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Gravas S, Manuel-Palacios J, Chavan C, Roehrborn CG, Oelke M, Averbeck MA, Biswas A, García LM, Mohamed K, Cortes V. Modeling study of the effect of placebo and medical therapy on storage and voiding symptoms, nocturia, and quality of life in men with prostate enlargement at risk for progression. Prostate Cancer Prostatic Dis 2024; 27:469-477. [PMID: 37794168 PMCID: PMC11319195 DOI: 10.1038/s41391-023-00731-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Modeling studies using large datasets from men with lower urinary tract symptoms/benign prostate enlargement (LUTS/BPE) can predict changes in International Prostate Symptom Score (IPSS) and risk of acute urinary retention/surgery under different treatment regimens and according to predictors (baseline characteristics) that commonly define risk of progression. We assessed the impact of treatments on different symptom types (storage, voiding, and nocturia), quality of life (QoL; IPSS Q8), and BPH Impact Index [BII]). METHODS Generalized least squares models were used to predict each outcome. Data from the CombAT study were used to predict outcomes for active treatments (dutasteride, tamsulosin, combination therapy). Predictors included: age; IPSS total, storage, voiding, nocturia and QoL (IPSS Q8) scores; BII; prostate volume; maximum urine flow rate (Qmax), prostate-specific antigen, postvoid residual urine (PVR); alpha-blocker usage within 12 months. Data from phase III dutasteride monotherapy studies were used to predict placebo outcomes. Results were visualized using an interactive web-based tool ( www.bphtool.com ). RESULTS Combination therapy provided greater predicted benefit than either monotherapy for all five outcomes for most patient profiles within the CombAT inclusion criteria. PVR and corresponding subscores were significant predictors of change in both storage and voiding subscores. Alpha-blocker use within 12 months, age (storage subscore), and Qmax (voiding subscore) were also significant predictors. PVR, age, Qmax, and nocturia score were significant predictors of change in nocturia. PVR, Qmax, previous alpha-blocker use, total IPSS, and QoL (IPSS Q8) score were significant predictors of change in QoL (IPSS Q8) score. For BII, significant predictors were PVR, age, total IPSS, and BII score. The multivariable effect of covariates and treatments is best visualized through the interactive web-based tool. CONCLUSIONS This predictive modeling study informs our understanding of how risk factors for disease progression interact and affect treatment impact on different symptom types and QoL scores.
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Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | | | | | - Claus G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthias Oelke
- Department of Urology, St. Antonius-Hospital, Gronau, Germany
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Gotoh D, Torimoto K, Morizawa Y, Hori S, Nakai Y, Miyake M, Fujimoto K. Efficacy and safety of dutasteride with tadalafil add-on therapy in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. BMC Res Notes 2022; 15:288. [PMID: 36064733 PMCID: PMC9446813 DOI: 10.1186/s13104-022-06183-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/27/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of add-on therapy with the phosphodiesterase type 5 inhibitor tadalafil in Japanese men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) treated with dutasteride. RESULTS Twenty-four patients were enrolled. The participants had a median age of 71.0 (64.8-73.0) years and a median prostate volume of 37.3 (29.7-41.8) mL as measured using transabdominal sonography. The efficacy indicators, such as International Prostate Symptom Score (IPSS), quality of life (QOL) score, night-time urinary frequency, and night-time maximum voided volume, improved significantly at 4 weeks, and the effects lasted until 24 weeks (IPSS: 9.5 vs. 17.0, QOL: 2.0 vs. 4.0, nocturia: 2.0 vs. 2.0, night-time maximum voided volume: 290.0 vs. 240.0 mL). Overactive bladder symptom score (OABSS) and sexual health inventory for men (SHIM) significantly improved at 12 weeks, and the effects lasted until 24 weeks (OABSS: 3.0 vs. 5.0, SHIM: 11.0 vs. 7.5). However, maximum urine flow and residual urine volume showed no improvement at any point. Adverse events occurred in two cases. Taken together, add-on therapy with tadalafil was effective for patients with LUTS/BPH resistant to dutasteride monotherapy. In addition, this therapy was not associated with severe adverse events.
