RESUMEN

Resveratrol is a polyphenol found naturally in fruits and plants. Recently, studies in humans and animal models have suggested beneficial properties of this polyphenol, such as improvements to metabolic and lipid profiles, along with antioxidant, anti-inflammatory and anti-proliferative effects. In the urogenital tract (UGT), resveratrol has also been tested clinically and experimentally as a therapeutic drug in several diseases; however, the translational efficacy of resveratrol, especially in UGT, is still a matter of debate. In the present review, we address the pre-clinical efficacy of resveratrol in UGT-related dysfunctions, focusing on lower urinary tract symptoms, non-cancerous prostatic disease (benign prostatic hyperplasia and prostatitis) and erectile dysfunction. In vitro studies indicate that resveratrol reduces inflammatory markers and oxidative stress, and improves endothelial function in UGT organs and cells isolated from humans and animals. Despite displaying low oral bioavailability, in vivo administration of resveratrol largely improves erectile dysfunction, benign prostatic hyperplasia, prostatitis and voiding impairments, as evidenced in different animal models. Resveratrol also acts as a microbiota modulator, which may explain some of its beneficial effects in vivo. In contrast to the large amount of pre-clinical data, there are insufficient clinical trials to establish resveratrol treatment efficacy in human UGT-related diseases. In summary, we provide an overview of the in vivo and in vitro efficacy of resveratrol in animal and human UGT dysfunctions, which may support future clinical trials.

Asunto(s)

Disfunción Eréctil , Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Prostatitis , Masculino , Animales , Humanos , Disfunción Eréctil/tratamiento farmacológico , Hiperplasia Prostática/tratamiento farmacológico , Resveratrol/farmacología , Resveratrol/uso terapéutico , Prostatitis/tratamiento farmacológico , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico

RESUMEN

Tadalafil, a phosphodiesterase-5 (PDE5) inhibitor, shown to exert a protection to heart failure (HF) associated damage or lower urinary tract symptoms (LUTS). Thus, we investigated the contribution of tadalafil chronic treatment in the alterations of LUTS in HF rats. Male rats were subjected to aortocaval fistula model for HF induction. Echocardiography, cystometric, renal function and redox cell balance, as well as concentration-response curves to carbachol, KCl, ATP and frequency-response curves to electrical field stimulation (EFS) were evaluated in Sham, HF, Tadalafil and HF-Tadalafil (12 weeks endpoint) groups. HF group to present increased in left-ventricle (LV) mass and in LV end-diastolic- and LV end-systolic volume, with a decreased ejection fraction. Tadalafil treatment was able to decrease in hypertrophy and improve the LV function restoring cardiac function. For micturition function (in vivo), HF animals shown an increase in basal pressure, threshold pressure, no-voiding contractions and decreased bladder capacity, being that the tadalafil treatment restored the cystometric parameters. Contractile mechanism response (in vitro) to carbachol, KCl, ATP and EFS in the detrusor muscles (DM) were increased in the HF group, when compared to Sham group. However, tadalafil treatment restored the DM hypercontractility in the HF animals. Moreover, renal function as well as the oxidative mechanism was impaired in the HF animals, and the tadalafil treatment improved all renal and oxidative parameters in HF group. Our data shown that tadalafil has potential as multi-therapeutic drug and may be used as a pharmacological strategy for the treatment of cardiovascular, renal and urinary dysfunctions associated with HF.

