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UP-3.067: Long-Term Efficacy of Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia
UNMODERATED POSTER SESSIONS
toms included in this prospective study from December 2000 to December 2003. They were classified according to the sonographically determined prostatic weight into 5 groups: less than 40 g, 40 t0 50 g, 50 to 60 g, 60 to 70 g and greater than 70 g. In each group patients were randomized to undergo open prostatectomy or TURP. All the patients with prostatic weight less than 40 g underwent TURP. We determined preoperative characteristics, perioperative complications, early and late postoperative outcomes, during 80 months follow up after surgery. The study was conducted in accordance with the Declaration of Helsinki and the local Medical Ethical Committee approved the study. Results: Baseline characteristics and perioperative complications revealed no significant difference between TURP and open prostatectomy patients in each prostatic weight group. Early postoperative outcomes were similar in both methods. IPSS, 80 months after surgery, was significantly higher in patients with larger prostatic weights who underwent TURP, especially when greater than 60 g. The overall incidence of a second intervention was 10.9% (15 0f 138) and 1.9% (2 0f 108) in TURP and open prostatectomy groups respectively. Among patients with no or mild erectile dysfunction (ED) preoperatively, 12.5% showed moderate to severe ED postoperatively (13.4% in TURP group vs. 11.25% in open prostatectomy group). Hypertension, capsular perforation and higher cardiac risk index were noted as major risk factors for postoperative ED in TURP group while older age, hypertension and hemorrhage were associated with postoperative ED in the open prostatectomy group. Conclusions: Improvement of urinary symptoms occurs with both TURP and open prostatectomy techniques and among patients with prostatic weight larger than 60 g open prostatectomy seems to be more effective in long term. UP-3.065 Effects of Isosorbide Dinitrate on the Urinary Flow Rate in Patients with Benign Prostatic Hyperplasia Roshani A, Khosropanah I, Salehi M, Noshad Kamran A Urology Research Center, Guilan University of Medical Sceinces, Rasht, Iran Introduction and Objectives: We compared the immediate effects of a systemic nitric oxide (NO) donor with placebo on the uroflowmetric parameters in patients with Benign Prostatic Hyperplasia.
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Materials and Methods: Eighty patients with BPH were included in the study. We examined peak flow rate and residual urine in all patients. Then, we randomized patients to receive either 20 mg sublingual isosorbide dinitrate (n⫽40) or placebo (n⫽40),20 minute prior to the second uroflowmetry which was performed one day after first test. Results: In the isosorbide group, the mean peak flow rate increased from 7.6ml/s before to 10.2ml/s after the intake of the isosorbide (P⬍0.05). Concomitantly, significant decrease of residual urine volume (-22ml;P⬍0.05) was found in the isosorbide group. No significant changes of micturition parameters were found in the placebo group. Conclusions: Organic nitrates influence micturition parameters in patients with benign prostatic hyperplasia. This might be explained by the known mechanism of NO donation (Smooth muscle relaxation) of nitrates. This new approach could offer a potential pharmacological option to treat obstructive lower urinary tract symptoms. UP-3.066 An Evaluation for Oral Desmopressin Therapy on Nocturia in Benign Prostatic Hyperplasia (BPH) in Imam Reza Hospital from 2006 To 2007 Taghavi Razavizade SR, Mahdavi R, Darabi MR, Keshvari M Mashhad University of Medical Sciences, Mashhad, Iran Introduction and Objective: Nocturia commonly seen with aging may result from several conditions of which benign prostatic hyperplasia (BPH) and loss of nighttime vasopressin production (or release) are very common causes. The relief of obstructive symptoms of BPH without addressing the nocturnal polyuria may result in disappointing clinical results. Materials and Methods: Twenty-three adult men (mean age: 62⫹ /- 2.5 years old) with BPH and bothering nocturia (⬎ or ⫽ 2 voids/night) were treated with oral desmopressin at bedtime. Patients received desmopressin tablets (0.1, 0.2, or 0.4 mg) during a 3–wk dose titration period and after 1- wk washout period the effective drug dose continued for 6 to 8 –wk. Positive clinical response defined as ⬎ or ⫽50% decrease in nocturnal voiding episodes. Results: All treated patients improved with such a treatment. The average of symptoms duration was 3.45⫹ / - 0.62 years. Nocturia episodes decreased from a mean of 4 ⫹ / - 0.36 episodes/ night be-