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Affiliation(s)
- Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Japan
- Department of Urology, Hirao Hospital, Kashihara, Japan
| | | | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Japan
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Wada N, Abe N, Miyauchi K, Ishikawa M, Makino S, Kakizaki H. Dutasteride add-on treatment to tadalafil for patients with benign prostatic enlargement is similarly effective as dutasteride add-on treatment to alpha blocker: a propensity-score matching analysis. Int Urol Nephrol 2022; 54:1193-1198. [PMID: 35362820 DOI: 10.1007/s11255-022-03198-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the efficacy of dutasteride add-on treatment to tadalafil in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic enlargement (BPE). METHODS A prospective study was conducted in patients with BPE who had not been satisfied with tadalafil monotherapy for more than 3 months. Inclusion criteria were prostate volume (PV) ≥ 30 ml and IPSS ≥ 8 or QOL index ≥ 3 under administration of tadalafil without anticholinergic agent. Before and 24 weeks after dutasteride add-on treatment to tadalafil, we assessed IPSS, overactive bladder symptom score (OABSS), serum PSA and testosterone, and uroflowmetry (UFM) to compare these parameters before and after dutasteride add-on treatment. Using a propensity-score matching analysis, the efficacy of dutasteride add-on treatment to tadalafil was compared with the previous study of dutasteride add-on treatment to alpha blocker. RESULTS Of 52 patients who were enrolled in this study, 48 patients completed the study (mean age: 72 ± 5 years old). Dutasteride add-on treatment to tadalafil significantly improved IPSS (from 16.4 ± 5.2 to 13.3 ± 6.4) and IPSS-QOL (from 4.0 ± 1.2 to 3.3 ± 1.1), and reduced PV from 55 ± 26 to 39 ± 22 ml. Propensity-score matching identified 42 matched pairs of patients. The improvement rate of IPSS and reduction rate of PV were similar between patients treated with dutasteride add-on treatment to tadalafil and dutasteride add-on treatment to alpha blocker. The logistic regression analysis showed that PV at baseline and reduction rate of PV after treatment were associated with the effective symptomatic outcome. CONCLUSIONS The dutasteride add-on is a reasonable treatment option for male patients with LUTS who are not satisfied with tadalafil monotherapy.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
| | - Noriyuki Abe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Mayumi Ishikawa
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shogo Makino
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
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Wada N, Abe N, Miyauchi K, Ishikawa M, Makino S, Kakizaki H. Risk factors for failure of long-term dutasteride add-on treatment to alpha-adrenergic antagonist for patients with lower urinary tract symptoms and benign prostatic enlargement. Int Urol Nephrol 2021; 54:31-36. [PMID: 34767140 DOI: 10.1007/s11255-021-03053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify the clinical factors resulting in the failure of dutasteride add-on treatment to alpha-adrenergic antagonist for patients with lower urinary tract symptoms and benign prostatic enlargement (BPE). METHODS We retrospectively surveyed the patient cohort who had been enrolled in the study of dutasteride add-on treatment to alpha-adrenergic antagonist from December 2009 to November 2011. Treatment failure was defined as receiving surgery for BPE or requiring intermittent catheterization or permanent bladder catheter for urinary retention or huge postvoid residual urine. Clinical parameters before dutasteride treatment were compared between the successful and failed group. RESULTS Of 92 patients, 23 (25%) were defined as treatment failure at 7-109 months (mean: 38 months) after dutasteride add-on treatment. In the failed group, the patient' age was younger (71.6 ± 6.8 vs 75.4 ± 8.4, p = 0.033), prostatic volume (PV) was larger (76 ± 41 vs 49 ± 26 ml, p = 0.005), voiding efficiency was lower (54 ± 27 vs 68 ± 24%, p = 0.045) and bladder outlet obstruction index was higher (73 ± 30 vs 48 ± 30, p = 0.015). The cox proportional-hazards model indicated that only intravesical prostatic protrusion (IPP) was associated with treatment failure. Non-failure rate at 3 years after dutasteride add-on treatment was 89% with patients of IPP < 13 mm versus 51% with those of IPP ≥ 13 mm (p < 0.001). CONCLUSION IPP ≥ 13 mm is the risk factor resulting in the failure of dutasteride add-on treatment to alpha-adrenergic antagonist. This kind of information should be provided to the patients early in the clinical practice so that they could consider the necessity of BPE surgery in the long run.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
