Alfuzosin ameliorates diabetes by boosting PGK1 activity in diabetic mice

AIMS

Diabetes mellitus (DM) has become a global problem, causing a huge economic burden. The purpose of this study is to find a new potential method and mechanism for the treatment of DM.

MAIN METHODS

The oxidation, glycation and insulin resistance cell models were built to screen the potential anti-diabetic chemicals. Then the DM mice were induced by the combination of high-fat diet (HFD) and intraperitoneal injection of streptozotocin (50 mg/kg) for five days. The alfuzosin (1.2 mg/kg) was administered by intraperitoneal injection once daily for sequential 12 weeks. Fasting blood glucose, blood lipid, oxidative stress and key markers of glucose metabolism were detected. PGK1/AKT/GLUT4 pathway related proteins were analyzed by Western blot.

KEY FINDINGS

Alfuzosin ameliorated oxidative stress, glycative stress and insulin resistance in HepG2 cells. Further, in a high-fat diet/streptozotocin (HFD/STZ)-induced diabetic mouse model, alfuzosin reduced fasting blood glucose, improved insulin sensitivity. Mechanically, alfuzosin activated PGK1 directly to stimulate the protein kinase B (AKT) signaling pathway, thus facilitating glucose uptake as well as improving insulin resistance.

SIGNIFICANCE

The present finding has shed a new light on the treatment of DM and provides validation for PGK1 as a therapeutic target for DM.

[The influence of alfuzosin monotherapy on the sexual function of patients with benign prostatic hyperplasia in real clinical practice (results of a Russian multicenter study)]

INTRODUCTION

The current armamentarium of drugs for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is diverse and includes both monotherapy and combination therapy. Indirect and limited direct comparisons have demonstrated that all alpha-1-blockers (a1-ABs) have similar efficacy when used at appropriate doses. Differences in tropism to the prostate of modern 1-ABs are largely responsible for the severity of their side effects, mainly negative influence on sexual function and cardiovascular system.

AIM

To evaluate the influence of Alfuprost MR 10 mg once daily on sexual function in patients with LUTS due to BPH during 3-months therapy in real clinical practice. The secondary endpoint was an effect on systolic, diastolic blood pressure (BP) and heart rate.

MATERIALS AND METHODS

A total of 537 men with LUTS/BPH were included in the study by urologists from 21 outpatient departments of the Russian Federation. The follow-up included 3 visits: visit of inclusion in the program of patients with a previously prescribed drug of Alfuprost MR in a dosage of 10 mg once a day (visit "0"), visit 1 at 30 days (+/-5 days) later, and visit 2 at 90 days (+/-5 days) after inclusion in the study. At each visit, evaluation of complaints and physical examination was performed. In addition, patients completed questionnaires: International prostate symptom score (IPSS) and quality of life (QoL) index; the full version of the International Index of Erectile Function (IIEF) questionnaire; the Likert scale for the patient and for the physician. Also, laboratory and instrumental studies used in routine clinical practice were recorded: total prostate specific antigen (PSA) in serum; ultrasound examination (US) of the bladder; transrectal ultrasound examination (TRUS) of the prostate; uroflowmetry (maximum urine flow rate (Qmax)); measurement of systolic and diastolic BP; measurement of heart rate.

RESULTS

after 3 months of therapy with Alfuprost MR in a dosage of 10 mg once a day, significant (p<0.05) improvement of all urodynamic parameters was documented, including a decrease in the average IPSS score by 55% and improvement of quality of life by 2.46 points (on the QoL index); increase of Qmax by 53%; reduction of the average postvoid residual to normal values. In addition to a significant improvement in the quality of urination, changes in sexual function were also positive. Thus, the average total IIEF score increased significantly (p<0,05) from 45.35 to 53.18 points. When considering specific domains of male sexual function, positive dynamics in all domains was noted: overall improvement of orgasm function, sexual desire, sexual satisfaction and overall sexual functioning was 11.98%, 15.14%, 19.7% and 18.46%, respectively. Hemodynamic indices remained stable during the 3-month follow-up; only clinically insignificant decrease in systolic BP by no more than 2 mm Hg during the entire follow-up period was observed. At the same time there was no influence on diastolic BP. Changes in heart rate were also clinically insignificant, averaging no more than 1 beat per minute.

