盐酸坦索罗辛治疗前列腺增生伴急性尿潴留的疗效观察

目的 探讨α1肾上腺素能受体阻滞剂盐酸坦索罗辛(tarnsulosin)对良性前列腺增生(BPH)伴急性尿潴留患者的治疗作用.方法 对70例BPH伴急性尿潴留患者采用随机、对照研究,分为治疗组(35例)和对照组(35例).患者均行保留导尿.治疗组加用盐酸坦索力辛0.4 mg,1次/d,连续服用7次,7d后拔除导尿管.结果 拔除导尿管后47.1％ (33/70)的患者能自行排尿.治疗组有效率为68.6％ (24/35),对照组为25.7％(9/35),两组比较差异有统计学意义(P＜0.01).结论 应用盐酸坦索罗辛治疗BPH伴急性尿潴留,提高了早期拔除导尿管后患者自行排尿的成功率,治疗的疗效与前列腺体积大小无关.     

超声测定前列腺的膀胱内突入对急性尿潴留的评价

目的:探讨膀胱内前列腺突入程度(IPP)与良性前列腺增生(BPH)患者首次发生急性尿潴留后排尿试验成败的关系。方法:对115例50岁以上首次并发急性尿潴留的BPH患者,按照拔除尿管后排尿试验成败分为成功组和失败组,分析两组间的临床资料。结果:排尿试验的失败率与膀胱内前列腺突入程度密切相关,1~3级的失败率分别是31%(12/39),61%(17/28),69%(33/48)。结论:膀胱内前列腺突入程度可以作为一个预测急性尿潴留后排尿试验结果的指标,并对于患者以后的治疗具有重要的指导意义。     

急性尿潴留对血清前列腺特异性抗原的影响

目的 :研究良性前列腺增生 (BPH)病人发生急性尿潴留时对血清前列腺特异性抗原 (PSA)的影响。　方法 :对 34例伴有急性尿潴留的BPH病人 ,于膀胱造瘘前及引流尿液 4 8h后分别检测血清PSA值 (放免法 )。　结果 :BPH伴急性尿潴留者血清PSA值为 (2 4 6± 16 1) μg/L(2 .6～ 4 5 .8μg/L) ,引流尿液 4 8h后血清PSA值降为(9.4± 6 .3) μg/L(1.7～ 16 .6 μg/L)。两者相比 ,差异有显著性 (P <0 .0 1)。 　结论 :急性尿潴留可使BPH病人血清PSA值显著升高。尿潴留缓解后 ,血清PSA值平均下降超过 5 0 %。     

经尿道前列腺汽化术治疗良性前列腺增生症

目的 :探讨良性前列腺增生症 (BPH)的手术新方法。　方法 :采用经尿道前列腺汽化术 (TVP)治疗BPH3 60例。　结果 :TVP平均手术时间 4 0min ,平均出血量 80ml。术后留置导尿管平均 4 .5d ,拔除导尿管后均自行排尿。术后第 3个月和第 6个月随访 ,国际前列腺症状评分 (IPSS)从术前 2 3分分别降至 11分和 7.2分 ,最大尿流率从 7.2ml/s分别上升为 13 .6、15 .8ml/s ,残余尿从 80ml分别降至 2 8.0、12 .0ml。　结论 :TVP是一种安全性高、并发症少、疗效确切的新手术方法     

经尿道前列腺汽化电切术后尿道狭窄并急性尿潴留38例临床分析

目的探讨经尿道前列腺汽化电切(TUVP)术后尿道狭窄并急性尿潴留的治疗效果。方法对38例TUVP术后后尿道狭窄并发急性尿潴留BPH患者的临床资料进行回顾性分析。结果 38例患者中9例(23.68%)一次性导尿成功,8例患者膀胱镜下实施尿道扩张后,成功留置导尿管,21例患者综合应用输尿管镜、电切镜及冷刀等进行治疗后导尿成功。本组患者均在急诊情况下采用不同方法实现膀胱减压,36例拔出尿管后均自行恢复排尿,2例患者(5.12%)拔出尿管后自行排尿失败后改行耻骨上膀胱穿刺造瘘。结论对于TUVP术后尿道狭窄并急性尿潴留患者,急诊情况下应用各种尿道腔内治疗可有效缓解患者临床症状,减轻痛苦,提高患者术后生活质量。     