| | - Noriyuki Abe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Mayumi Ishikawa
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shogo Makino
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
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Watanabe M, Yamaguchi S, Kakizaki H, Hirabayashi N, Ishida H. Evaluation of Alpha 1 Adrenoceptor Antagonist Dose Increase Therapy: An Essential Strategy for Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia. Curr Urol 2020; 14:113-121. [PMID: 33224003 DOI: 10.1159/000499250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction There have been a number of reports on dose increase therapy (DI-T) with the alpha 1 adrenoceptor antagonists (α1-blockers) naftopidil and tamsulosin for lower urinary tract symptoms associated with benign prostatic hyperplasia. Methods and Results The reports on DI-T (naftopidil 75 mg/d, tamsulosin 0.4 mg/d) in non-responders to low-dose initial therapy (LI-T, naftopidil 50 mg/d, tamsulosin 0.2 mg/d) were summarized. In each study, a non-responder was defined as a patient without sufficient improvements on the International Prostate Symptom Score (IPSS), IPSS Quality of Life, maximum flow rate of urine, or treatment satisfaction. These reports showed that 22.4-76.1% of patients were non-responders to LI-T, indicating that a novel treatment strategy for such patients is important. Moreover, 22.5-90.0% of non-responders to LI-T showed a response to DI-T, which achieved the same level of efficacy as low-dose maintenance therapy. Specifically, the improvements of the IPSS voiding symptom sub-score and maximum flow rate of urine were superior. The predictive factors for non-response to α1-blockers LI-T were insufficient improvement of subjective symptoms and objective findings during LI-T. These patients require high-dose initial therapy or DI-T at an early stage, since adverse events associated with naftopidil and tamsulosin do not show a dose-response relationship. Conclusions DI-T with α1-blockers has high potential as an essential treatment strategy for lower urinary tract symptoms associated with benign prostatic hyperplasia.
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Affiliation(s)
- Masaki Watanabe
- Department of Urology, Hokkaido Social Welfare Association Furano Hospital, Furano
| | | | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa
| | - Naoki Hirabayashi
- Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan
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Obstructive patterns in videourodynamic studies predict responses of female dysfunctional voiding treated with or without urethral botulinum toxin injection: a long-term follow-up study. Int Urogynecol J 2020; 31:2557-2564. [PMID: 32556406 DOI: 10.1007/s00192-020-04333-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We report long-term changes in VUDS profiles of women with dysfunctional voiding and investigate potential predictors for treatment response. METHODS Women with dysfunctional voiding and available VUDS data between November 1997 and June 2018 were enrolled for retrospective analysis. The patients were all treated with medication first. In refractory patients, urethral botulinum toxin was provided as an additional option. The primary outcome was the change of VUDS parameters between baseline and follow-up studies. The secondary outcomes were baseline parameters and clinical factors that were associated with the BOOI response (> 10 points of BOOI reduction). RESULTS A total of 195 women with DV were included in this study. The mean age was 54.5 years old. Sixty patients received urethral botulinum toxin injection. For all patients, Pdet decreased from 47.2 to 36.8 cm H2O (p < 0.0001), and BOOI decreased from 26.4 to 17.7 (p = 0.0001). Patients with urethral injection had significantly smaller Qmax, voided volume, and voiding efficiency (VE) and significantly larger PVR and BOOI at baseline, indicating a severer obstruction in this group. The overall BOOI response rate was 44% (85/195). A higher baseline BOOI was associated with the BOOI response in multivariate analysis. CONCLUSIONS In this long-term study of women with dysfunctional voiding, medical treatment with or without urethral botulinum toxin injection both resulted in reduction of Pdet and BOOI. A more prominent obstructive profile at baseline VUDS study was associated with a higher rate of BOOI response at follow-up study.
