A double-blind trial on the effect of alpha-adrenergic blocker (bunazosin hydrochloride) in the symptomatic treatment of prostatism

A double-blind placebo-controlled study of bunazosin for the treatment of symptomatic prostatism is reported, incorporating urologic departments of 25 hospitals. Four different doses of bunazosin hydrochloride was administrated orally to 174 patients having benign prostatic hyperplasia and 31 with bladder neck contracture for a period of four weeks; high dose group (45 patients, 3 mg/day for the first week followed by 4.5 mg/day for the next three weeks), middle dose group (45 patients, from 1.5 mg/day for the first week to 3.0 mg/day for the next three), low dose group (39 patient, 0.15 mg/day for the first to 1.5 mg/day for the next three) and a control group (40 patients, 0.125 mg/day for the entire four weeks). Subjective symptoms (urinary frequency, retarded urination, prolonged urination, condition of urinary stream and abdominal pressure at voiding) and objective signs (residual ratio, maximum and mean flow rate, voiding time) were observed and analyzed statistically. No bias in the background features was confirmed between any of the four groups. The subjective improvement rates evaluated by the attending doctors demonstrated a significant dose-dependent efficacy of bunazosin by H-test (p less than 0.01), although the objective improvement rates revealed no significant difference between any of the four groups. The global improvement rate evaluated by the same means demonstrated that the middle dose group was significantly superior to the control group (p less than 0.05 by U-test). According to each subjective symptom evaluated by the criteria of the drug efficacy, a dose-dependent significant (p less than 0.01) was noticed between the four groups in the improvement of the voiding condition. Although there was no significant difference by use of the H-test, the middle dose group had a significant superiority to the control group in the improvement rate of retarded voiding by use of the U-test (p less than 0.05). Only in the symptomatic cases of prolonged voiding, were dose-dependent significant differences observed between all four groups by use of the H-test (p less than 0.05). On the other hand, there was no significant difference between the four groups in the subjective or global improvement rates. Judging from the real data and the graded classification of objective signs, the high and middle dose groups were significantly superior to the control in terms of voiding time, and the high and low dose groups were the same as the control for residual urine ratio.(ABSTRACT TRUNCATED AT 400 WORDS)     

The evaluation of the effects of bunazosin hydrochloride in the treatment of prostatic hyperplasia]

Thirty-five patients with prostatic hyperplasia were entered into a randomized controlled study using bunazosin hydrochloride(alpha 1-adrenergic blocker). Eighteen patients were allocated to be treated with an initial dose of 1.5 mg/day (group 1) and 17 patients received an initial dose of 3.0 mg/day (group 2). Subjective symptoms and parameters of urodynamic studies were evaluated after 4 weeks and 12 weeks. There were 5 withdrawals or exclusions within 4 weeks and 6 within 12 weeks. Therefore, 15 patients in group 1 and 15 patients in group 2 were eligible for evaluation at 4 weeks, 12 patients in group 1 and 11 patients in group 2 were eligible for evaluation at 12 weeks. The rates of the improvement in subjective symptoms such as retarded urination, protracted urination, weakened urinary stream, abdominal straining on voiding, and sense of residual urine were 40%, 25% in group 1 and 46.7%, 36.4% in group 2, at 4 weeks and at 12 weeks, respectively. The rate of improvement in objective parameters of the urodynamic study such as voiding volume, residual volume, maximum flow rate and average flow rate were 26.7%, 16.7% in group 1 and 26.7%, 20.0% in group 2, at 4 weeks and at 12 weeks, respectively. Thus, these improvements were not correlated with the dosage of drug. Adverse effects such as diarrhea, mild headache, palpitation and gastric disturbance were observed in 2 patients in group 1, and 3 patients in group 2. In the 24 patients treated with the drug over 12 weeks, there were no specific adverse effects due to prolonged administration. These findings showed that bunazosin hydrochloride is beneficial for the treatment of prostatic hyperplasia, and could be safety administered for a prolonged period of time up to 12 weeks.     