前列腺螺旋管的并发症

作者对6例BPH尿潴留的手术高危病人,采用最新设计的镀金前列腺螺旋管(Prostacath)治疗。置管全部成功,无手术死亡。术后所有病人均可自主排尿。1例有会阴部不适感,4例有尿急,应用抗胆硷药可减轻。平均尿流率6.1ml/s,术前尿细菌培养,5例阳性,术后3例无菌。平均置管8.6个月。3例取出螺旋管,其中,2例因病情好转行TURP,1例因螺旋管近端移位再发尿潴留。结果发现2例有结石痂形成,其中1例结石痂几乎充满了螺旋管尖端部分的整个腔隙,结石成分属磷酸钙石和鸟粪石。讨论:BPH急性尿潴留不能立即手术的病人,保留导尿管多有尿道不适感,且易产生尿路感尿。对等待手术者,采用前列腺螺旋管明显优于导尿管,操作简单而安全,置管后大多数尿潴留可解除。     

前列腺增生症伴或不伴组织学前列腺炎患者临床特点分析

目的 探讨组织学前列腺炎(histological prostatitis,HP)与良性前列腺增生(BPH)患者临床特点的相关性.方法 BPH患者1 68例,根据伴或不伴HP分为HP组(n=96)和非HP组(n=72).比较分析两组患者年龄、前列腺体积、PSA、PSAD、国际前列腺症状评分(IPPS)、术前合并尿路感染和急性尿潴留情况的差异.结果 非HP组和HP组平均年龄、前列腺体积、PSA、PSAD、IPPS、术前合并尿路感染和急性尿潴留情况分别为(68.9±6.9)与(71.7±7.1)岁、(60.1±31.5)与(70.5±30.7) ml、(5.82±4.4)与(7.59±5.9)ng/ml、(0.105±0.084)与(0.111±0.079)、(17.2±3.4)与(20.9±3.7)、27.8％ (20/72)与30.2％ (29/96)、25.0％ (18/72)与40.6％ (39/96).两组患者年龄、前列腺体积、PSA、IPPS、术前合并急性尿潴留情况比较,差异均有统计学意义.PSAD和术前合并尿路感染情况比较,两组差异无统计学意义.结论 HP的发生与尿路感染无关,但与患者年龄、前列腺体积相关；合并HP会加重BPH患者尿路症状,并增加出现急性尿潴留的风险；对BPH合并HP患者血清PSAD较PSA更具特异性,并增加出现急性尿潴留的风险.     

网状镍钛合金内支架植入治疗高危前列腺增生症尿潴留

目的初步探讨尿道金属内支架植入术治疗高危前列腺增生症（BPH）尿潴留的疗效。方法对56例高危BPH尿潴留患者采用网状镍钛合金支架进行尿道内支架植入术进行治疗。术后随访6～30个月。结果56例患者全部一次植入成功；54例立即自行排尿，另2例留置导尿管3天后自行排尿。术前测定IPSS平均为（26±4．2）分，RUV为（148±13．5）ml；术后随访期间IPSS平均（7．3±2．7）分，RUV为（58．4±16．7）ml（P〈0．01）。结论网状镍钛合金内支架植入术是高危前列腺增生症（BPH）尿潴留的有效治疗方法。     