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Yamanishi T, Asakura H, Seki N, Tokunaga S. Efficacy and safety of combination therapy with tamsulosin, dutasteride and imidafenacin for the management of overactive bladder symptoms associated with benign prostatic hyperplasia: A multicenter, randomized, open-label, controlled trial (DIrecT Study). Int J Urol 2017; 24:525-531. [DOI: 10.1111/iju.13359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Tomonori Yamanishi
- Department of Urology; Continence Center; Dokkyo Medical University; Mibu Tochigi Japan
| | - Hirotaka Asakura
- Department of Urology; Saitama Medical University Hospital; Saitama Japan
| | - Narihito Seki
- Department of Urology; Kyushu Central Hospital; Fukuoka Japan
| | - Shoji Tokunaga
- Medical Information Center; Kyushu University Hospital; Fukuoka Japan
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De Nunzio C, Brassetti A, Proietti F, Gacci M, Serni S, Esperto F, Tubaro A. Dutasteride add-on therapy reduces detrusor mass in patients with benign prostatic enlargement not satisfied with alpha-adrenergic antagonist monotherapy: A single center prospective study. Neurourol Urodyn 2017; 36:2096-2100. [PMID: 28257560 DOI: 10.1002/nau.23247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/23/2017] [Accepted: 01/25/2017] [Indexed: 11/08/2022]
Abstract
AIMS The ultrasound assessment of bladder wall thickness (BWT) and intravesical prostatic protrusion (IPP) have emerged as a non-invasive, inexpensive, time-saving alternatives to pressure-flow studies to assess benign prostatic obstruction (BPO). Aim of our study was to evaluate the effect on detrusor mass of dutasteride add-on therapy in men with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE). METHODS A consecutive series of BPE patients with a prostate volume (PV) ≥30 mL and an international prostate symptoms score (IPSS) ≥8 not satisfied with Tamsulosin monotherapy were enrolled. Free maximum flow (Qmax), PV, BWT, and IPP were recorded at baseline and at 24 weeks follow-up. RESULTS Overall, 27 men were enrolled. Dutasteride significantly improved LUTS (-46.7%; P = 0.001) and Qmax (+18.7%; P = 0.001) and reduced PV (-13%; P = 0.002), BWT (-40.3%; P = 0.001), and IPP (-14.9%; P = 0.015). At baseline, based on BWT ≥5 mm and an IPP >10 mm, 13/27 (48%) and 15/27 (55%) patients were defined at risk for BPO, respectively; while after 24 weeks of treatment they were 3/27 (11.1%) and 11/27 (40%), respectively. CONCLUSIONS Dutasteride add-on therapy significantly reduced IPP and detrusor mass and was effective in improving LUTS in patients with BPE not satisfied with αBs monotherapy. The possible role of BWT and IPP as proxies of medical treatment outcomes should be confirmed by further studies.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy
| | - Flavia Proietti
- Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy
| | - Mauro Gacci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Esperto
- Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy
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Kolontarev K, Govorov A, Kasyan G, Priymak D, Pushkar D. Current drug therapy of patients with BPH-LUTS with the special emphasis on PDE5 inhibitors. Cent European J Urol 2016; 69:398-403. [PMID: 28127458 PMCID: PMC5260456 DOI: 10.5173/ceju.2016.879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/04/2016] [Accepted: 10/16/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptom (LUTS) development in men [1]. The intensity of the symptoms may vary from mild to severe, significantly affecting the quality of life. Erectile dysfunction (ED) is one of the most challenging issues in modern urology that significantly influences the quality of life in men worldwide. The objective of this literature review was to analyze the current drug therapies of patients with BPH-LUTS, with the special emphasis on PDE5 inhibitors. MATERIAL AND METHODS The authors searched the literature for the period from 2000 until 2015 in MEDLINE and PubMed. RESULTS Twenty-three articles were selected based on their reliability. A detailed analysis of the selected papers was performed. Primary attention was given to articles describing the use of PDE5. Works describing the use of different groups of drugs in patients with BPH-LUTS were also selected. CONCLUSIONS The current literature analysis suggests that the introduction of PDE5 inhibitors in clinical practice for the treatment of patients with BPH-LUTS will allow for significant expansion of the therapeutic options for the treatment of this disease.
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Affiliation(s)
| | | | - George Kasyan
- Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Dmitry Pushkar
- Moscow State University of Medicine and Dentistry, Moscow, Russia
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Hashimoto M, Shimizu N, Sugimoto K, Hongoh S, Minami T, Nozawa M, Yoshimura K, Hirayama A, Tahara H, Uemura H. Efficacy of Adding Dutasteride to α-Blocker Therapy Treated Benign Prostatic Hyperplasia Patients with Small Volume Prostate (<30 mL). Low Urin Tract Symptoms 2016; 9:157-160. [PMID: 26991643 DOI: 10.1111/luts.12127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the efficacy of dutasteride add-on therapy for patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) with small prostates who have been treated with α-blocker therapy for >3 months. METHODS A total of 110 men with clinical BPH were enrolled. There were 17 and 93 subjects with a prostate volume (PV) <30 and ≥30 mL, respectively. All subjects had been treated with α-blocker therapy for >3 months. Subjective and objective clinical variables were assessed using the total International Prostate Symptom Score (IPSS-T), IPSS quality of life (IPSS-QoL), IPSS voiding subscore (IPSS-V), IPSS storage subscore (IPSS-S), overactive bladder symptom score (OABSS), PV, prostate specific antigen (PSA) level, post-void residual (PVR), and maximum flow rate (Qmax). These variables were assessed at baseline and every 3 months for 1 year. RESULTS In the small prostate group, IPSS-T and IPSS-V showed improvements from baseline at 6 and 9 months, storage subscore at 6 months, and OABSS at 3 months, but no sustained improvements were observed. During the study period, only the IPSS QoL scores did not show any improvement. Conversly, dutasteride was significantly effective at improving IPSS-T, IPSS-V, IPSS-S, and IPSS-QoL scores throughout the study period in the large prostate BPH group. PSA levels and PV significantly decreased in both groups throughout the study. CONCLUSIONS Benign prostatic hyperplasia in LUTS patients with small prostates did not show a sustainable benefit from the addition of dutasteride to α-blocker therapy.