Clinical evaluation of bunazosin hydrochloride for the treatment of voiding disturbances due to neurogenic bladder--a double-blind study

The therapeutic utility of bunazosin hydrochloride was evaluated by a multi-center (67 hospitals) double-blind controlled study in patients who complained of voiding disturbances due to neurogenic bladder. For means of comparison, bethanechol chloride and placebo were used as reference drugs. Bunazosin hydrochloride was orally administered 1.5 mg per day for the first week and 3.0 mg per day for two weeks thereafter (Group E). Bethanechol chloride 15 mg (Group B) and placebo (Group P) were orally administered three times daily for three weeks. Three hundred and twenty-three cases were subjected to this study. The global improvement rating was analyzed for 244 cases (83 in Group E, 78 in Group B and 83 in Group P). The global utility rating (GUR) was analyzed for 252 cases (84 in Group E, 81 in Group B and 87 in Group P). Three hundred and twenty cases (107 in Group E, 104 in Group B and 109 in Group P) were analyzed with respect to overall safety rating (OSR). The global improvement ratings (excellent and good) were 32.5% in Group E, 28.2% in Group B and 21.2% in Group P. In the evaluation of GUR, Group E was superior to Group P. In addition, the incidence judged to be useless in Group E was significantly lower than that in Group B. There were no differences in OSR among these three groups. In the total evaluation of the subjective symptoms, the rates of improvement were not different among these three groups. In the total evaluation of the objective findings, the improvement rate in Group E was significantly higher than that in Group P. In addition, the deterioration rate in Group E was significantly lower than that in Group B. In objective findings before and after administration of bunazosin hydrochloride (Group E), the volume of residual urine, the rate of residual urine and the average flow rate improved significantly However, the bladder capacity, the maximum resting bladder pressure and the maximum urethral pressure did not change significantly. Bunazosin hydrochloride improved the objective findings regardless of the bladder capacity and the maximum resting bladder pressure. These significant improvements were marked in the neurogenic bladder patients who were able to urinate and in the patients whose urethral pressure was high. There were no differences in the incidence of side effects or in the appearance of abnormal values of laboratory findings in these three groups. Neither specific signs nor serious clinical side effects except those reported previously were observed.(ABSTRACT TRUNCATED AT 400 WORDS)     

Clinical efficacy of oxendolene (antiandrogen) and bunazosin hydrochloride (alpha-adrenergic blocker) in the treatment of prostatism--comparative study of oxendolone, bunazocin hydrochloride and their combination

Antiandrogen and alpha-adrenergic blockers have recently been tried in the medical treatment for benign prostatic hypertrophy and bladder neck contracture. We herein report our results of a randomized comparative study on the clinical efficacy of oxendolone, bunazosin hydrochloride (bunazosin) and their combination for the treatment of benign prostatic hypertrophy and bladder neck contracture. The attending doctors evaluated at twelve weeks the improvement rate for three treatment regimens, 400 mg/day oxendolone, 3 mg/day bunazosin and a combination of both. Oxendolone + bunazosin showed the highest improvement rate in the evaluation of each subjective symptom and objective finding and of both. Oxendolone + bunazosin tended to show a better clinical efficacy than the other of these regimens, when the improvement was defined as that with more than one degree in the severity of retarded voiding, prolonged voiding, urinary stream condition, abdominal pressure on voiding and residual urine sensation. The improvement of such subjective symptoms seemed to occur earlier with oxendolone + bunazosin or bunazosin than with oxendolone. A significant difference was shown among the three treatment regimens in the general improvement rate on four subjective symptoms, with oxendolone + bunazosin being the highest followed by bunazosin and oxendolone in this order. The improvement rates of maximum and mean flow rate which are most important parameters to evaluate the voiding condition, at twelve weeks were significantly higher with oxendolone + bunazosin. No serious side effects were observed in this study, although treatment regimens containing bunazosin caused some minor side effects. These side effects could be prevented by the use of initial low doses of bunazosin with a subsequent gradual increment up to 3 mg/day. Taking the differences in the mechanism of oxendolone and bunazosin and the results of our study into consideration, we believe that the combination of oxendolone and bunazosin would be more useful in a clinical situation.     

Inguinal hernia as a sequela of disordered bladder emptying?]

We examined 56 patients with hernias and 49 patients with other diseases prior to operation. They were all above 50 years of age. The urological screening examination included the patients history of the frequency of urination during night and day time, dysuria, the common risk factors (smoking, coughing, obstipation), obesity, a sonographic measurement of the prostate diameters, a sonographic evaluation of residual urine and the determination of the urinary flow rate. None of the above parameters showed a significant difference between the two groups. Surprisingly more than 60% of all men showed a pathological voiding function (either residual urine and/or a pathological flow rate). Our conclusions are: 1. Patients with inguinal hernias do not show a greater incidence of pathological bladder function than patients of the control group. The benign prostatic hypertrophy as a risk factor for the development of inguinal hernias is most questionable. 2. Because the results showed no significant difference between the two groups, a determination of residual urine prior to operation is not necessary. 3. More than 60% of the men above 50 years showed a pathological voiding function. We recommend a urological screening test for all men above 50 years of age during hospitalisation.     