fore treatment to1.17⫹ / - 0.28 episodes/ night after therapy (P⬍ 0.0001). I-PSS decreased from 16.9 ⫹ / - 1.16 before treatment to10.47⫹ / - 0.98 after therapy (P⬍ 0.0001 ). Serum sodium levels changes were significant (P ⫽ 0.02), but hyponatremia did not occur. Conclusion: Oral desmopressin tablets provide an effective and well tolerated treatment for nocturia due to BPH and cause significant reduction in nocturil episodes, I-PSS measure serum sodium levels with limited side effects. UP-3.067 Long-Term Efficacy of Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia Yamanishi T, Mizuno T, Kamai T, Furuya N, Yoshida K Dept of Urology, Dokkyo Medical University, Tochigi, Japan Introduction and Objective: Alpha1Adrenoceptor antagonists are recommended as the main pharmacological treatment for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS). Short-term efficacy of tamsulosin has been verified in many randomized controlled trials. However, there is a relative paucity of long-term data on maintenance of the efficacy of this drug. The aim of the present study is to evaluate the long-term efficacy of tamsulosin for patients with BPH/LUTS in real-life clinical practice. Materials and Methods: A total of 113 males with BPH/LUTS (68.5⫾8.8 years, mean prostate volume 34.2(15.7 ml), who were treated with tamsulosin (0.2 mg daily) for more greater than 3 months, were retrospectively evaluated. The International Prostate Symptom Score (I-PSS), quality of life (QOL) score, average and maximum flow rate (Qave and Qmax, respectively), and postvoid residual urine volume (PVR) were determined before (baseline) and after the initiation of treatment. Results: Of these patients, 72 (64%) remained on tamsulosin (12– 48 months of treatment) and 41 (36%) withdrew after a mean 17.4 months on average, because of insufficient therapeutic response in 16 (14%; 1 stopped medication, 6 changed to other drugs, and 9 underwent surgery), and adverse effects (headache) in 1 (1%). The mean total I-PSS, total I-PSS storage subscore, total I-PSS voiding subscore, post-micturition score, and QOL score were significantly decreased (all P⬍0.0001) after 1-month treatment and
UROLOGY 74 (Supplment 4A), October 2009
UNMODERATED POSTER SESSIONS
remained stable up to 48 months of treatment. Qave and Qmax were significantly increased (P⬍0.0001 and P⬍0.0001, respectively) and PVR and %PVR were significantly decreased (P⫽0.0051 and P⫽0.0001, respectively) after 3-month treatment. The means of these scores did not change significantly but rather appeared to remain stable for 24 – 48 months. Conclusions: Effects of tamsulosin on BPH/LUTS are immediate (within 1 month) and persist (for over 12 months). Tamsulosin is well tolerated for PH/LUTS. UP-3.068 The Risk Factors Increasing Post Void Residual Urine Volume after LongTerm Anticholinergics Therapy Over 1 Year in Patients with Benign Prostatic Hyperplasia Accompanied with Overactive Bladder Cho I, Song H, Cho S, Lee K, Chung J, Park S Dept of Urology, Inje University, Seoul, South Korea Introduction and Objectives: Benign prostatic hyperplasia (BPH) patients usually accompanies overactive bladder (OAB). Adding anticholinergics in these patients evokes us to worry about deterioration of obstructive symptom and possibility of acute urinary retention. We evaluated risk factors increasing post void residual (PVR) volume in long term anticholinergics therapy over 1 year in patients with BPH and OAB. Materials and Methods: We selected BPH patients treated with ␣ -blockers, over 40 years, with international prostate symptom score (IPSS) of 8 or more, and 4th question of IPSS (urgency score) of 2 or more for OAB. A selected group of 57 patients were evaluated by age, history of diabetes mellitus and central nervous system (CNS) disease, prostate volume, uroflowmetry, PVR volume, prostatic specific antigen (PSA), and IPSS retrospectively. All patients were subdivided into 2 groups respectively according to use or no use of anticholinergics and 5-␣-reductase inhibitor. We evaluated risk factors increasing PVR volume in each group before and after treatment, and analyzed univariately and multivariately the mean value of the risk factors in 2 groups. Results: The other risk factors, except prostate volume, in 2 groups subdivided according to use or no use of anticholinergics, had no significant differences and the prostate volume and PSA before treatment, in 2 groups subdivided according to use or no use of 5-␣-reductase inhibitor, had the signif-
icant differences statistically. Age, diabetes mellitus, CNS disease, PSA, prostate volume, the use of anticholinergics and the no use of 5-␣-reductase inhibitor, which were regarded as risk factors increasing PVR volume, were analyzed for PVR volume more than 50ml respectively. Age over 65 years (p⫽0.010), CNS disease (p⫽0.000) and the use of anticholinergics (p⫽0.000) increased PVR volume more than 50ml significantly in univariate analysis. Age over 65 years, CNS disease and the use of anticholinergics were reanalyzed multivariately. The use of anticholinergics and CNS disease had the relative risk 13.9, 26.6 for increasing PVR volume more than 50ml respectively. Conclusions: The long term anticholinergics therapy over 1 year and history of CNS disease are the risk factors increasing PVR volume more than 50ml in patients with BPH and OAB. UP-3.069 Improvement of Voiding Dysfunction by Alpha1-Adrenorecptor Antagonist Following Prostate Brachytherapy for Localized Prostate Cancer Watanabe T, Sasaki K, Uematsu K, Uesugi T, Edamura K, Araki M, Uehara S, Saika T, Nasu Y, Kumon H Okayama University, Okayama, Japan Introduction and Objective: I125 prostate brachytherapy for localized prostate cancer has been worldwide spread. However it is popular that patients are often suffered from voiding dysfunction following brachytherapy. We examined prospectively if silodosin, one of the latest generation of ␣1-adrenoreceptor antagonist (␣1blocker) which is a highly selective inhibitor of the ␣1A adrenergic receptor, could improve the voiding dysfunction following brachytherapy. Materials and Methods: Twenty-four patients who received I125 prostate brachytherapy for localized prostate cancer from July 2007 to October 2008 and did not show voiding dysfunction before brachytherapy were examined. Patients
UROLOGY 74 (Supplment 4A), October 2009
were divided into 3 groups; 1) who did not receive ␣1-adrenoreceptor antagonist, 2) received silodosin for 2 weeks just after brachytherapy, 3) received silodosin for 4 weeks. The change of uroflowmetry (UFM) parameters, international prostate symptom score (IPSS) and King’s health questionnaire (KHQ) scores were compared among these three groups before and 2, 4, 12 weeks after brachytherapy. Results: The total score, QOL score and voiding components of IPSS in patients group who received silodosin for 4 weeks were significantly smaller compared with those parameters in groups without silodosin and 2 weeks medication of silodosin, despite all groups demonstrated the growth of voiding dysfunction representing the increase of IPSS each scores. There were not significant differences among the 3 groups in IPSS storage components, UFM parameters and KHQ scores. After the examination periods of 12 weeks, 3 patients in the group without silodosin, a patient in the group with 2 and 4 weeks silodosin medication, respectively, requested the medication of ␣1-blocker including other ␣1-blocker except silodosin. Conclusions: Even the patients without voiding dysfunction before prostate brachytherapy showed the growth of voiding dysfunction representing the increase of IPSS score until early periods after brachytherapy. The medication of ␣1-blocker, silodosin, relatively for short period could improve the voiding symptoms rather than the storage symptoms.
