Efficacy of combination therapy tadalafil plus tamsulosin in ureteral stents-related symptoms relief

Introduction

Ureteral stents-related symptoms (USRs) are the common complications of ureteral stenting. Tamsulosin a selective alpha-1 blocker and Tadalafil a PDE-5 inhibitor are one of drugs have been used for USRs relief. In this study we aimed to evaluate the effectiveness and safety of combination therapy Tamsulosin+Tadalafil for treating USRs comparing it with the efficacy of either Tamsulosin or Tadalafil monotherapies.

Material and methods

279 patients with indwelled unilateral ureteral stents were randomized to Tamsulosin 0.4 mg + Tadalafil 5 mg once a day (Group 1, n = 67), Tamsulosin 0.4 mg once a day (Group 2, n = 71), Tadalafil 5 mg once a day (Group 3, n = 69) and Placebo once a day (Group 4, n = 72). USRs severity was registered and calculated by using the Ureteral Symptoms Score Questionnaire (USSQ) at the 14th day of treatment. Side-effects and total analgesic use were recorded and compared.

Results

At the endpoint in patients with unilateral ureteral stents the combination therapy Tamsulosin + Tadalafil led to statistically lower intensity of urinary symptoms comparing with Tamsulosin (15.2 ±4.3 vs 21.8±3.6, p = 0.0003) or Tadalafil (15.2 ±4.3 vs 20.6 ±2.8, p = 0.0004) monotherapy. All groups of treatment demonstrated significant relief of USRs comparing with Placebo mostly beneficial in the combined therapy group. Body pain and analgesic need in Group 1 was lower than in Groups 2, 3 or 4. Side-effects were registered rarely without statistical differences in frequency between groups.

Conclusions

Combination therapy with Tamsulosin + Tadalafil is an effective and safe option that achieves the statistically more significant relief of USRs comparing with Tadalafil or Tamsulosin monotherapies.

Assessment of the effectiveness of radiofrequency ablation as a technique for destroying small renal tumors in patients older than 70

Introduction

During the past few decades, the percentage of older people in the population has been steadily growing due to the tendency of extended life expectancy. The efficacy of radiofrequency ablation (RFA) and tumor enucleoresection (TE) in the treatment of selected older patients with renal cell carcinoma (RCC) T1aN0M0 sized ≤4.0 cm has been a popular topic in many recent studies.

The aim of this study was to access the effectiveness of radiofrequency ablation in patients older than 70 with T1aN0M0 RCC.

Material and methods

A total of 86 patients aged 70–84 with histologically confirmed solitary kidney tumors T1aN0M0 who underwent RFA (n = 39) and TE (n = 47) were been included in this study. The patients were assigned to groups based on the impact of their comorbidities. Rockwood’s Clinical Frailty Scale Score (FS) and Charlson Comorbidity Index score (CCI) were used to separate fit from unfit older patients. The RFA group was characterized by an FS and CCI of 4–5 while the TE group had scores of ≤3. Five-year disease-specific survival (DSS), 5-yrs overall survival (OS) and relapse-free survival (RFS) were considered as criteria of treatment.

Results

The 5-yr DSS in the RFA group was 97.4% vs. 95.7% in the TE group (p >0.05), while 5-yr OS was 74.4% vs. 80.9% (p <0.05) and RFS – 94.9% vs. 93.6% (p >0.05) respectively. Functioning of the operated kidneys did not deteriorate at the 6^th and 12^th month after RFA/TE as assessed by radioisotope renography.

Conclusions

In patients over 70 years of age, percutaneous RFA might be considered as an effective option for the successful treatment of T1aN0M0 RCC, as it preserves the functioning of the treated kidney and has oncological outcomes similar to TE.