Clinical effects of terodiline hydrochloride on urinary frequency and sense of residual urine--a double blind clinical trial using flavoxate hydrochloride as a control

A double blind clinical trial was performed as a multicenter study to determine the usefulness of terodiline hydrochloride (HCl), an anticholinergic and calcium antagonistic agent, for urinary frequency or sense of residual urine in patients with psychogenic diseases, chronic prostatitis or chronic cystitis. Either 24 mg of terodiline HCl a day or 600 mg of flavoxate HCl a day was given for 4 weeks. One hundred and ninety-nine patients completed the test. The final global improvement rating was 70% in patients given terodiline HCl and 48% in patients given flavoxate HCl. The difference was statistically significant (p less than 0.01). Diurnal and nocturnal urinary frequency and urinary incontinence were less in patients given terodiline HCl than in patients given flavoxate HCl (p less than 0.01). No difference was noted between the two agents in relieving sense of residual urine. Compared with the control period, the average urinary frequency decreased 2.0 times a day in patients given terodiline HCl and 0.7 times in patients given flavoxate HCl. The difference was statistically significant (p less than 0.01). Adverse effects were observed in 12% of the patients given terodiline HCl and in 16% of the patients given flavoxate HCl. They included thirst, difficult urination, constipation, slight increase of serum GOT, GPT or alkaline phosphatase, and so forth. They disappeared with discontinued use of the agent. The global utility rating was 68% in patients given terodiline HCl and 45% in patients given flavoxate HCl, the difference being significant (p less than 0.01). These results indicate that terodiline HCl is useful for the treatment of urinary symptoms in patients with psychogenic diseases, chronic prostatitis or chronic cystitis.     

The effect of moxisylyte hydrochloride in the symptomatic treatment of benign prostatic hyperplasia

The clinical effectiveness of moxisylyte hydrochloride (Moxyl, Fuji Rebio), a selective alpha 1-adrenoceptor blocking agent, was investigated in patients with symptomatic benign prostatic hyperplasia. Moxisylyte hydrochloride was administered at the dose of 90 mg per day orally for four weeks. Residual urine sensation was improved in 9 out of 17 cases (53%), retarded urination in 14 out of 19 (74%), prolonged urination in 12 out of 19 (63%), weak stream in 14 out of 21 (67%) and strained voiding in 11 out of 19 cases (58%). Residual urine volume and residual urine ratio were decreased in 14 out of 21 cases (67%), maximum urine flow rate was increased in 14 out of 21 (67%) and mean flow rate was increased in 15 out of 21 cases (71%). There was, however, no statistical significance between pre- and post drug administration in objective parameters. Our open trial showed that the subjective efficacy of moxisylyte hydrochloride was 82% (18/22 cases), the objective one was 59% (13/22 cases) and overall efficacy was 77%. Side effects were observed in four of all subjects (18.2%), and drug administration had to be ceased in only one of these patients due to mild dizziness. Other side effects were mild nausea, headache and chest discomfort. Decrease in blood pressure was not seen in all but one case.     

Voiding patterns in patients with post-prostatectomy incontinence: urodynamic and demographic analysis