双氯芬酸钠栓联合坦索罗辛对前列腺增生伴急性尿潴留中的疗效观察

目的 评价双氯芬酸钠栓和坦索罗辛联合治疗前列腺增生(BPH)患者并发急性尿潴留(AUR)的有效性.方法 选择急、门诊有AUR的BPH患者56例,留置导尿后随机分为A,B两组.A组28例使用双氯芬酸钠栓(25mg,bid,直肠给药)和坦索罗辛(0.2mg,qd).B组28例单服坦索罗辛(0.2mg,qd).3d后拔除导尿管,观察自主排尿情况.所有患者均在入院1h内抽血查血清C-反应蛋白浓度,并与无AUR的BPH患者进行比较.结果 A组有25例3d后能自主排尿,有效率为89％.B组28位患者中20例能自主排尿,有效率为71％.两组相比,差异有显著性(P＜0.01).AUR患者的C-反应蛋白浓度为(0.49±0.19)mg/dL,显著高于无AUR的患者(0.26±0.23)mg/dL.但在AUR患者中,C-反应蛋白浓度与前列腺大小、PSA值、潴留的尿量、年龄无相关性.两组无明显副作用事件发生.结论 非甾体抗炎药联合α1-受体阻滞剂治疗BPH伴AUR患者,较单用α1-受体阻滞剂更有效.     

坦索罗辛在妇科手术后尿潴留中的作用

目的 :评价坦索罗辛 (哈乐 )预防妇科手术后尿潴留的临床价值。方法 :研究组于拔导尿管前 3d开始用哈乐 0 .2mg ,qn ,3～ 5d ;对照组为回顾既往病例 ,拔导尿管前无特殊处理 ,拔导尿管后用传统的方法。比较两组的尿潴留发生率、剩余尿量、感染情况、住院天数等。结果 :研究组的尿潴留发生率为 15 .3% ,对照组为 90 .0 % ;研究组住院天数平均 (10 .8± 3.3)d ,而对照组为 (17.0± 5 .6 )d ,差异内有显著性意义 (P 0 .0 5 )。结论 :哈乐可明显地减少尿潴留的发生率、缩短住院天数 ,是预防和治疗妇科手术后的尿潴留的有效的药物。     

A comparative study on the use of tamsulosin versus alfuzosin in spontaneous micturition recovery after transurethral catheter removal in patients with benign prostatic growth

Purpose

To compare the efficacy and safety of tamsulosin and alfuzosin in patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH).

Methods

Ninety men with AUR due to BPH underwent urinary catheterization and were randomly assigned to treatment groups with tamsulosin 0.4 mg (37 patients), alfuzosin 10 mg (34 patients), and placebo (19 patients). After 4 days of the drug treatment, the catheters were removed, and the patients underwent trial without catheter (TWOC). A TWOC was considered successful if the patient had a voided volume >100 ml and post-void residual urine <200 ml.

Results

TWOC was successful in 16 patients (43.2 %) in the tamsulosin group, 12 patients (35.2 %) in the alfuzosin group, and 5 patients (26.3 %) in the placebo group. Logistic regression analysis showed that both drugs were equally effective and that the type of alpha-blocker was not a predictive factor for TWOC success (OR 1.137, 95 % CI 0.639–2.022) (p = 0.662).

Conclusion

Even though there were no statistically significant differences when comparing the three groups, tamsulosin showed a tendency to be more effective in a successful catheter removal. The lack of objective criteria in the definition of successful micturition leads us to believe that the effectiveness of both drugs reported in the literature is overestimated.     

Clinical impact of tamsulosin on generic and symptom-specific quality of life for benign prostatic hyperplasia patients: Using international prostate symptom score and Rand Medical Outcomes Study 36-item Health Survey

