Evaluation of Tamsulosin 0.4 mg versus 0.8 mg in management of lower urinary tract symptoms due to benign prostatic enlargement

PURPOSE

To compare the efficacy and the safety of Tamsulosin 0.4 mg/day and 0.8 mg/day in patients suffering from lower urinary tract symptoms due to benign prostatic obstruction.

PATIENTS AND METHODS

A prospective interventional, double-blinded, controlled study was carried out on 93 patients who met the criteria and divided randomly into two groups: group A for Tamsulosin 0.4 mg/day and group B for Tamsulosin 0.8 mg/day. International prostate symptom score, post void residual urine volume, and maximum flow rate of urine were assessed before and after 4 weeks of treatment.

RESULTS

Both study groups showed a significant reduction in storage sub-score but only frequency was significantly reduced in group B (P < 0.001). On the other hand, Tamsulosin 0.8 mg was superior to Tamsulosin 0.4 mg regarding voiding sub-score except for straining (P = 0.325). Accordingly, the total international prostate symptom score was significantly improved in group B versus group A (P < 0.001). Furthermore, maximum flow rate and post-void residual urine volume were notably improved in Group B as compared to Group A (P < 0.001). Of all adverse events only dizziness was noted to be statistically significant in Group B versus Group A (P < 0.001).

CONCLUSION

Tamsulosin 0.8 mg has shown better outcomes in treating patients who suffer from lower urinary tract symptoms due to benign prostatic enlargement than Tamsulosin 0.4 mg, and besides that, it is well tolerated.

TRIAL REGISTRATION NUMBER

M S 292/2020, SID: 373, date: 22/4/2020.

Combination of pregabalin and Amitriptyline in management of chronic idiopathic pain following penile prosthesis implantation: a pilot study

BACKGROUND

Chronic post-penile prosthesis pain is de novo pain persisting > 2 months post-operatively. This pain is inadequately reported, poorly understood and undermanaged. The purpose of this current pilot study was to improvise a medical approach to alleviate the condition and assess the combination of Pregabalin and Amitriptyline in its management.

RESULTS

The study enrolled 9 patients complaining of idiopathic penile, pelvic, or scrotal pain persisting > 2 months after penile prosthesis implantation. Patients were prescribed pregabalin 75mg/12h (escalated after 1 week to 150mg/12h upon demand) and Amitriptyline 25mg once daily for 3 months. The pain was reassessed after 10, 30 and 100 days. The dose of pregabalin required and the side effects of the medication were noted. Findings revealed a significant decrease in pain duration (p = 0.007), frequency (p < 0.001), and intensity (p < 0.001); in glanular (p = 0.008), shaft pain (p = 0.046) but not scrotal (p = 0.112). Moreover, a significant decrease was found in sharp pain (p = 0.003) and pain aggravated by touch (p = 0.008) but not aching pain (p = 0.277). Additionally, significant improvement was reported in QoL (p < 0.001) and dose escalation of pregabalin to 150mg/12h was required in only 1 case (11%).

CONCLUSION

The combination of pregabalin and amitriptyline is very effective in the management of chronic idiopathic pain following penile prosthesis implantation. However, due to the ambiguity and lack of reporting of the condition, we recommend a multicentric contribution to acknowledge the condition, and weigh its prevalence accurately, whilst evaluating the efficacy of our approach. This study received ethical approval from Ain Shams University Research Ethics Committee (REC) FWA 000017585, on 04/13/2023 (REC-FMASU@med.asu.edu.eg).

TRIAL REGISTRATION

no FMASU R98/2023.

Comparison Between Mini-Percutaneous Nephrolithotomy and Standard Percutaneous Nephrolithotomy in Management of Large Renal Stones: A Randomized, Controlled Clinical Trial

Objectives: The aim of this study was to compare mini-percutaneous nephrolithotomy (PNL) and standard PNL in management of renal stones (20-40 mm) with regard to the operative time, fluoroscopy time, blood loss, stone-free rate, and postoperative complications. Subjects and Methods: This prospective, randomized comparative study was carried out on 93 patients divided into two groups: Group A included 44 patients who underwent standard PNL, whereas Group B included 49 patients who underwent mini-PNL. Results: Standard PNL showed shorter operative time, yet longer hospitalization and nephrostomy and catheterization time. The mean drop in hemoglobin level was significantly lower in the mini-PNL group. In the 1st postoperative week, the stone-free rate was higher in the standard PNL group, but this was statistically insignificant. However, 4 weeks postoperatively, the stone-free rate was significantly higher in Group A. Postoperative pain and the need for postoperative analgesia were significantly higher in standard PNL patients. Conclusions: Standard PNL achieved a higher stone-free rate and shorter operative time, while mini-PNL had the advantage of shorter hospitalization time and lower incidence of pain and postoperative complications.

Evaluation of the risk factors associated with the development of post-transurethral resection of the prostate persistent bacteriuria

Objectives

To determine the preoperative, intraoperative and postoperative risk factors that influence the development of persistent post-transurethral resection of the prostate (TURP) urinary tract infection (UTI) defined as pyuria and/or bacteriuria remaining for 3 weeks after surgery.

Patients and methods

This is a prospective study including 100 patients scheduled for TURP. Urine analysis and culture was performed immediately after catheter removal, then at 1 and 3 weeks postoperatively, and the results were correlated to various preoperative, intraoperative and postoperative potential risk factors to detect any significant relation to persistent UTI.

Results

There was a statistically significant relationship between bacteriuria and the following risk factors: old age, past history of diabetes mellitus, large prostatic size, positive preoperative urine analysis and culture, preoperative catheter use, previous urological interventions, large size of sheath, long duration of operation, postoperative catheter events and postoperative manual wash.

Conclusions

Many risk factors have been found to contribute to the development of post-TURP UTI and avoiding these factors can enhance recovery of patients undergoing TURP.