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Affiliation(s)
- Mamoru Hashimoto
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Nobutaka Shimizu
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Koichi Sugimoto
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Sachiko Hongoh
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takafumi Minami
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Masahiro Nozawa
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuhiro Yoshimura
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Akihide Hirayama
- Department of Urology, Nara Hospital Kinki University Faculty of Medicine, Ikoma, Japan
| | - Hideo Tahara
- Department of Urology, Mimihara General Hospital, Sakai, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
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Aikawa K, Kataoka M, Ogawa S, Akaihata H, Sato Y, Yabe M, Hata J, Koguchi T, Kojima Y, Shiragasawa C, Kobayashi T, Yamaguchi O. Elucidation of the Pattern of the Onset of Male Lower Urinary Tract Symptoms Using Cluster Analysis: Efficacy of Tamsulosin in Each Symptom Group. Urology 2015; 86:349-53. [PMID: 26194300 DOI: 10.1016/j.urology.2015.04.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/09/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To present a new grouping of male patients with lower urinary tract symptoms (LUTS) based on symptom patterns and clarify whether the therapeutic effect of α1-blocker differs among the groups. METHODS We performed secondary analysis of anonymous data from 4815 patients enrolled in a postmarketing surveillance study of tamsulosin in Japan. Data on 7 International Prostate Symptom Score (IPSS) items at the initial visit were used in the cluster analysis. IPSS and quality of life (QOL) scores before and after tamsulosin treatment for 12 weeks were assessed in each cluster. Partial correlation coefficients were also obtained for IPSS and QOL scores based on changes before and after treatment. RESULTS Five symptom groups were identified by cluster analysis of IPSS. On their symptom profile, each cluster was labeled as minimal type (cluster 1), multiple severe type (cluster 2), weak stream type (cluster 3), storage type (cluster 4), and voiding type (cluster 5). Prevalence and the mean symptom score were significantly improved in almost all symptoms in all clusters by tamsulosin treatment. Nocturia and weak stream had the strongest effect on QOL in clusters 1, 2, and 4 and clusters 3 and 5, respectively. CONCLUSION The study clarified that 5 characteristic symptom patterns exist by cluster analysis of IPSS in male patients with LUTS. Tamsulosin improved various symptoms and QOL in each symptom group. The study reports many male patients with LUTS being satisfied with monotherapy using tamsulosin and suggests the usefulness of α1-blockers as a drug of first choice.
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Affiliation(s)
- Ken Aikawa
- Department of Urology, Fukushima Medical University, Fukushima, Japan.