UP-3.070 The Prospective Study of the Efficacy of Tamsulosin, Serenoa Repens, and Serenoa Repens Plus Tamsulosin Treatment for Patients with Benign Prostatic Hyperplasia: CombTSR Study Argirovic D1, Argirovic A2, Grebenarovic D2 1 Outpatient Clinic Argirovic, Belgrade, Serbia; 2CHC Zemun,Department of Urology, Belgrade, Serbia
UP-3.069, Figure 1
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toms included in this prospective study from December 2000 to December 2003. They were classified according to the sonographically determined prostatic weight into 5 groups: less than 40 g, 40 t0 50 g, 50 to 60 g, 60 to 70 g and greater than 70 g. In each group patients were randomized to undergo open prostatectomy or TURP. All the patients with prostatic weight less than 40 g underwent TURP. We determined preoperative characteristics, perioperative complications, early and late postoperative outcomes, during 80 months follow up after surgery. The study was conducted in accordance with the Declaration of Helsinki and the local Medical Ethical Committee approved the study. Results: Baseline characteristics and perioperative complications revealed no significant difference between TURP and open prostatectomy patients in each prostatic weight group. Early postoperative outcomes were similar in both methods. IPSS, 80 months after surgery, was significantly higher in patients with larger prostatic weights who underwent TURP, especially when greater than 60 g. The overall incidence of a second intervention was 10.9% (15 0f 138) and 1.9% (2 0f 108) in TURP and open prostatectomy groups respectively. Among patients with no or mild erectile dysfunction (ED) preoperatively, 12.5% showed moderate to severe ED postoperatively (13.4% in TURP group vs. 11.25% in open prostatectomy group). Hypertension, capsular perforation and higher cardiac risk index were noted as major risk factors for postoperative ED in TURP group while older age, hypertension and hemorrhage were associated with postoperative ED in the open prostatectomy group. Conclusions: Improvement of urinary symptoms occurs with both TURP and open prostatectomy techniques and among patients with prostatic weight larger than 60 g open prostatectomy seems to be more effective in long term. UP-3.065 Effects of Isosorbide Dinitrate on the Urinary Flow Rate in Patients with Benign Prostatic Hyperplasia Roshani A, Khosropanah I, Salehi M, Noshad Kamran A Urology Research Center, Guilan University of Medical Sceinces, Rasht, Iran Introduction and Objectives: We compared the immediate effects of a systemic nitric oxide (NO) donor with placebo on the uroflowmetric parameters in patients with Benign Prostatic Hyperplasia.
S314
Materials and Methods: Eighty patients with BPH were included in the study. We examined peak flow rate and residual urine in all patients. Then, we randomized patients to receive either 20 mg sublingual isosorbide dinitrate (n⫽40) or placebo (n⫽40),20 minute prior to the second uroflowmetry which was performed one day after first test. Results: In the isosorbide group, the mean peak flow rate increased from 7.6ml/s before to 10.2ml/s after the intake of the isosorbide (P⬍0.05). Concomitantly, significant decrease of residual urine volume (-22ml;P⬍0.05) was found in the isosorbide group. No significant changes of micturition parameters were found in the placebo group. Conclusions: Organic nitrates influence micturition parameters in patients with benign prostatic hyperplasia. This might be explained by the known mechanism of NO donation (Smooth muscle relaxation) of nitrates. This new approach could offer a potential pharmacological option to treat obstructive lower urinary tract symptoms. UP-3.066 An Evaluation for Oral Desmopressin Therapy on Nocturia in Benign Prostatic Hyperplasia (BPH) in Imam Reza Hospital from 2006 To 2007 Taghavi Razavizade SR, Mahdavi R, Darabi MR, Keshvari M Mashhad University of Medical Sciences, Mashhad, Iran Introduction and Objective: Nocturia commonly seen with aging may result from several conditions of which benign prostatic hyperplasia (BPH) and loss of nighttime vasopressin production (or release) are very common causes. The relief of obstructive symptoms of BPH without addressing the nocturnal polyuria may result in disappointing clinical results. Materials and Methods: Twenty-three adult men (mean age: 62⫹ /- 2.5 years old) with BPH and bothering nocturia (⬎ or ⫽ 2 voids/night) were treated with oral desmopressin at bedtime. Patients received desmopressin tablets (0.1, 0.2, or 0.4 mg) during a 3–wk dose titration period and after 1- wk washout period the effective drug dose continued for 6 to 8 –wk. Positive clinical response defined as ⬎ or ⫽50% decrease in nocturnal voiding episodes. Results: All treated patients improved with such a treatment. The average of symptoms duration was 3.45⫹ / - 0.62 years. Nocturia episodes decreased from a mean of 4 ⫹ / - 0.36 episodes/ night be-