PURPOSE: A significant percentage of patients with post-prostatectomy incontinence have been reported to void by Valsalva's maneuver, which is our observation as well. We determine the mechanism of voiding in patients with post-prostatectomy incontinence and correlate this to demographic data, urodynamic parameters and outcome after artificial urinary sphincter implantation, and identify possible risk factors. MATERIALS AND METHODS: Videourodynamic data from 61 consecutive patients with post-prostatectomy incontinence were reviewed to determine voiding patterns. The causes of incontinence were radical prostatectomy in 58 patients and transurethral resection of the prostate followed by radiation therapy in 3. The relationship between voiding patterns and demographic data (age, diabetes mellitus, degree and duration of incontinence, history of radiation therapy or treated bladder neck contracture) as well as urodynamic parameters (bladder capacity, compliance, instability, sensation, leak point pressure and residual urine) were studied. After artificial urinary sphincter implantation outcome was assessed in relation to the voiding patterns. RESULTS: Stress incontinence was present in all patients while concomitant urgency/urge incontinence was present in 48%. Of the patients 43 (70.5%) voided by detrusor contraction (group 1) while the remaining 18 (29.5%) voided by straining (group 2). Mean patient age +/- SD was 70.8 +/- 6.9 and 69.2 +/- 7.2 years, and duration of incontinence was 48 +/- 33 and 46 +/- 30 months in groups 1 and 2, respectively (p >0.05). Also, no significant differences were found between the groups with regard to other demographic data. Delayed first sensation (at volume greater than 140 ml.) was seen in 42.5% and 29.4%, capacity less than 300 ml. in 41.9% and 39%, impaired/poor compliance in 25.6% and 22.2%, bladder instability in 16.3% and 5.6%, abdominal leak point pressure 60 cm. H(2)O or less in 59.4% and 60% and residual urine greater than 50 ml. in 11.6% and 17.6% in groups 1 and 2, respectively (p >0.05). After artificial urinary sphincter implantation 35% and 22.2% of patients used greater than 1 pad a day in groups 1 and 2, respectively. One patient in each group reported difficulty during urination and both patients had no residual urine. CONCLUSIONS: No identifiable demographic or urodynamic risk factors could be detected in association with the strain pattern of voiding in patients with post-prostatectomy incontinence. The absence of a difference in bladder compliance, residual urine volume and outcome after artificial urinary sphincter implantation between detrusor and strain voiders would suggest no increased risk for complications in the strain voiding group.     

Surgery (TUR-P) as a recommended initial treatment modality for the presented case

The pathophysiology of lower urinary tract dysfunction in the presented case comprised voiding dysfunction and overactive bladder. Two etiologies for voiding dysfunction in this case could be considered, bladder outlet obstruction due to benign prostatic hyperplasia (BPH) or detrusor underactivity. Prospected efficacies of pharmacological and surgical treatment (transurethral resection of prostate: TUR-P) for this case were compared based on a literature review. Alpha-1 blockers improve both voiding and storage symptoms in patients with BPH. However, improvement of maximum flow rate (Qmax) on uroflowmetry is limited within a small range and there is no evidence of significant reduction in residual urine volume. Alpha-1 blockers have no significant efficacy in improvement of objective measures in patients with detrusor underactivity. Although anticholinergics improve overactive bladder symptoms, they are contraindicated for patients with severe voiding dysfunction with residual urine. There is a lack of study on efficacy of apha-1 blocker administration combined with anticholinergics available in our hands for patients with BPH and overactive bladder. On the other hand, TUR-P brings remarkable improvement in voiding and storage symptoms, increase of flow rate and reduction of residual urine as a gold-standard surgical treatment for BPH. Urge incontinence and uninhibited detrusor contraction on cystometry reportedly disappeared in 60% of patients following TUR-P. TUR-P also improves subjective symptom and objective measures in patients with BPH and detrusor underactivity. Based on the literature review, surgery is recommended as a standard initial therapy for the presented patient with significant voiding dysfunction (Qmax 9.4 ml/sac and residual urine 72 ml).     

Botulinum A toxin treatment of urethral sphincter pseudodyssynergia in patients with cerebrovascular accidents or intracranial lesions

PURPOSE: Detrusor overactivity and urethral sphincter pseudodyssynergia may develop during recovery from cerebrovascular accidents or intracranial lesions, resulting in difficulty in urination, a large amount of residual urine, and recurrent urinary tract infection. This study evaluated the effectiveness of urethral injection of botulinum A toxin in treating these patients. METHODS: Twenty-one patients with chronic cerebrovascular accidents or intracranial lesions and difficult urination were enrolled. Patients participating in the study elected to receive either 100 units of botulinum A toxin (n = 11) or served as medically treated controls (n = 10). The urodynamic parameters and voiding efficiency after treatment were compared between the 2 groups. RESULTS: An excellent result was obtained in 6 patients and an improved result in 4 patients, resulting in an overall success rate of 91% in the study group. Four patients with frank urinary retention before treatment resumed spontaneous voiding. The maximal effects of botulinum A toxin appeared about 2 weeks after treatment. The voiding pressure decreased (57.8 +/- 35.2 vs. 33.8 +/- 16.9 cm H2O, p = 0.005) and the maximal flow rate increased (7.2 +/- 5.9 vs. 10.3 +/- 5.2 ml/s, p = 0.005) significantly. In the control group, 4 patients (40%) had spontaneous voiding 6 months after medical treatment, whereas 6 patients remained unchanged requiring an indwelling Foley catheter (n = 2) or clean intermittent catheterization (n = 4). The symptom score and the quality of life index showed significantly greater improvement in the study group than in the control group. CONCLUSION: This study demonstrates that urethral injection of botulinum A toxin is effective and without adverse effects in the treatment of patients with urethral sphincter pseudodyssynergia after cerebrovascular accidents or the development of intracranial lesions.     