AIM: To examine the efficiency of alpha1-blocker treatment on disease-specific and generic quality of life (QOL) in men with clinically diagnosed benign prostatic hyperplasia (BPH), the improvement of QOL scores with International prostate symptom score (I-PSS) and Rand Medical Outcomes Study 36-item Health Survey (SF-36) was prospectively analyzed. METHODS: A total of 68 newly diagnosed patients with symptomatic BPH that satisfied all inclusion and none of the exclusion criteria were prospectively recruited. All patients received 0.2 mg/day of tamsulosin for 12 weeks. All patients underwent pretreatment documentation of lower urinary tract symptoms (LUTS) and assessment of symptom-specific QOL. Symptoms and general health-related QOL (HRQOL) were assessed using the I-PSS and SF-36, respectively. Also, other objective variables, such as prostate volume, maximal urinary flow and postvoid residual urine volume, were evaluated. RESULTS: After 12 weeks, decrease in I-PSS was 27% compared with baseline (from 16.4 +/- 7.18 to 11.9 +/- 7.56). All questionnaires in the I-PSS showed improvement after tamsulosin treatment and the I-PSS QOL score was improved from 4.51 +/- 1.14 to 3.17 +/- 1.38 (P < 0.0001) at 12 weeks after tamsulosin administration. In intragroup comparisons of HRQOL scores with age-gender adjusted SF-36 Japanese national norms, three SF-36 subscales (bodily pain, BP; social function, SF; and mental health, MH) were worse in the BPH group aged over 70 years, while younger BPH groups aged <70 had better mean SF-36 physical function (PF) scores compared with age-gender adjusted Japanese national norms. In the BPH group with a prostatic volume > or =20 mL, three mean SF-36 scales (BP, SF and MH) were significantly improved after tamsulosin treatment. It is noteworthy that these SF-36 subscales were identical to those observed to worsen in the older BPH group compared to Japanese national norms. CONCLUSIONS: Treatment with tamsulosin for symptomatic BPH patients is associated with significant improvement in the generic HRQOL, in addition to disease-specific QOL and symptoms, at 3 months after drug administration. In particularly, for generic HRQOL with SF-36, tamsulosin treatment can efficiently improve three mean SF-36 subscales (BP, SF and MH) that are decreased in older BPH patients.     

Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia

OBJECTIVE: To evaluate the efficacy of tamsulosin compared to placebo for treating catheterized patients with acute urinary retention (AUR) caused by benign prostatic hyperplasia (BPH), by comparing the numbers of patients who voided successfully after removing their catheter. PATIENTS AND METHODS: This was a randomized, double-blind, placebo-controlled, parallel-group, multicentre study. Men with AUR secondary to BPH were catheterized and then, if they fulfilled the entry criteria, were randomly assigned to receive either 0.4 mg tamsulosin hydrochloride in a modified-release capsule once daily, or a placebo. After up to eight doses the catheter was removed and the ability to void unaided assessed. RESULTS: In all, 149 men (mean age 69.4 years) were randomly assigned to receive tamsulosin (75) or placebo (74); eight were not evaluable, so the intent-to-treat population was 141 men. Thirty-four men taking tamsulosin and 18 taking placebo did not require re-catheterization on the day of the trial without catheter (48% and 26% respectively, P = 0.011; odds ratio 2.47, 95% confidence interval, CI, 1.23-4.97). Success using free-flow variables was also higher in the men who received tamsulosin, at 37 (52%) vs 24 (34%) on placebo (P = 0.019; odds ratio 2.34, 95% CI 1.15-4.75). Withdrawals were high (120 men, 81%), mostly because of a need for re-catheterization (89 men, 60%). Dizziness and somnolence occurred in seven (10%) and four (6%) men who received tamsulosin, and two (3%) who received placebo, but overall the incidence of adverse events was similar in the two groups. One patient died from carcinomatosis. CONCLUSION: Men catheterized for AUR can void more successfully after catheter removal if treated with tamsulosin, and are less likely to need re-catheterization. The side-effect profile was similar for tamsulosin and placebo, and consistent with known pharmacology. From these results tamsulosin can be recommended for treating men after catheterization for AUR, and can reduce the likelihood of the need for re-catheterization.     

Efficacy and safety of tamsulosin hydrochloride compared to doxazosin in the treatment of Indonesian patients with lower urinary tract symptoms due to benign prostatic hyperplasia