CONCLUSIONS

The results of observational study allow to recommend Alfuprost MR as a first-line therapy for BPH, including for sexually active men and patients with various types of sexual dysfunction. Considering minimal and clinically insignificant vasodilatory effects observed during 3 months of therapy, it is possible to prescribe Alfuprost MR in a dosage of 10 mg once daily, including comorbid patients.

[Modern possibilities of therapy of a urological patient with concomitant diseases of the cardiovascular system]

INTRODUCTION

Currently, there is a large selection of -blockers on the pharmaceutical market, while they have comparable effectiveness, slightly differing only in safety profile. However, even small differences are of fundamental importance for comorbid patients, especially for those patients who are prone to developing cardiovascular diseases in adulthood. The choice of -blockers, which is able to minimize the risks of cardiovascular complications, is important.

MATERIALS AND METHODS

Outpatient cards of 120 patients with BPH and concomitant high blood pressure or stage 1-2 hypertension, who had been taking Alfuprost MR for at least 12 weeks, were analyzed. All patients were divided into two groups of the same number. In group 1, 60 patients with LUTS/BPH and concomitant high blood pressure did not take any antihypertensive drugs, while 60 patients with LUTS/BPH and stage 1-2 hypertension in group 2 received antihypertensive drugs (according to the recommendation of an internist or cardiologist). Based on the analyzed data, the efficacy of the drug Alfuprost MR, its safety profile, including the effect on blood pressure and pulse, and the recorded adverse events after 4 and 12 weeks were assessed.

RESULTS

An analysis of the results of a retrospective study showed an improvement in LUTS in both groups, starting from 4 weeks of treatment, followed by positive dynamics by 12 weeks of therapy with Alfuprost MR. The data obtained correspond to those presented in the literature. During 3 months of therapy, it was recorded: a decrease in the average score on the IPSS scale by 30%; an increase in the average urine flow rate by 20.6%; a decrease in the average amount of residual urine to normal values; an improvement in the quality of life of patients, according to the results of filling out the QoL questionnaire, by an average of 1.8 points. Patients in both groups had clinically insignificant fluctuations in systolic and diastolic blood pressure, less than 1 mmHg (in both groups) during 12 weeks of therapy; changes in heart rate during 3 months of therapy with Alfuprost MR were also clinically insignificant and averaged no more than 1 beat per minute In the medical records of patients, no adverse reactions were registered during therapy with Alfuprost MR, which confirms the high safety profile of the drug in clinical practice.

CONCLUSION

Thus, Alfuprost MR is an effective means for the treatment of LUTI in BPH, with minimal vasodilating effects, which allows the drug to be prescribed to comorbid patients with concomitant high blood pressure or hypertension, including those taking antihypertensive drugs.

Alfuzosin and Its Effect on Ejaculatory Dysfunction: A Systematic Review

Studies have demonstrated that alfuzosin not only improves lower urinary tract symptoms (LUTS) but also appears to preserve ejaculatory dysfunction (EjD). The objective of this study was to evaluate the impact of alfuzosin on ejaculatory function using the ‘Male Sexual Health Questionnaire (MSHQ)-EjD Short Form’ – a validated, abridged-version of the 25-item MSHQ specifically assessing EjD. A systematic search of MEDLINE, PubMed, Scopus, Embase, and grey literature was performed in January 2017 to identify relevant cohort studies. Search terms were ‘alfuzosin’, ‘benign prostatic hyperplasia’, ‘ejaculatory dysfunction’ and their synonyms without exclusions. Six cohort studies conducted between 2008 to 2015 were selected for analysis. Three of these were conducted in Korea, one in Thailand, one in China, and one in Tunisia. Overall, 1,371 patients were enrolled in these studies with a median age of 62.3 years. All studies quantified patient LUTS and ejaculatory function using the International Prostate Symptom Score (IPSS) and MSHQ-EjD Short Form, respectively. IPSS had a median decrease of 6.6 while MSHQ-EjD had a median increase of 1.9. This review highlights the very real association between sexual function and LUTS. This systematic review confirms that alfuzosin may improve ejaculatory function in addition to LUTS and should be considered in men who are sexually active or who already complain of deteriorating ejaculation.