A randomized controlled study comparing clinical effects of naftopidil and tamsulosin on benign prostatic hyperplasia

A prospective randomized controlled study was performed to compare the clinical effects of naftopidil and tamsulosin. Men complaining of lower urinary tract symptoms due to benign prostatic hyperplasia were randomized into two groups : one receiving 50mg naftopidil once daily (Naf group, n=36 patients), and the other receiving 0.2 mg tamsulosin once daily (Tam group, n=32 patients). In the Naf group at 12 weeks, 7 items of the International Prostate Symptom Score (IPSS), storage and voiding symptoms, total IPSS, quality of life (QOL) index (QOLI) and Qmax were improved significantly. In the Tam group at 12 weeks, 6 items of IPSS except urgency, storage and voiding symptoms, total IPSS, QOLI and Qmax were improved significantly. Improvement of residual urine volume (PVR) was insignificant in both groups. In intergroup comparison between the Naf and the Tam groups, variations of 7 items of IPSS, storage and voiding symptoms, total IPSS, QOLI, Qmax and PVR at 4 and 12 weeks after treatment were not statistically significant. There was almost no difference in clinical efficacy between Naf and Tam.     

Clinical studies on acute uncomplicated cystitis in women]

A total of 499 female patients with acute uncomplicated cystitis were observed and analyzed clinically for age distribution, characteristics of symptoms, bacterial culture of urine, behavioral aspects of recurrent cystitis and others. The patients were between 3 years and 88 years old (average: 43 years) and the majority of patients were from 20 to 69 years old. From 81.1% of the patients Escherichia coli was detected, followed by Staphylococcus spp (11.2%). The major symptoms were pain on urination (421 cases), urinary frequency (421 cases) and residual urine sensation (418 cases). The major causes of cystitis as reported by the patient were fatigue (131 cases), infrequent voiding (114 cases) and exposing the body to coldness (103); only 42 patients reported a relationship between sexual intercourse and cystitis. The patients who had been suffering from "honeymoon cystitis" were significantly inclined to be suffering from acute uncomplicated cystitis again in comparison with those who had not suffered from honeymoon cystitis. There was suggested to be a relationship between sexual intercourse and recurrent cystitis.     

The Effect of Urapidil on Neurogenic Bladder: A Placebo Controlled Double-Blind Study

Purpose

We assessed the efficacy and safety of urapidil, a new alpha-blocker, for the treatment of neurogenic bladder dysfunction in a prospective double-blind trial.

Materials and Methods

A total of 136 patients was randomly assigned to receive placebo (group 1), or treatment with 30 mg. of urapidil for 4 weeks (group 2) or 30 mg. for 2 weeks followed by 60 mg. for 2 weeks (group 3).

Results

Urinary frequencies decreased significantly only in group 3. The sum of obstructive symptom scores decreased significantly in all groups. However, a significant difference in subjective symptoms was not noted among the groups. Average and maximum flow rates, and residual urine improved significantly in groups 2 and 3 but not in group 1. Regarding cystometric parameters, no significant changes were noted in any group. In the pressure-flow study, the pressure at maximum flow rate and minimum urethral resistance (pressure at maximum flow rate divided by the square of maximum flow rate) decreased significantly only in group 3. In the urodynamic assessment, significant improvement was noted in groups 3 versus 1. There were no significant differences between the sexes or among underlying diseases with regard to symptomatic and urodynamic improvements. Side effects were noted in 2 patients in group 3 and 1 in group 2, none of which was severe.

Conclusions

Urapidil improved voiding dysfunction in patients with a neurogenic bladder and decreased urethral resistance in a dose related fashion.     