fore treatment to1.17⫹ / - 0.28 episodes/ night after therapy (P⬍ 0.0001). I-PSS decreased from 16.9 ⫹ / - 1.16 before treatment to10.47⫹ / - 0.98 after therapy (P⬍ 0.0001 ). Serum sodium levels changes were significant (P ⫽ 0.02), but hyponatremia did not occur. Conclusion: Oral desmopressin tablets provide an effective and well tolerated treatment for nocturia due to BPH and cause significant reduction in nocturil episodes, I-PSS measure serum sodium levels with limited side effects. UP-3.067 Long-Term Efficacy of Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia Yamanishi T, Mizuno T, Kamai T, Furuya N, Yoshida K Dept of Urology, Dokkyo Medical University, Tochigi, Japan Introduction and Objective: Alpha1Adrenoceptor antagonists are recommended as the main pharmacological treatment for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS). Short-term efficacy of tamsulosin has been verified in many randomized controlled trials. However, there is a relative paucity of long-term data on maintenance of the efficacy of this drug. The aim of the present study is to evaluate the long-term efficacy of tamsulosin for patients with BPH/LUTS in real-life clinical practice. Materials and Methods: A total of 113 males with BPH/LUTS (68.5⫾8.8 years, mean prostate volume 34.2(15.7 ml), who were treated with tamsulosin (0.2 mg daily) for more greater than 3 months, were retrospectively evaluated. The International Prostate Symptom Score (I-PSS), quality of life (QOL) score, average and maximum flow rate (Qave and Qmax, respectively), and postvoid residual urine volume (PVR) were determined before (baseline) and after the initiation of treatment. Results: Of these patients, 72 (64%) remained on tamsulosin (12– 48 months of treatment) and 41 (36%) withdrew after a mean 17.4 months on average, because of insufficient therapeutic response in 16 (14%; 1 stopped medication, 6 changed to other drugs, and 9 underwent surgery), and adverse effects (headache) in 1 (1%). The mean total I-PSS, total I-PSS storage subscore, total I-PSS voiding subscore, post-micturition score, and QOL score were significantly decreased (all P⬍0.0001) after 1-month treatment and
UROLOGY 74 (Supplment 4A), October 2009
UNMODERATED POSTER SESSIONS
remained stable up to 48 months of treatment. Qave and Qmax were significantly increased (P⬍0.0001 and P⬍0.0001, respectively) and PVR and %PVR were significantly decreased (P⫽0.0051 and P⫽0.0001, respectively) after 3-month treatment. The means of these scores did not change significantly but rather appeared to remain stable for 24 – 48 months. Conclusions: Effects of tamsulosin on BPH/LUTS are immediate (within 1 month) and persist (for over 12 months). Tamsulosin is well tolerated for PH/LUTS. UP-3.068 The Risk Factors Increasing Post Void Residual Urine Volume after LongTerm Anticholinergics Therapy Over 1 Year in Patients with Benign Prostatic Hyperplasia Accompanied with Overactive Bladder Cho I, Song H, Cho S, Lee K, Chung J, Park S Dept of Urology, Inje University, Seoul, South Korea Introduction and Objectives: Benign prostatic hyperplasia (BPH) patients usually accompanies overactive bladder (OAB). Adding anticholinergics in these patients evokes us to worry about deterioration of obstructive symptom and possibility of acute urinary retention. We evaluated risk factors increasing post void residual (PVR) volume in long term anticholinergics therapy over 1 year in patients with BPH and OAB. Materials and Methods: We selected BPH patients treated with ␣ -blockers, over 40 years, with international prostate symptom score (IPSS) of 8 or more, and 4th question of IPSS (urgency score) of 2 or more for OAB. A selected group of 57 patients were evaluated by age, history of diabetes mellitus and central nervous system (CNS) disease, prostate volume, uroflowmetry, PVR