An efficient spectrofluorimetric method adopts doxazosin, terazosin and alfuzosin coupling with orthophthalaldehyde: Application in human plasma

A new, selective and sensitive spectrofluorimetric method was designed for the quantitation of doxazosin (DOX), terazosin (TER) and alfuzosin (ALF) in their dosage forms and human plasma. The method adopts efficient derivatization of the studied drugs with ortho-phthalaldehyde (OPA), in the presence of 2-mercaptoethanol in borate buffer (pH9.7) to generate a highly fluorescent isoindole derivatives, which can strongly enhance the fluorescence intensities of the studied drugs, allowing their sensitive determination at 430nm after excitation at 337nm. The fluorescence-concentration plots were rectilinear over the ranges (10.0-400.0) ng/mL. Detection and quantification limits were found to be (0.52-3.88) and (1.59-11.76) ng/mL, respectively. The proposed method was validated according to ICH guidelines, and successfully applied for the determination of pharmaceutical preparations of the studied drugs. Moreover, the high sensitivity of the proposed method permits its successful application to the analysis of the studied drugs in spiked human plasma with % recovery (96.12±1.34-100.66±0.57, n=3). A proposal for the reaction mechanism was presented.

To compare the efficacy of tamsulosin and alfuzosin as medical expulsive therapy for ureteric stones

Aims and Objectives:

This study aims to evaluate the efficacy of tamsulosin and alfuzosin for the distal ureteral stone. This study assessed the spontaneous passage and expulsion of the stone.

Materials and Methods:

The study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, from May 2013 to May 2014. A total number of 136 patients diagnosed as distal ureteric stone (US) of size <10 mm were included in this study. It was divided into two groups (I and II) out of which 36 cases were excluded. Group I received tablet tamsulosin 0.4 mg/day, and Group II received alfuzosin 10 mg/day. The efficacy of tamsulosin and alfuzosin as an adjunctive medical therapy was determined.

Results:

Both the drugs can be safely used for the distal USs. The stone expulsion rate was seen in 36 patients (72.0%) in Group I, and in 34 patients (68.0%) in Group II (P = 0.545). The passage of stones noticed by 32 patients in each Groups I and II (P = 1.000). The mean number of pain attacks was 2.91 ± 1.01 for Group I, and 1.8 ± 0.83 for Group II (P < 0.001 and P < 0.001). Thus, we propagate the use of alfuzosin significantly lower number of pain attacks. The drug-related side-effects were postural hypertension (four in Group I and one in Group II) and retrograde ejaculation (eight in Group I, and one in Group II). Thus, the difference was statistically significant in terms of retrograde ejaculation but insignificant for postural hypotension.

Conclusion:

There is no difference between both medications in term of efficacy (passing stones) for the management of distal ureteral stones. Both medications are safe and effective. In addition, alfuzosin was better tolerated than tamsulosin as it has fewer side effects.

Drug treatment of bothersome lower urinary tract symptoms after ureteric JJ-stent insertion: A contemporary, comparative, prospective, randomised placebo-controlled study, single-centre experience

Objective

To provide a guide for medication to alleviate bothersome lower urinary tract symptoms (LUTS) in patients after JJ ureteric stenting.

Patients and methods

Between June 2011 and June 2015, a prospective randomised placebo-controlled study was conducted on 200 consecutive cases of ureteric stones that required JJ stents. All patients had signed informed consent and JJ-stent placement confirmed by X-ray. The patients were randomised into five groups: A, solifenacin 5 mg; B, trospium chloride 20 mg; C, antispasmodic; and E, α-blocker; and a placebo group (D). A standard model was created to lessen patient selection bias. Eligible patients were enrolled and assessed for side-effects and bothersome LUTS using the validated Ureteric Stent Symptoms Questionnaire. Appropriate statistical analysis was carried out.

Results

In all, 150 male patients in the five groups were compared. LUTS were less in groups A and B (P < 0.05), while dry mouth was significantly reported in Group A. Individual comparisons with the placebo group showed a non-significant difference with Group C, while Group E had significant nocturia improvement. Selective comparison of two best groups (A and B) showed less frequency in Group B, while the other LUTS were less in Group A with comparable side-effects.