AIM: The objective of the study was to compare the efficacy and safety of tamsulosin hydrochloride and doxazosin in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). METHODS: The safety and efficacy of tamsulosin (0.2 mg) and doxazosin (2 mg) was determined after once daily administration for 6 weeks in an open-label, randomized, multicenter study of 101 men with BPH. The International Prostatic Symptom Score (IPSS), maximal urinary flow rates (Qmax), average urinary flow rates (Qave) and residual urine were determined at baseline and again at 6 weeks as efficacy parameters. The primary parameters used for safety evaluation were vital signs (blood pressure and heart rate) and adverse events. The number of patients with a clinically significant response to treatment with tamsulosin or doxazosin was determined and defined as those with >20% improvement from the baseline Qmax or >20% decrease in total IPSS. RESULTS: The total IPSS decreased significantly in both the tamsulosin and doxazosin groups compared to baseline. There was a significant difference in the decrease in total IPSS between two groups. Qmax, Qave and residual urine significantly improved only in the tamsulosin group. There were no significant differences in systolic blood pressure, diastolic blood pressure or heart rate profile in the tamsulosin group; however, doxazosin resulted in a significant difference in systolic and diastolic blood pressure. Tamsulosin was well tolerated; only three patients (6%) in the tamsulosin group reported an adverse event (dizziness) while 11 patients (22%) in the doxazosin group reported an adverse event (dizziness), one of whom withdrew from the study. CONCLUSIONS: Tamsulosin was shown to be more effective than doxazosin in the treatment of LUTS due to BPH.     

前列腺增生急性尿潴留TWOC失败的因素分析

目的分析前列腺增生引起的急性尿潴留患者进行留置导尿后再予以试行拔除尿管(TWOC)后患者再次发生尿潴留的危险因素。方法回顾性分析2017年4月至2019年4月在自贡市第一人民医院治疗的前列腺增生并发第一次急性尿潴留的65例患者的临床资料,65例患者既往均接受了在留置尿管后口服0.4mg/d盐酸坦索罗辛并在第3天进行试行拔管的处理,拔管后患者再次出现尿潴留视为TWOC失败,单因素及多因素Logistic回归分析患者年龄、前列腺体积、膀胱内前列腺突出度(IPP)、国际前列腺症状评分(IPSS)等相关参数与TWOC失败的相关性。结果 TWOC成功组23例(35.4%),TWOC失败组42例(64.6%),单因素分析结果显示TWOC成功组与失败组比较前列腺体积(P=0.030)、IPSS(P<0.001)、IPP(P=0.002)存在明显统计学差异。多因素Logistic回归分析得出患者IPSS(OR=2.462,95%CI:1.216~4.985,P=0.012),IPP(OR=2.606,95%CI:1.224~5.545,P=0.013)是TWOC失败的独立危险因素。结论患者IPP、IPSS评分是预测TWOC失败的重要指标。     

Short‐term effects of crossover treatment with silodosin and tamsulosin hydrochloride for lower urinary tract symptoms associated with benign prostatic hyperplasia

Objectives: To compare the efficacy and safety of silodosin and tamsulosin in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) by a randomized crossover method. Methods: BPH patients with the complaint of LUTS were included in this study, and were randomly divided into two groups: a silodosin‐preceding group (4 weeks of twice‐daily administration of silodosin at 4 mg, followed by 4 weeks of once‐daily administration of tamsulosin at 0.2 mg) or a tamsulosin‐preceding group (4 weeks' administration of tamsulosin, followed by 4 weeks' administration of silodosin). No drug withdrawal period was provided when switching the drug. Results: In the first treatment period, both drugs significantly improved the International Prostate Symptom Score total score, but the improvement by silodosin was significantly superior to that by tamsulosin. After crossover treatment, significant improvement was observed only with silodosin treatment. Moreover, intergroup comparison of changes revealed that silodosin showed significant improvement of straining and nocturia with first and crossover treatments, respectively, compared with tamsulosin. Silodosin also significantly improved quality of life (QOL) score in both treatment periods, while tamsulosin significantly improved QOL score only in the first treatment period. The most frequent adverse drug reaction was ejaculatory disorder with silodosin; however, the incidence of dizziness with silodosin was similar to that with tamsulosin. Conclusions: In BPH/LUTS patients, silodosin exhibits excellent efficacy in improving subjective symptoms in both initial and crossover treatment, and it appears to improve the QOL of patients.     

Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study

OBJECTIVE: While the lipido-sterolic extract of Serenoa repens (LSESr)-Permixon((R))-has been shown to have an equivalent efficacy to finasteride in patients with benign prostatic hyperplasia (BPH), to date, there has been no valid comparison of phytotherapy with alpha-blockers. The aim of this study was to assess the equivalent efficacy of Permixon and tamsulosin.METHODS: Eight hundred and eleven men with symptomatic BPH (I-PSS> or =10) were recruited in 11 European countries for a 12-month, double-blind randomized trial. After a 4-week run-in period, 704 patients were randomly assigned to either tamsulosin 0.4mg/day (N=354) or Permixon 320mg/day (N=350). I-PSS, QoL and Q(max) were evaluated at baseline and periodically for 1 year. Prostate volume and serum prostate-specific antigen (PSA) were measured at selection and at endpoint. The endpoint analysis was performed on the per-protocol population of 542 patients (tamsulosin: N=273; Permixon: N=269).RESULTS: At 12 months, I-PSS decreased by 4.4in each group and no differences were observed in either irritative or obstructive symptom improvements. The increase in Q(max) was similar in both treatment groups (1.8ml/s Permixon, 1.9ml/s tamsulosin). PSA remained stable while prostate volume decreased slightly in the Permixon-treated patients. The two compounds were well tolerated, however, ejaculation disorders occurred more frequently in the tamsulosin group.CONCLUSION: This study demonstrates that Permixon and tamsulosin are equivalent in the medical treatment of lower urinary tract symptoms in men with BPH, during and up to 12 months of therapy.     

Long-term treatment outcome of tamsulosin for benign prostatic hyperplasia

BACKGROUND: The present study assessed the long-term efficacy (>12 months) of tamsulosin in 123 patients with lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH). METHODS: The patients received a starting dose of tamsulosin of 0.2 mg/day, with a further titration up to 0.4 mg/day until symptom relief. Subjective and objective clinical variables were assessed using the international prostate symptom score (IPSS), IPSS quality of life (QoL) score, BPH impact index score, peak urinary flow rate (Q(max)) and postvoid residual urine volume. RESULTS: Except for Q(max), all clinical variables showed significant sustained improvements from baseline throughout the study period (median follow up, 43 months). Thirty patients (24.4%) withdrew because of surgical interventions. The Cox proportional hazards model showed that a baseline IPSS total score >or=15 (HR [hazard ratio] 2.13; 95% CI 1.04-4.34) was predictive of failure for tamsulosin therapy. Furthermore, during the first 12 months, a lowest IPSS total score >or=13 (HR 2.34; 95% CI 1.12-4.89), a lowest IPSS QoL score >or=3 (HR 4.16; 95% CI 1.26-13.68), and a lowest BPH impact index score >or=4 (HR 3.54; 95% CI 1.62-7.75) were also predictive of failure for tamsulosin therapy. CONCLUSIONS: Tamsulosin treatment of BPH patients for more than 12 months showed a sustained, stable efficacy. Patients without short-term effects were prone to withdraw from tamsulosin therapy, but so did patients with a high baseline IPSS total score, even if therapy was effective for at least 12 months.     

Outcomes and complications of naftopidil versus tamsulosin for elderly men with lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review and meta-analysis

We conducted a systematic review and meta-analysis to assess the outcomes and complications of naftopidil in treating elderly men with lower urinary tract symptoms secondary to benign prostatic hyperplasia and compared them with those administered with tamsulosin. A literature review was performed to identify the available randomised controlled trials concerning the comparison between naftopidil and tamsulosin for men with LUTS/BPH. We searched the following databases: the Cochrane Library Database, PubMed, Embase and Web of Science. Eleven publications involving 1,114 men (557 in the naf group and 557 in the tam group) were pooled in our analysis. We found no significant differences in the total IPSS, IPSS storage score, IPSS voiding score, quality of life index, peak urinary flow rate, average flow rate and post-void residual volumes. We assessed cardiovascular and sexual adverse events, acute urinary retention, surgical intervention, withdrawals due to any reason and withdrawals due to adverse events. The incidence of adverse events was similar among patients in naf and tam groups. In conclusion, naftopidil shared comparable efficacy and similar incidence of adverse events with tamsulosin and appears to be a promising agent for and alternative to tam. However, more prospective trials with high quality and long-term treatment duration are needed to verify this observation.