volume, prostatic specific antigen (PSA), and IPSS retrospectively. All patients were subdivided into 2 groups respectively according to use or no use of anticholinergics and 5-␣-reductase inhibitor. We evaluated risk factors increasing PVR volume in each group before and after treatment, and analyzed univariately and multivariately the mean value of the risk factors in 2 groups. Results: The other risk factors, except prostate volume, in 2 groups subdivided according to use or no use of anticholinergics, had no significant differences and the prostate volume and PSA before treatment, in 2 groups subdivided according to use or no use of 5-␣-reductase inhibitor, had the signif-
icant differences statistically. Age, diabetes mellitus, CNS disease, PSA, prostate volume, the use of anticholinergics and the no use of 5-␣-reductase inhibitor, which were regarded as risk factors increasing PVR volume, were analyzed for PVR volume more than 50ml respectively. Age over 65 years (p⫽0.010), CNS disease (p⫽0.000) and the use of anticholinergics (p⫽0.000) increased PVR volume more than 50ml significantly in univariate analysis. Age over 65 years, CNS disease and the use of anticholinergics were reanalyzed multivariately. The use of anticholinergics and CNS disease had the relative risk 13.9, 26.6 for increasing PVR volume more than 50ml respectively. Conclusions: The long term anticholinergics therapy over 1 year and history of CNS disease are the risk factors increasing PVR volume more than 50ml in patients with BPH and OAB. UP-3.069 Improvement of Voiding Dysfunction by Alpha1-Adrenorecptor Antagonist Following Prostate Brachytherapy for Localized Prostate Cancer Watanabe T, Sasaki K, Uematsu K, Uesugi T, Edamura K, Araki M, Uehara S, Saika T, Nasu Y, Kumon H Okayama University, Okayama, Japan Introduction and Objective: I125 prostate brachytherapy for localized prostate cancer has been worldwide spread. However it is popular that patients are often suffered from voiding dysfunction following brachytherapy. We examined prospectively if silodosin, one of the latest generation of ␣1-adrenoreceptor antagonist (␣1blocker) which is a highly selective inhibitor of the ␣1A adrenergic receptor, could improve the voiding dysfunction following brachytherapy. Materials and Methods: Twenty-four patients who received I125 prostate brachytherapy for localized prostate cancer from July 2007 to October 2008 and did not show voiding dysfunction before brachytherapy were examined. Patients
UROLOGY 74 (Supplment 4A), October 2009
were divided into 3 groups; 1) who did not receive ␣1-adrenoreceptor antagonist, 2) received silodosin for 2 weeks just after brachytherapy, 3) received silodosin for 4 weeks. The change of uroflowmetry (UFM) parameters, international prostate symptom score (IPSS) and King’s health questionnaire (KHQ) scores were compared among these three groups before and 2, 4, 12 weeks after brachytherapy. Results: The total score, QOL score and voiding components of IPSS in patients group who received silodosin for 4 weeks were significantly smaller compared with those parameters in groups without silodosin and 2 weeks medication of silodosin, despite all groups demonstrated the growth of voiding dysfunction representing the increase of IPSS each scores. There were not significant differences among the 3 groups in IPSS storage components, UFM parameters and KHQ scores. After the examination periods of 12 weeks, 3 patients in the group without silodosin, a patient in the group with 2 and 4 weeks silodosin medication, respectively, requested the medication of ␣1-blocker including other ␣1-blocker except silodosin. Conclusions: Even the patients without voiding dysfunction before prostate brachytherapy showed the growth of voiding dysfunction representing the increase of IPSS score until early periods after brachytherapy. The medication of ␣1-blocker, silodosin, relatively for short period could improve the voiding symptoms rather than the storage symptoms.
UP-3.070 The Prospective Study of the Efficacy of Tamsulosin, Serenoa Repens, and Serenoa Repens Plus Tamsulosin Treatment for Patients with Benign Prostatic Hyperplasia: CombTSR Study Argirovic D1, Argirovic A2, Grebenarovic D2 1 Outpatient Clinic Argirovic, Belgrade, Serbia; 2CHC Zemun,Department of Urology, Belgrade, Serbia
UP-3.069, Figure 1
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