Conclusions

In symptomatic patients following JJ-stent insertion, anti-muscarinic medication, namely solifenacin 5 mg or trospium chloride 20 mg, was the best. The advantage of trospium over solifenacin is in the control of frequency rather than the other symptoms. Addition of an α-blocker (alfuzosin 10 mg) is valuable when nocturia is the predominant symptom.

The effect of alfuzosin on renal resistive index, urinary electrolytes and β2 microglobulin levels and TGF β-1 levels of kidney tissue in rats with unilateral ureteropelvic junction obstruction

BACKGROUND

In this study, it was aimed to determine the effects of alfuzosin on experimentally generated unilateral partial ureteropelvic junction obstruction (UPO) in rats.

MATERIALS AND METHODS

Thirty Long-Evans rats were randomly allocated into five groups. In control group (C), nothing was performed; in group Sham (S) only laparotomy was done; in Alfuzosin group (A) only alfuzosin was administered for two weeks (10 mg/kg/day p.o.) without any surgery; in UPO group, unilateral UP junction obstruction was produced; and in the Group UPT (ureteropelvic obstruction + treatment), alfuzosin was administered for two weeks (10 mg/kg/day p.o.) in addition to UPO production. Renal pelvic anteroposterior diameters were determined with ultrasonography (USG) and renal arterial resistivity indexes by color Doppler USG. Urine was collected both at the beginning and at the end of the experiment for 24 h in all the groups and at the end of the experiment, blood samples were obtained. Blood and urine electrolytes and TGF-β1, urine density, urine β2 microglobulin levels were determined. Renal tissue samples harvested from all of the rats were histopathologically evaluated. Results were determined using one-way ANOVA t-test; p < 0.05 was accepted as significant.

RESULTS

Urine density in the UPT group was lower with respect to UPO group and blood electrolytes were preserved as close to normal (p < 0.05). In the UPT group, urine TGF-β1 and blood TGF-β1, blood β2 microglobulin levels and histopathologic damage scores were lower compared to the UPO group (p < 0.05).

CONCLUSION

It is shown in this experimental unilateral partial UPO model that alfuzosin treatment prevents obstructive renal damage.

Modified corneal incisions in intraoperative floppy iris syndrome (IFIS)-prone patients

BACKGROUND

We aimed to report a simple technique that involves modified anterior (to the limbus) elongated corneal incisions in order to reduce the incidence and severity of intraoperative floppy iris syndrome (IFIS) and related complications.

METHODS

This was a retrospective study of phacoemulsification cataract surgeries performed by a single surgeon on patients receiving tamsulosin or alfuzosin between 1 January 2009 and 31 July 2012 at Meir Medical Center, Kfar-Sava, Israel. We recorded preoperative gender, age, α-antagonist medication, coexisting pseudoexfoliation (PXF), and intraoperative use of ophthalmic viscosurgical devices (OVDs), pupil size, complications, IFIS grading and the need for additional operative strategies to manage IFIS. Elongated corneal incisions were performed approximately 1 mm anterior to the limbus.

RESULTS

Ninety-three eyes of 81 men were included. Mean age was 76.5 years (range 55 to 96 years). Forty-seven eyes (40 patients) had documented use of alfuzosin and 45 eyes (40 patients) of tamsulosin. One patient received both. The overall rate of IFIS was 22.6 % (n = 21). Eyes of patients who were treated with alfuzosin had a milder grading (p < 0.001) and an overall lower percentage of IFIS compared to tamsulosin (4.26 % versus 42.22 % respectively, p < 0.001). No additional strategies were used to manage IFIS during surgery. No intraoperative complications occurred.

CONCLUSION

Anterior elongated incisions are simple and efficient in preventing IFIS, exempting the surgeon from the use of additional expensive devices or materials in most cases. They do not limit the surgeon to one strategy, and therefore, if necessary, another may be applied at any given time.

Metabolic syndrome does not impair the response to alfuzosin treatment in men with lower urinary tract symptoms: a double-blind, randomized, placebo-controlled study

OBJECTIVE

This study is a placebo-controlled comparison of the response to alfuzosin treatment for lower urinary tract symptoms (LUTS) in patients with and without metabolic syndrome (MetS).