| | - Masao Kataoka
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Soichiro Ogawa
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Hidenori Akaihata
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Yuichi Sato
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Michihiro Yabe
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Junya Hata
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Tomoyuki Koguchi
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | | | | | - Osamu Yamaguchi
- Division of Bioengineering and LUTD Research, Nihon University College of Engineering, Koriyama, Japan
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Wada N, Matsumoto S, Kita M, Hashizume K, Kakizaki H. Decreased urinary nerve growth factor reflects prostatic volume reduction and relief of outlet obstruction in patients with benign prostatic enlargement treated with dutasteride. Int J Urol 2014; 21:1258-62. [PMID: 25039474 DOI: 10.1111/iju.12570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/17/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine urinary nerve growth factor before and after dutasteride treatment, and to analyze correlations between clinical parameters and change of urinary nerve growth factor in patients with benign prostatic enlargement. METHODS We prospectively studied 30 patients with benign prostatic enlargement who had not been satisfied with α-adrenergic antagonist monotherapy for more than 3 months. Before and 24 weeks after dutasteride add-on treatment, we assessed International Prostate Symptom Score, prostatic volume, filling cystometry and pressure-flow study. Urinary nerve growth factor was measured by enzyme-linked immunosorbent assay, and normalized to the urinary creatinine (nerve growth factor/creatinine) before and 24 weeks after dutasteride add-on treatment. RESULTS In baseline characteristics before dutasteride, there was no significant correlation between urinary nerve growth factor/creatinine and any clinical parameters including age, International Prostate Symptom Score, prostatic volume, presence of detrusor overactivity, detrusor pressure at maximum flow rate, bladder outlet obstruction index or bladder contractility index. Dutasteride significantly reduced prostatic volume (from 68 ± 31 mL to 49 ± 28 mL) and improved International Prostate Symptom Score (from 17.2 ± 8.7 to 13.1 ± 6.8), storage (from 8.0 ± 4.3 to 6.0 ± 2.9) and voiding symptom subscore of International Prostate Symptom Score (from 9.3 ± 5.7 to 7.1 ± 4.5). In urodynamic study, detrusor pressure at maximum flow rate (from 77 ± 32 cmH2 O to 59 ± 24 cmH2 O) and bladder outlet obstruction index (from 62 ± 32 to 42 ± 27) were significantly decreased after dutasteride treatment. Urinary nerve growth factor/creatinine was significantly decreased after dutasteride from 2.61 ± 2.50 to 1.64 ± 1.68. The change of urinary nerve growth factor/creatinine significantly correlated only with the change of prostatic volume (r = 0.38) and bladder outlet obstruction index (r = 0.36). CONCLUSIONS Urinary nerve growth factor decreases in association with reduction of prostatic volume and relief of bladder outlet obstruction. Urinary nerve growth factor might be useful as a biomarker to monitor the improvement of bladder outlet obstruction in patients with benign prostatic enlargement.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
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Araki K, Naya Y, Inahara M, Suzuki F, Ota S, Tsuji H, Mikami K, Yanagisawa M, Awa Y, Suzuki H. Early effect of dutasteride added to alpha-1 blocker therapy for patients with lower urinary tract symptoms associated with benign prostatic hyperplasia. Int J Urol 2014; 21:815-9. [DOI: 10.1111/iju.12459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 03/07/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Kazuhiro Araki
- Department of Urology; Teikyo University Chiba Medical Center; Ichihara Chiba Japan
| | - Yukio Naya
- Department of Urology; Teikyo University Chiba Medical Center; Ichihara Chiba Japan
| | - Masahiko Inahara
- Department of Urology; Teikyo University Chiba Medical Center; Ichihara Chiba Japan
| | - Fumio Suzuki
- Oami Urological Clinic; Oamisirasato Chiba Japan
| | - Syo Ota
- Department of Urology; Sanno Hospital; Chiba Chiba Japan
| | | | - Kazuo Mikami
- Department of Urology; Chibaken Saiseikai Narashino Hospital; Narashino Chiba Japan
| | - Mitsuru Yanagisawa
- Department of Urology; Graduate School of Medicine; Chiba University; Chiba Chiba Japan
| | | | - Hiroyoshi Suzuki
- Department of Urology; Toho University Sakura Medical Center; Sakura Chiba Japan
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WADA N, MATSUMOTO S, KITA M, HASHIZUME K, KAKIZAKI H. Improvement of Overactive Bladder Symptoms and Bladder Ischemia with Dutasteride in Patients with Benign Prostatic Enlargement. Low Urin Tract Symptoms 2014; 7:37-41. [DOI: 10.1111/luts.12047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 12/01/2013] [Accepted: 12/09/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Naoki WADA
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa Japan
| | - Seiji MATSUMOTO
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa Japan
| | - Masafumi KITA
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa Japan
| | - Kazumi HASHIZUME
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa Japan
| | - Hidehiro KAKIZAKI
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa Japan
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Oelke M. Editorial comment on "Wada N, Kita M, Hashizume K, et al. Urodynamic effects of dutasteride add-on therapy to alpha-adrenergic antagonist for patients with benign prostatic enlargement: prospective pressure-flow study. Neurourol Urodyn 2013;32:1123-7". Neurourol Urodyn 2012. [PMID: 23192914 DOI: 10.1002/nau.22358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Matthias Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
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