ABSTRACT
INTRODUCTION: Marketing authorization of alphablockers is limited principally to men with benign hypertrophy of prostate. The objective of this review is to evaluate clinical and urodynamic improvement of alphablockers in women. METHOD: A review of the literature was carried out on all prospective studies about the use of alphablockers in women with urination disorders. RESULTS: Seventeen articles have been included. The selected articles were classified according to the studied population: lower urinary tract disorders, bladder emptying disorders without details on mechanism, bladder outlet obstruction, detrusor hypoactivity overactive bladder. Four studies were randomized against placebo. There was an improvement in the IPSS in 8 studies going as far as a decrease of 11,7 points (4.6 vs. 16.3 P<0.05). The voiding IPSS subscore was improved overall in 8 studies with a decrease of up to 6,2 points (9.6±5.5 vs. 14.8±4 P<0.01). Two trials showed an improvement of clinical scores versus placebo with an improvement of IPSS from -11.7 vs -9.5 (P<0.05) and -5.6 vs -2.6 (P<0.05). Urodynamic parameters were also often improved with a decrase of Qmax going to+5.8mL/s (P<0.05). Alphablocker also appear to improve non obstructive voiding disorders. The benefit in overactive bladder seems limited. CONCLUSION: Alphablockers may be indicated in voiding disorders of women. Their exact role must be established.
Subject(s)
Adrenergic alpha-Antagonists/therapeutic use , Urination Disorders/drug therapy , Female , Humans , Treatment OutcomeABSTRACT
INTRODUCTION: We aimed to assess the impact of antiplatelet and anticoagulation therapy for patients undergoing HoLEP. METHODS: We performed a study during the learning curve on a consecutive series of patients who underwent HoLEP surgery from 2015 to 2018. The patients were divided into 3 groups: a control group, patients with antiplatelet therapy and patients with anticoagulation therapy. RESULTS: A total of 223 patients underwent HoLEP surgery during this period: 124 in the control group, 63 in the antiplatelet group and 36 in the anticoagulant group. In the anticoagulant group, we observe significant differences with the control group for the catheterization time (2.05 days vs 5.17 days; P<0.001), the hospital length of stay (1.5 nights vs 4.49 nights; P<0.001) and complications (8.9% vs 58%; P<0.001). No difference between the control and antiplatelet groups in terms of catheterization time, hospital length of stay and complications (2.05 days vs 2.68 days; 1.5 nights vs 1.6 nights) but variation in terms of complications and bleeding complications (8.9% vs 21%; P<0,001; 8.1% vs 19%; P<0,001) CONCLUSION: Our study shows that HoLEP is therefore associated with a higher risk of bleeding for patients treated with anticoagulation therapy. Complications increase morbidity with longer catheterization time, hospitalization times and higher transfusion's rates, revision surgery and readmission. LEVEL OF EVIDENCE: 3.
Subject(s)
Laser Therapy , Lasers, Solid-State , Prostatic Hyperplasia , Transurethral Resection of Prostate , Anticoagulants/adverse effects , Humans , Male , Prostatic Hyperplasia/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate the value of MRI for surveillance of primary hemi-HIFU therapy for localized PCa in a single-center. PATIENTS AND METHODS: Patients with localized prostate cancer were treated with hemi-HIFU from October 2009 to March 2014. All patients performed MRI before focal therapy, the reader was blinded to the treatment. Oncological failure was defined as positive biopsy or biochemical recurrence (Phoenix). RESULTS: Twenty-five patients were treated with hemi-HIFU in one center. The median nadir PSA was 1.45±1.4ng/mL. Prostate volume decreased from 45 cc to 25 cc on MRI findings. At 20 months, none of the patients had histological recurrence. Biochemical-free survival rate was 88%. MRI evaluation had a negative predictive value of 100% on the treated area and 81% on the untreated area. PSAd≥0.1ng/mL(2) was a predictive factor for cancer on untreated area (P=0.042). CONCLUSION: MRI control at 6 months is a potentially effective evaluation of treated area after hemi-HIFU and may replace randomized biopsies if PSAd<0.1ng/mL(2) during follow-up. LEVEL OF EVIDENCE: 4.
Subject(s)
Magnetic Resonance Imaging , Prostatic Neoplasms/pathology , Prostatic Neoplasms/therapy , Ultrasound, High-Intensity Focused, Transrectal , Aged , Aged, 80 and over , Humans , Male , Middle AgedABSTRACT
INTRODUCTION: The objective of this study was to evaluate the clinical outcome of primary megaureters and to evaluate predictive factor for surgery need based on ultrasound values. METHODS: A total of 43 primary obstructive megaureters detected in 41 patients have been evaluated between January 2000 and may 2010. RESULTS: Mostly boys (73%) were concerned by megaureters, mainly on the left side (66%). Twenty patients were prenatally diagnosed. Surgical indications were: pyonephrosis (3), recurrent pyelonephritis (14), scintigraphic damage (3), ureteric diameter aggravation (7), disease occurring on unique kidney (2). Regarding the 30 patients who benefit surgery, the retrovesical ureter measured, before surgery 19.15 mm (± 7.17) on average and 3.18 mm, 44 months later. Over the 10 patients treated medically, the initial diameter was 9.91 mm and at the end of the study, five patients had megaureter completely regressed, three patients had a diameter greater than 10mm at the end of the study and two faced a worsening evolution with sudden and complete renal damage on scintigraphic nephrogram, after recurrent pyelonephritis despite antibioprophylaxis. CONCLUSION: We recommend a careful watch-fulling of primary megaureters; mainly for those with recurrent infections and whenever the retrovesical ureter diameter exceeds 14 mm at first ultrasound.