MATERIAL AND METHODS

A total of 80 men with LUTS were included in the study. Patients had a maximum flow rate of <15 mL/sec, prostate volume of >20 mL, and International Prostate Symptom Score (IPSS) of >8. All eligible men (n=68) for evaluation were initially divided into two groups as MetS (n=34) and non-MetS (n=34) groups. Patients were further randomized to receive alfuzosin (10 mg/day) or placebo (n=17/group; a total of four groups). The outcome was measured at 12(th) week according to the changes from baseline in IPSS, quality of life (QoL) scores, maximum flow rate (Qmax), and postmictional residue.

RESULTS

Alfuzosin significantly improved LUTS in men with and without MetS compared with patients receiving placebo (p<0.05). Mean IPSS scores in treatment groups decreased significantly, whereas patients receiving placebo had no statistically significant difference (p>0.05). Similarly, alfuzosin treatment resulted in a significant increase in Qmax in patients with LUTS/benign prostatic enlargement when compared with patients in placebo group (p<0.05). Mean QoL scores measured by IPSS-QoL and QoL questionnaires also improved significantly in patients receiving alfuzosin for 3 months regardless of the presence of MetS (p<0.05).

CONCLUSION

Our results revealed that the presence of MetS in patients with LUTS did not impair the response to alfuzosin treatment.

Mixed micelle cloud point-magnetic dispersive μ-solid phase extraction of doxazosin and alfuzosin

Mixed micelle cloud point extraction (MM-CPE) combined with magnetic dispersive μ-solid phase extraction (MD-μ-SPE) has been developed as a new approach for the extraction of doxazosin (DOX) and alfuzosin (ALF) prior to fluorescence analysis. The mixed micelle anionic surfactant sodium dodecyl sulfate and non-ionic polyoxyethylene(7.5)nonylphenylether was used as the extraction solvent in MM-CPE, and diatomite bonding Fe₃O₄ magnetic nanoparticles were used as the adsorbent in MD-μ-SPE. The method was based on MM-CPE of DOX and ALF in the surfactant-rich phase. Magnetic materials were used to retrieve the surfactant-rich phase, which easily separated from the aqueous phase under magnetic field. At optimum conditions, a linear relationship between DOX and ALF was obtained in the range of 5-300 ng mL(-1), and the limits of detection were 0.21 and 0.16 ng mL(-1), respectively. The proposed method was successfully applied for the determination of the drugs in pharmaceutical preparations, urine samples, and plasma samples.

Efficacy of Long-Term Daily Dosage of Alfuzosin 10 mg upon Sexual Function of Benign Prostatic Hypertrophy Patients: Two-Year Prospective Observational Study

Purpose

To identify sexual function improvement associated with alfuzosin (10 mg daily for 2 years).

Materials and Methods

We enrolled 30 men with lower urinary tract symptom (LUTS) who visited Gyeongsang National University Hospital between 2010 and 2012. At first visit, urinalysis, prostate specific antigen, transrectal ultrasound, and uroflowmetry were performed. The nternational Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), and Male Sexual Health Questionnaire Ejaculation Function Domain (MSHQ-EjFD) questionnaires were administered, and the subjects answered the same questionnaires at 1 month, 6 months, 1 year, and 2 years of follow-up.

Results

Twelve men completed of the entire study. After administration of alfuzosin, the median IPSS at first visit, 1 month, 6 months, 1 year, and 2 years was 18.00 (interquatile range [IQR]: 14.00~29.75), 20.00 (IQR: 11.50~30.00), 15.50 (IQR: 8.50~25.25), 14.50 (IQR: 9.25~19.50), and 11.50 (IQR: 5.00~17.75), respectively, which showed an improvement. The median QoL at the same times was 4.50 (IQR: 4.00~5.00), 4.50 (IQR: 4.00~5.00), 3.00 (IQR: 2.00~4.00), 3.50 (IQR: 2.25~4.00), and 3.00 (IQR: 1.00~3.00), respectively, and also showed improvement. Likewise, the median IIEF was 36.50 (IQR: 24.50~46.75), 37.50 (IQR: 26.75~47.25), 45.50 (IQR: 35.00~59.75), 48.50 (IQR: 34.75~62.75), and 47.50 (IQR: 43.25~61.00), while the median MSHQ-EjFD was 19.00 (IQR: 12.0~24.75), 19.50 (IQR: 13.50~27.75), 23.00 (IQR: 19.25~32.25), 26.50 (IQR: 18.25~34.50), 27.00 (IQR: 21.50~32.50), respectively, with both showing improvement.