Asunto(s)

Insuficiencia Cardíaca , Riñón , Síntomas del Sistema Urinario Inferior , Tadalafilo/farmacología , Vejiga Urinaria , Animales , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/fisiopatología , Riñón/metabolismo , Riñón/fisiopatología , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Síntomas del Sistema Urinario Inferior/metabolismo , Síntomas del Sistema Urinario Inferior/fisiopatología , Masculino , Oxidación-Reducción/efectos de los fármacos , Ratas , Ratas Sprague-Dawley , Vejiga Urinaria/metabolismo , Vejiga Urinaria/fisiopatología

RESUMEN

PURPOSE: To assess the effects of Serenoa repens alone or in combination with other phytotherapy compared to placebo in men with LUTS due to benign prostatic enlargement. MATERIALS AND METHODS: Following a registered protocol (CRD42021226655), we searched (December 2020) MEDLINE, CENTRAL, Embase, ClinicalTrials.gov, WHO-ICTRP trials platform and other sources with no restrictions on language, publication date or status. We included randomized controlled trials, and we critically appraised them using the Cochrane Tool for Risk of Bias Assessment (RoB 2). We conducted random-effects meta-analysis when appropriate. The primary outcomes included urinary symptoms score, quality of life, and adverse events. The certainty of the evidence was rated using GRADE. RESULTS: We included 27 trials with 4,853 participants. S. repens results in little to no difference in urinary symptoms, quality of life, and adverse events at short- and long-term follow-up. S. repens combined with other phytotherapy may slightly reduce urinary symptoms at short-term follow-up, but the results are uncertain. The results on quality of life and adverse events are also very uncertain. CONCLUSIONS: S. repens alone may result in no clinical benefits for men with LUTS. There is greater uncertainty in the effects of S. repens in combination with other phytotherapy.

Asunto(s)

Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Síntomas del Sistema Urinario Inferior/etiología , Fitoterapia , Hiperplasia Prostática/complicaciones , Serenoa , Humanos , Masculino

RESUMEN

PURPOSE: Williams-Beuren syndrome is a chromosomal disorder caused by a deletion at region 7q11.23. Lower urinary tract symptoms are highly prevalent and significantly affect quality of life. We assessed the long-term outcomes of lower urinary tract symptoms in children with Williams-Beuren syndrome. MATERIALS AND METHODS: From February 2001 to July 2016, 90 patients with Williams-Beuren syndrome were evaluated in our hospital, of whom 31 (20 boys) had at least 5 years of followup. Baseline evaluation included a history of lower urinary tract symptoms, frequency-volume chart and the impact on quality of life measured on a scale of 0 (delighted) to 6 (terrible). Pharmacological therapy with oxybutynin or doxazosin was offered to symptomatic patients. We present the outcome of lower urinary tract symptoms after 5 and 10 years of followup. RESULTS: At baseline 27 (87.1%) patients were symptomatic. Median duration of followup was 10 (range 6-13) years. Pharmacological therapy was started for 25 (92.6%) symptomatic patients at baseline, including oxybutynin for 19 (76.0%), doxazosin for 1 (4.0%) and a combination of the 2 agents for 5 (20.0%). Medical therapy was still in use by 61.2% after 5 years and 52.9% after 10 years (p=0.043). Median duration of pharmacological treatment was 7 (range 6-11) years. A significant improvement of lower urinary tract symptoms was observed over time, with 35.5% and 29.5% patients considered symptomatic after 5 years and 10 years, respectively (p <0.001). Quality of life was also markedly improved over time (p <0.001). CONCLUSIONS: This long-term study showed significant improvement of lower urinary tract symptoms in children and adolescents with Williams-Beuren syndrome over time. Long-term pharmacological treatment was needed in most patients.

Asunto(s)

Síntomas del Sistema Urinario Inferior/etiología , Síndrome de Williams/complicaciones , Adolescente , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Niño , Doxazosina/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Masculino , Ácidos Mandélicos/uso terapéutico , Factores de Tiempo , Agentes Urológicos/uso terapéutico , Síndrome de Williams/tratamiento farmacológico