Clinical effects of distigmine bromide (Ubretid), a cholinesterase inhibitor, on micturition disturbance by benign prostatic hypertrophy--comparative study of distigmine bromide and the combination of distigmine bromide and adrenergic blocker]

We report the results of a comparative study on the clinical efficacy of the single use of distigmine bromide and its combined use with prazosin hydrochloride in the treatment of benign prostatic hypertrophy. The single use and combined use groups were administered 10 mg/day of distigmine bromide and the same with 1 mg/day of prazosin hydrochloride for a period of 8 weeks respectively. In the single administration group, marked improvement was found in one patient (9%), moderate improvement in 4 patients (36.3%), slight improvement in 3 patients (27.2%) and aggravation in 3 patients. In the combined use group, marked improvement was found in one patient (11.0%), moderate improvement in 5 patients (55.5%), and slight improvement in 3 patients (33.3%). No significant differences were found in the improvement rate between the two groups. However, significant improvements were found in both groups for the subjective symptoms of urinary disturbance, diurnal and nocturnal frequency. As a result of the examination of objective findings, a significant decrease in residual urine ratio was also shown in both groups, while significant improvement for average flow and maximum flow rates were found in only the combined use group. In conclusion, distigmine bromide and distigmine bromide+prazosin hydrochloride are considered very useful for the treatment of miturition disturbance due to benign prostatic hypertrophy.     

Comparison of tamsulosin and naftopidil for efficacy and safety in the treatment of benign prostatic hyperplasia: a randomized controlled trial

OBJECTIVES: To compare the efficacy and safety of two alpha1a/alpha1d adrenoceptor (AR) antagonists with different affinity for the alpha1AR subtypes, tamsulosin and naftopidil, in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Patients with BPH were randomized to receive either tamsulosin or naftopidil. The primary efficacy variables were the changes in the total International Prostate Symptom Score (IPSS), maximum flow rate on free uroflowmetry, and residual urine volume. The secondary efficacy variables were average flow rate, changes in the IPSS storage score, IPSS voiding score, and quality-of-life (QoL) Index score, from baseline to endpoint (12 weeks). Data on all randomized patients were included in the safety analyses for adverse effects and changes in blood pressure. RESULTS: Of the 185 patients enrolled data for 144 who were eligible for inclusion in the efficacy analysis were analysed (75 from the tamsulosin and 69 from the naftopidil group). There was no significant difference in any variable at baseline between the groups. There were statistically significant improvements for all primary and secondary variables in both groups, except for residual urine in the tamsulosin group. However, there was no significant intergroup difference in the improvement of any efficacy variable between the groups. The adverse effects were comparable, with no significant differences in systolic and diastolic blood pressure after treatment in both groups. CONCLUSIONS: This study suggests that naftopidil is as effective and safe as tamsulosin. Both drugs were effective in improving storage and voiding symptoms. However, there was no difference in clinical efficacy or adverse effects between the alpha1 AR antagonists with different affinity to alpha1 subtypes, alpha1a and alpha1d.     

盆腔肿瘤放疗后排尿功能障碍患者的尿动力学评估

目的:评估盆腔肿瘤放疗后患者下尿路功能,分析排尿功能障碍类型.方法:对放疗组21例患者:子宫颈癌15例,骶髓肿瘤2例,直肠癌4例;正常对照组17例,采用常规方法行尿动力学测定,按照美国泌尿协会症状评分(AUA评分)标准进行评分,分析评分与放疗剂量关系,以及尿频尿急、排尿困难、尿失禁三类排尿功能障碍发生的原因.结果:膀胱容量、顺应性、逼尿肌收缩强度、残余尿与对照组比较有显著性差异(P<0.05);放疗组尿失禁患者6例(28.6%),排尿困难11例(52.3%),尿频尿急4例(14.0%).放疗后患者的排尿功能障碍严重程度与放疗剂量有一定相关性(r=0.43,P<0.05).结论:盆腔肿瘤放疗对膀胱尿道功能有明显影响,尿动力学检查有助于放疗后复杂排尿功能障碍的评估.     