Conclusions

After administration of alfuzosin (10 mg daily for 2 years), the IPSS, QoL, IIEF, and MSHQ-EjFD all improved significantly. This means long-term administration of 10 mg of alfuzosin daily would be effective not only for LUTS but also erectile function and ejaculation.

Efficacy of nifedipine and alfuzosin in the management of distal ureteric stones: A randomized, controlled study

INTRODUCTION

Stone disease is a significant and world-wide health problem. Recently, certain drugs have been used as a supplement to observation alone in an effort to improve spontaneous stone expulsion. We evaluated the efficacy of nifedipine and alfuzosin in the medical treatment of symptomatic, uncomplicated distal ureteral stones.

MATERIALS AND METHODS

This was a randomized controlled prospective study to determine the efficacy of alfuzosin and nifedipine as an adjunctive medical therapy, to increases the stone-expulsion rates in distal ureteric calculus of size ≤10 mm. Investigators and patients were blinded to the randomization scheme. Patients were randomly divided into three equal groups of 35 patients each. Patients in Group I received tablet nifedipine 30 mg/day, Group II received alfuzosin 10 mg/day and Group III was the control group received tablet diclofenac sodium. The patient blood pressure, stone position on imaging, number of pain attacks, time of stone-expulsion, hospital re-admission and any adverse events were assessed. Patients were followed-up weekly and continued until the patient was rendered stone free or up to 28 days. Statistical analysis was performed and P < 0.05 was considered to be significant.

RESULTS

Stone-expulsion was observed in 60%, 85.7% and 20% patients in Group I, II and III respectively. A statistically significant difference was noted in between Groups I versus III, Groups II versus III and Groups I versus II (P < 0.0001, P < 0.0001, and P < 0.0315 respectively). The mean number of pain attacks was 2.91 ± 1.01 for Group I, 1.8 ± 0.83 for Group II, and 2.82 ± 1.12 for Group III, which is statistical significant in Groups II versus III, and Groups I versus II (P < 0.001 and P < 0.001). Hospital re-admission rate was less in treatment groups when compare to control group (P < 0.0001).

CONCLUSION

The use of alfuzosin and nifedipine as a medical expulsive therapy for distal ureteric stones proved to be safe and effective in term of increased stone-expulsion rate, reduced pain attacks and decrease hospital re-admissions.

The effects of tamsulosin and alfuzosin on iris morphology: an ultrasound biomicroscopic comparison

CONTEXT

It is well known that Alpha-1 adrenergic receptor antagonists affect the receptors in the prostate and also iris dilator muscle, leading to loss of iris muscle tone.

OBJECTIVE

To compare morphological alterations of iris secondary to tamsulosin and alfuzosin use.

PARTICIPANTS

Patients included in the study were grouped as follows: 16 patients treated with tamsulosin (Group 1), 14 patients treated with alfuzosin (Group 2) and 18 untreated controls (Group 3).

MATERIALS AND METHODS

All patients underwent ultrasound biomicroscopic and pupillometric examination. Iris thickness was measured at the dilator muscle region (DMR; measured at half of the distance between the scleral spur and the pupillary margin) and sphincter muscle region (SMR; Standardized at 0.75 mm from the pupillary margin). DMR/SMR was also calculated for each patient. Differences among groups were analysed. Main outcome measures were DMR, SMR, DMR/SMR and pupillary diameter.

RESULTS

Mean duration of treatments were 2.4 ± 0.96 years (1-4) and 2.3 ± 1.01 years (1-4) in Groups 1 and 2. Pupillary diameters were reduced in Groups 1-2 compared to Group 3 (p < 0.001, p < 0.001). The SMR was similar in Groups 1 and 2 (p: 0.114). These values were not significantly different from that of Group 3 (p: 0.196, p: 0.209). However, thickness in the DMR in Groups 1-2 were significantly lower than that of controls (Group 3) whereas there was no significant difference between Groups 1 and 2 (p: 0.041, p: 0.039 and 0.986, respectively). Mean DMR/SMR ratios were significantly lower in Groups 1-2 than that of Group 3 (p: 0.040 and p: 0.040, respectively).