RESUMEN

INTRODUCTION: In men, lower urinary tract symptoms (LUTS) are primarily attributed to benign prostatic hyperplasia (BPH). Therapeutic options are targeted to relax prostate smooth muscle and/or reduce prostate enlargement. Areas covered: This article reviews the major preclinical and clinical data on PDE5 inhibitors with a specific focus on tadalafil. It includes details of the role of the nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) - PDE5 pathway in the LUT organs (bladder and prostate) in addition to the available data on tadalafil in patients with LUTS secondary to BPH with or without erectile dysfunction (ED). Expert opinion: Preclinical and clinical data have clearly demonstrated that PDE5 inhibitors induce bladder and prostate relaxation, which contributes to the improvement seen in storage symptoms in both animal models of bladder and prostate hypercontractility. Tadalafil is effective both as a monotherapy and add-on therapy in patients with LUTS secondary to BPH. Furthermore, as LUTS-BPH and ED are urological disorders that commonly coexist in aging men, tadalafil is more advantageous than α1-adrenoceptors and should be used as the first option. Tadalafil is a safe and tolerable therapy and unlike α1- adrenoceptors and 5-alpha reductase inhibitors, which can cause sexual dysfunctions, tadalafil improves sexual function.

Asunto(s)

Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Hiperplasia Prostática/tratamiento farmacológico , Tadalafilo/uso terapéutico , Inhibidores de 5-alfa-Reductasa/uso terapéutico , Animales , Disfunción Eréctil/tratamiento farmacológico , Humanos , Masculino , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Disfunciones Sexuales Fisiológicas/tratamiento farmacológico , Resultado del Tratamiento

RESUMEN

OBJECTIVES: To evaluate whether the presence of basal cell hyperplasia (BCH) in negative biopsies is associated with concurrent lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH), clinical prostatitis, and future prostate cancer (PCa) in repeat prostate biopsy. METHODS: We performed a retrospective analysis of 6471 men, 50-75 years old with prostate-specific antigen between 2.5 and 10 ng/ml and prior negative biopsy who were enrolled in the Reduction by Dutasteride of PCa Events trial and underwent a 2-year repeat biopsy. The association between baseline BCH and risk of PCa, BPH/LUTS and clinical prostatitis measured at baseline were evaluated with logistic regression in uni/multivariable analysis, controlling for baseline patient characteristics. RESULTS: Among 6471 men enrolled, 84 (1.3%) had BCH in the baseline prostate biopsy. BCH was associated less chronic inflammation and more prostate atrophy (P < 0.05) and was unrelated to baseline patient characteristics. In both uni/multivariable analyses, BCH was not associated with PCa in repeat biopsy (univariable odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.53-1.82, P > 0.05; multivariable OR=1.15, 95% CI = 0.61-2.16, P > 0.05), BPH/LUTS (univariable OR = 1.13, 95% CI = 0.71-1.81, P > 0.05; multivariable OR = 1.20, 95% CI = 0.74-1.94, P > 0.05), or clinical prostatitis (univariable OR = 0.56, 95% CI = 0.18-1.81, P > 0.05; multivariable OR = 0.57, 95% CI = 0.18-1.83, P > 0.05). CONCLUSION: Among men undergoing repeat prostate biopsy with a baseline negative biopsy, BCH was associated with more histological atrophy and less chronic prostatitis, but was unrelated to LUTS/BPH, clinical prostatitis or future PCa risk.

Asunto(s)

Biopsia/métodos , Dutasterida/administración & dosificación , Síntomas del Sistema Urinario Inferior/diagnóstico , Próstata/patología , Hiperplasia Prostática/diagnóstico , Prostatitis/diagnóstico , Inhibidores de 5-alfa-Reductasa/administración & dosificación , Administración Oral , Anciano , Enfermedad Crónica , Diagnóstico Diferencial , Relación Dosis-Respuesta a Droga , Humanos , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Síntomas del Sistema Urinario Inferior/etiología , Masculino , Persona de Mediana Edad , Pronóstico , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/tratamiento farmacológico , Neoplasias de la Próstata , Prostatitis/complicaciones , Estudios Retrospectivos