Usefulness and safety of bunazosin hydrochloride in neurogenic bladder after prolonged administration]

Bunazosin hydrochloride (Ea-0643), a selective alpha 1-blocker, was administered to 14 patients with neurogenic bladder over prolonged periods of time in order to determine its efficacy and safety. Subjective symptoms were classified into 4 grades, and their response assessed after 12 weeks of treatment. The proportion of patients showing improvement by at least one grade was 50.0% for retarded urination, 16.7% for prolonged urination, 25.0% for urinary stream condition, 25.0% for abdominal pressure at voiding, and 28.6% for residual urine. Objective symptoms were also assessed after 12 weeks of treatment, and a statistically significant improvement was recognized in the volume of spontaneously voided urine, the maximum and mean flow rates on uroflowmetry. It should be noted that both of those flow rates had improved significantly only 2 weeks into the treatment. The degree of improvement in subjective and objective symptoms and the degree of general improvement were all higher at week 12 than at week 2 of treatment. Current knowledge of the mechanism of action of this drug, coupled with the observations made in this study, suggests that, once it has improved the urodynamics, it exhibits a sustained effect for prolonged periods of treatment. However, further studies are warranted concerning the mechanisms of the pharmacological action of the drug from a pathological viewpoint. The proportion of patients in whom Ea-0643 was judged to be useful at 12 weeks of treatment was 41.7%, but when the assessment of 'slightly useful' was taken into consideration, the usefulness rate rose as high as 91.7%. Stomatitis was observed in only one case as a side effect of this drug.(ABSTRACT TRUNCATED AT 250 WORDS)     

Successful therapy of interstitial cystitis with pentosanpolysulfate

Sodium pentosanpolysulfate (Elmiron) is a synthetic, sulfated polysaccharide available in an oral form that is excreted into the urine. This drug was used in a double-blind fashion to evaluate its efficacy in the management of symptoms of interstitial cystitis. A dose of 100 mg. 3 times daily was used for a minimum of 4 months and was continued for longer than 18 months in some individuals. A total of 62 patients was evaluated from 2 different medical centers. Subjective improvements were greater in all parameters when the drug was compared to placebo therapy, with significant improvement in pain, urgency, frequency and nocturia. Objective improvement in average voided volumes was greater with the drug than with placebo (p equals 0.009). No significant difference was found between drug and placebo groups in the average number of daily voiding episodes.     

FOUR-HOUR VOIDING OBSERVATION IN YOUNG BOYS WITH POSTERIOR URETHRAL VALVES

Purpose

We evaluated 4-hour voiding observation as a method of basic assessment of bladder dysfunction in young boys with posterior urethral valves.

Materials and Methods

Voiding pattern, including number of voids, voided and residual urine volume, and bladder capacity, was determined noninvasively in 24 boys younger than 4 years with posterior urethral valves and compared to that of healthy age matched controls. Results were then compared to those of standard cystometry.

Results

The number of voids was higher, voided was smaller and residual urine volume was higher in the posterior urethral valve group. There was no difference in voiding pattern before and after removal of the anatomical obstruction. Voided and residual urine volume, and bladder capacity were higher on standard cystometry than on voiding observation.

Conclusions

Four-hour voiding observation is an easy noninvasive method that focuses on emptying difficulties and clearly detects differences in voiding patterns between boys with posterior urethral valves and healthy, nontoilet trained children. We recommend the method as a complement to standard cystometry for the diagnosis and followup of bladder dysfunction in young boys with posterior urethral valves to identify the need for treatment.     

A comparative study assessing clinical effects of naftopidil and tamsulosin hydrochloride on benign prostatic hyperplasia

We compared the efficacy of naftopidil with that of tamsulosin hydrochloride for benign prostatic hyperplasia patients. Eighty-five patients without improvement of quality of life (QOL) score by the administration of 50-75 mg naftopidil for more than four weeks were assigned to receive doses of 0.1-0.2 mg tamsulosin hydrochloride and 89 patients without improvement of QOL score by the administration of 0.1-0.2 mg tamsulosin hydrochloride for more than four weeks were assigned to receive doses of 50-75 mg naftopidil once a day for 8 weeks. International prostate symptom score, maximum flow rate, residual urine volume and side effect profile were determined before the administration of the first medicine, before the administration of the second medicine and after 8 weeks of treatment with the second medicine. In the group without improvement of QOL score by naftopidil, significant improvements in symptoms of urgency, weak stream and straining were observed after 8 weeks of treatment with tamsulosin hydrochloride. In the group without improvement of QOL score by tamsulosin hydrochloride, significant improvements in symptoms of incomplete emptying, intermittency and nocturia were observed after 8 weeks of treatment with naftopidil. In conclusion, improvement of symptoms by each alpha 1-blocker differs symptom by symptom. Tamsulosin hydrochloride was superior to naftopidil for the symptoms of urine flow and naftopidil was superior to tamsulosin hydrochloride for the symptom of nocturia.