CONCLUSIONS

In patients using these medications, the iris seems to be thinner at the dilator muscle region, but preserving the sphincter muscle region.

alfuzosin as medical expulsive therapy for ureteric stones

OBJECTIVE

To evaluate and compare the efficacy of tamsulosin and alfuzosin as medical expulsive therapy for ureteric stones.

PATIENTS AND METHODS

In all, 112 patients with ureteric stones of ⩽10 mm, located along the ureter, were randomly divided into three groups. In group I, 32 patients received no α-blockers (controls), in group II 40 patients received tamsulosin 0.4 mg daily, and in group III 40 patients received alfuzosin 10 mg daily. All patients were given analgesia and antibiotics when indicated. The follow-up was weekly for 4 weeks.

RESULTS

The mean stone size and age were comparable in the three groups. The stone expulsion rate was 44%, 85% and 75% in groups I, II and III, respectively. Half of the stones in group II passed within 2 weeks, half in group III passed within 3 weeks, while more than half of the stones in group I did not pass even after 4 weeks. The mean number of painful episodes was 2.45, 1.38 and 1.64 in groups I, II and III, respectively. The drug-related side-effects reported by patients were mild and transient.

CONCLUSION

The use of tamsulosin or alfuzosin as medical expulsive therapy for ureteric stones in the three sections of the ureter (upper, middle and lower) was safe and effective, as shown by the increased overall stone expulsion rate, reduced stone expulsion time and fewer pain episodes. Tamsulosin was associated with a greater rate of stone expulsion than was alfuzosin.

Efficacy of alfuzosin after shock wave lithotripsy for the treatment of ureteral calculi

PURPOSE

We evaluated the efficacy of alfuzosin for the treatment of ureteral calculi less than 10 mm in diameter after extracorporeal shock wave lithotripsy (ESWL).

MATERIALS AND METHODS

A randomized, single-blind clinical trial was performed prospectively by one physician between June 2010 and August 2011. A total of 84 patients with ureteral calculi 5 to 10 mm in diameter were divided into two groups. Alfuzosin 10 mg (once daily) and loxoprofen sodium 68.1 mg (as needed) were prescribed to group 1 (n=41), and loxoprofen sodium 68.1 mg (as needed) only was prescribed to group 2 (n=44). The drug administration began immediately after ESWL and continued until stone expulsion was confirmed up to a maximum of 42 days after the procedure.

RESULTS

Thirty-nine of 41 (95.1%) patients in group 1 and 40 of 43 (93.0%) patients in group 2 ultimately passed stones (p=0.96). The number of ESWL sessions was 1.34±0.65 and 1.41±0.85 in groups 1 and 2, respectively (p=0.33). The patients who required analgesics after ESWL were 8 (19.5%) in group 1 and 13 (30.2%) in group 2 (p=0.31). Visual analogue scale pain severity scores were 5.33±1.22 and 6.43±1.36 in groups 1 and 2, respectively (p=0.056). The time to stone expulsion in groups 1 and 2 was 9.5±4.8 days and 14.7±9.8 days, respectively (p=0.005). No significant adverse effects occurred.

CONCLUSIONS

The use of alfuzosin in combination with ESWL seems to facilitate stone passage and to reduce the time of stone expulsion but does not affect the stone-free rate.

Comparison and efficacy of low-dose and standard-dose tamsulosin and alfuzosin in medical expulsive therapy for lower ureteral calculi: prospective, randomized, comparative study

PURPOSE

Typically in Korea, for a standard dose (0.4 mg) of tamsulosin, two low doses (0.2 mg) are administered. The aim of this study was to evaluate and compare the efficacy of tamsulosin (0.2 mg and 0.4 mg) and alfuzosin (10 mg) in the treatment of lower ureteral stones.

