (ESWL) in Japanese male patients with ureteral stone. METHODS: One hundred and two Japanese male patients with ureteral stones who underwent ESWL were randomly divided into three groups. Group A (38 patients) was given tamsulosin (0.2 mg/day); group B (30 patients) was given c horeito, a herbal medicine (7.5 g/day); and group C (34 patients) received no medication. Stone clearance was assessed at 1, 7, 14, and 28 days after ESWL using plain abdominal radiography and abdominal ultrasonography. After 28 days, stone delivery was checked every 2 weeks. RESULTS: The stone-free rate was 84.21%, 90%, and 88.24% for groups A, B, and C, respectively (P = 0.3425). The mean expulsion time was 15.66 +/- 6.14 days in group A, 27.74 +/- 25.36 days in group B, and 35.47 +/- 53.70 days in group C. The expulsion time of group A was significantly shorter than that of groups B (P = 0.0116) and C (P = 0.0424). CONCLUSIONS: The addition of tamsulosin to conservative treatment appeared to be effective in shortening the stone expulsion time.

Noradrenergic control of arginine vasopressin release from the ewe hypothalamus in vitro: sensitivity to oestradiol.

The present study aims at ascertaining the influence of alpha(1)-adrenoreceptors on arginine vasopressin (AVP) release in vitro and determine whether E(2) modulates the alpha(1)-adrenoreceptor and AVP interaction. Ten minutes after ewe killing, sagittal midline hypothalamic slices (from the anterior preoptic area to the mediobasal hypothalamus with the median eminence, 2 mm thick, 2 per sheep) were dissected, placed in oxygenated minimum essential media-alpha (MEM-alpha) at 4 degrees C and within 2 h were singly perifused at 37 degrees C with oxygenated MEM-alpha (pH 7.4; flow rate 0.15 ml/min), either with or without E(2) (24 pg/ml). After 4 h equilibration, 10 min fractions were collected for 4 h interposed with 10 min exposure at 60 min to a specific alpha(1)-adrenoreceptor agonist or antagonist at various doses (0.1-10 mm). At the end of all perifusions, slices responded to KCl (100 mm) with AVP efflux (p < 0.05). Release of AVP was enhanced (p < 0.05) by the alpha(1)-adrenoreceptor agonist (methoxamine 10 mm; no E(2), n = 7 perifusion chambers: from 14.3 +/- 2.7 to 20.9 +/- 3.9, with E(2), n = 10: from 10.7 +/- 1.2 to 18.4 +/- 3.4 pg/ml) or the antagonist (thymoxamine 10 mm; no E(2), n = 5: from 9.5 +/- 3.1 to 30.4 +/- 6.0, with E(2), n = 10: from 10.8 +/- 0.9 to 39.1 +/- 6.3 pg/ml). With the agonist, the response occurred only at 80 min (p < 0.05) both in the presence and absence of E(2). Whereas, after the antagonist, values were higher (p < 0.05) throughout the post-treatment period (80-170 min) without E(2), but declined by 150 min in the presence of E(2). Furthermore, the response to the alpha(1)-adrenoreceptor antagonist was greater (p < 0.05; 90-140 min) than the agonist only in the presence of E(2). In conclusion, these results reveal direct alpha(1)-adrenoreceptor-mediated control of the hypothalamic AVP neuronal system which is modulated by E(2).

[Contemporary medical management of the benign prostatic syndrome]. / Aktuelle Aspekte der medikamentösen Therapie bei benignem Prostatasyndrom (BPS).

Two groups of drugs, alpha blockers and 5-alpha-reductase inhibitors (5ARI), are currently widely used for the medical treatment of benign prostatic syndrome (BPS). Alpha blockers are characterized by a rapid onset of efficacy. If given at an adequate dose, all alpha blockers have a similar efficacy, yet quantitative differences regarding side effects exist. The onset of clinical efficacy of 5ARIs is delayed and dependent on prostate volume. Symptom improvement is generally less pronounced than with alpha blockers, yet this difference declines with time. 5ARI, in contrast to alpha blockers, reduce prostate volume and the risk of long-term BPS complications such as prostate surgery or acute urinary retention. The combination therapy of alpha blockers and 5ARI is superior to either monotherapy; however, this superiority becomes evident only after prolonged (>1 year) therapy. Because of additive side effects, this combination should be reserved for BPS patients with a high risk of progression. Regarding plant extracts, no definitive recommendation can be given because of a limited number of high-quality clinical trials. The use of antimuscarinics in men with BPS with a dominance of storage symptoms and without significant obstruction is promising, although further trials, particularly with a longer study duration, are required.

Electroacupuncture-induced analgesia in a rat model of ankle sprain pain is mediated by spinal alpha-adrenoceptors.

In a previous study, we showed that electroacupuncture (EA) applied to the SI-6 point on the contralateral forelimb produces long-lasting and powerful analgesia in pain caused by ankle sprain in a rat model. To investigate the underlying mechanism of EA analgesia, the present study tested the effects of various antagonists on known endogenous analgesic systems in this model. Ankle sprain was induced in anesthetized rats by overextending their right ankle with repeated forceful plantar flexion and inversion of the foot. When rats developed pain behaviors (a reduction in weight-bearing of the affected hind limb), EA was applied to the SI-6 point on the contralateral forelimb for 30 min under halothane anesthesia. EA significantly improved the weight-bearing capacity of the affected hind limb for 2h, suggesting an analgesic effect. The alpha-adrenoceptor antagonist phentolamine (2mg/kg, i.p. or 30 microg, i.t.) completely blocked the EA-induced analgesia, whereas naloxone (1mg/kg, i.p.) failed to block the effect. These results suggest that EA-induced analgesia is mediated by alpha-adrenoceptor mechanisms. Further experiments showed that intrathecal administration of yohimbine, an alpha(2)-adrenergic antagonist, reduced the EA-induced analgesia in a dose-dependent manner, whereas terazosin, an alpha(1)-adrenergic antagonist, did not produce any effect. These data suggest that the analgesic effect of EA in ankle sprain pain is, at least in part, mediated by spinal alpha(2)-adrenoceptor mechanisms.