MATERIALS AND METHODS

A total of 141 patients presenting with a single 4- to 10-mm sized lower ureteral stone were randomly assigned to 4 groups. Patients in group 1 (n=41) and group 2 (n=30) received an oral dose of 0.2 mg tamsulosin once and twice daily, respectively, and patients in group 3 (n=36) received a daily oral dose of 10 mg alfuzosin. Patients in group 4 (n=34) received trospium chloride only. The spontaneous passage of stones, the stone expulsion time, and adverse effects were evaluated.

RESULTS

There were no significant differences in patient background, including age, sex, BMI, stone size, stone side, and symptom duration. The spontaneous stone passage rate through the ureter was higher and the stone expulsion time was faster in groups 1, 2, and 3 than in group 4. There were no statistically different changes in groups 1, 2, and 3. The adverse effects observed in all groups were comparable and were mild.

CONCLUSIONS

Tamsulosin at 0.2 mg and 0.4 mg and alfuzosin (10 mg) proved to be safe and effective. A first cycle of medical expulsive therapy with tamsulosin 0.2 mg could be considered as an option in the management of single lower ureteral stone.

α-Blockers for the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: An Update on Current Clinical Evidence

The pathogenesis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is multifactorial, making its treatment difficult. Multimodal therapy including α-adrenergic antagonists (α-blockers), anti-inflammatory agents, and other pain treatments may provide optimal management for CP/CPPS. Although α-blockers are the most prescribed drugs for patients with CP/CPPS, not all studies support their efficacy. A recent meta-analysis of small trials suggested that treatment with α-blockers, possibly in combination with antibacterial agents, is efficacious in relieving symptoms. Third-generation α1A blockers (silodosin, tamsulosin) may provide efficacy as well as reduced cardiovascular side effects. Future research should aim to identify potential biomarkers associated with treatment response.

Tamsulosin versus Alfuzosin in the Treatment of Patients with Distal Ureteral Stones: Prospective, Randomized, Comparative Study

Purpose

We evaluated and compared the efficacy of tamsulosin and alfuzosin in the medical treatment of symptomatic, uncomplicated distal ureteral stones.

Materials and Methods

A total of 87 patients with distal ureteral stones of ≤10 mm were randomly divided into 3 groups. Group I patients (n=29) received 0.4 mg tamsulosin daily, group II patients (n=30) received 10 mg alfuzosin daily, and group III patients (n=28) were not given tamsulosin or alfuzosin. Patients in all groups received Diclofenac sodium regularly for 1 week and then on demand. Follow-up was done on a weekly basis for 30 days.

Results

The mean stone size was comparable in the 3 groups (4.97±2.24, 5.47±2.13, and 5.39±1.81 mm, respectively). The stone expulsion rate was 86.2%, 76.6%, and 50% in groups I, II, and III, respectively. The difference in groups I and II with respect to group III was significant (p=0.0028 and 0.035). The mean expulsion time for groups I to III was 7.52±7.06, 8.26±7.34, and 13.90±6.99 days, respectively. The expulsion time was significantly shorter in groups I and II than in group III (p=0.0097 and 0.026). Patients taking tamsulosin and alfuzosin had fewer pain attacks than did group III patients (1.24±0.57 vs. 1.43±0.67 vs. 1.75±1.17). Only 3 cases of drug side effects, 2 in group I and 1 in group II, were recorded.

Conclusions

The use of tamsulosin or alfuzosin for the medical treatment of lower ureteric stones proved to be safe and effective. Moreover, tamsulosin did not have any significant benefits over alfuzosin.

Alpha blockers for the treatment of benign prostatic hyperplasia

The evolution of alpha blocker therapy for benign prostatic hyperplasia (BPH) has focused on improving convenience and tolerability. Indications for treating BPH include reversing signs and symptoms or preventing progression of the disease. The indication that most commonly drives the need for intervention is relief of lower urinary tract symptoms (LUTS) with the intent of improving quality of life. Alpha blockers are the most effective, least costly, and best tolerated of the drugs for relieving LUTS. Four long-acting alpha 1 blockers are approved by the Food and Drug Administration for treatment of symptomatic LUTS/BPH: terazosin, doxazosin, tamsulosin, and alfuzosin. All are well tolerated and have comparable dose-dependent effectiveness. Tamsulosin and alfuzosin SR do not require dose titration. Alfuzosin, terazosin, and doxazosin have all been shown to be effective in relieving LUTS/BPH independent of prostate size.