RESUMEN

Lower urinary tract symptoms (LUTS), comprising storage (such as urinary incontinence and urinary frequency), voiding, and postmicturition symptoms, are highly prevalent conditions that affect millions of people worldwide. LUTS have a profound effect on quality of life and are a considerable cost to health care systems. In men specifically, BPH commonly leads to LUTS. Clinical studies also show an association of LUTS with erectile dysfunction (ED). Nitric oxide (NO) has long been recognized as an important nonadrenergic, noncholinergic (NANC) transmitter in bladder, urethra, prostate, and corpus cavernosum smooth muscle. Data from clinical and basic research show that oxidation and degradation of soluble guanylate cyclase (sGC; also known as GCS) and reduced cyclic GMP (cGMP) levels are involved in the physiopathology of genitourinary diseases. The NO-sGC-cGMP signalling pathway has a role in disease pathophysiology of the bladder, urethra, prostate, and corpus cavernosum in animal models and humans. Advances in targeting sGC directly to enhance cGMP production independently of endogenous NO have been made using NO-independent stimulators and activators of sGC. These molecules are potential therapeutics in the treatment of LUTS and ED.

Asunto(s)

Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Envejecimiento , Animales , Benzoatos/farmacología , Complicaciones de la Diabetes , Activadores de Enzimas/farmacología , Humanos , Hipertensión/complicaciones , Indazoles/farmacología , Óxido Nítrico/metabolismo , Obesidad/complicaciones , Inhibidores de Fosfodiesterasa 5/farmacología , Pirazoles/farmacología , Piridinas/farmacología , Especies Reactivas de Oxígeno/metabolismo , Factores de Riesgo , Guanilil Ciclasa Soluble/metabolismo , Sistema Urinario/metabolismo

RESUMEN

ABSTRACT Purpose To investigate the lower urinary tract changes in mice treated with L-NAME, a non-selective competitive inhibitor of nitric oxide synthase (NOS), or aminoguanidine, a competitive inhibitor of inducible nitric oxide synthase (iNOS), after 5 weeks of partial bladder outlet obstruction (BOO), in order to evaluate the role of constitutive and non-constitutive NOS in the pathogenesis of this experimental condition. Materials and Methods C57BL6 male mice were partially obstructed and randomly allocated into 6 groups: Sham, Sham + L-NAME, Sham + aminoguanidine, BOO, BOO + L-NAME and BOO + aminoguanidine. After 5 weeks, bladder weight was obtained and cystometry and tissue bath contractile studies were performed. Results BOO animals showed increase of non-voiding contractions (NVC) and bladder capacity, and also less contractile response to Carbachol and Electric Field Stimulation. Inhibition of NOS isoforms improved bladder capacity and compliance in BOO animals. L-NAME caused more NVC, prevented bladder weight gain and leaded to augmented contractile responses at muscarinic and electric stimulation. Aminoguanidine diminished NVC, but did not avoid bladder weight gain in BOO animals and did not improve contractile responses. Conclusion It can be hypothesized that chronic inhibition of three NOS isoforms in BOO animals leaded to worsening of bladder function, while selective inhibition of iNOS did not improve responses, what suggests that, in BOO animals, alterations are related to constitutive NOS.

Asunto(s)

Animales , Masculino , Obstrucción del Cuello de la Vejiga Urinaria/tratamiento farmacológico , Óxido Nítrico Sintasa/antagonistas & inhibidores , NG-Nitroarginina Metil Éster/farmacología , Inhibidores Enzimáticos/farmacología , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Guanidinas/farmacología , Óxido Nítrico/antagonistas & inhibidores , Presión , Factores de Tiempo , Micción/efectos de los fármacos , Micción/fisiología , Vejiga Urinaria/efectos de los fármacos , Vejiga Urinaria/fisiopatología , Obstrucción del Cuello de la Vejiga Urinaria/fisiopatología , Distribución Aleatoria , Reproducibilidad de los Resultados , Resultado del Tratamiento , NG-Nitroarginina Metil Éster/uso terapéutico , Inhibidores Enzimáticos/uso terapéutico , Guanidinas/uso terapéutico , Ratones Endogámicos C57BL , Contracción Muscular/efectos de los fármacos

RESUMEN

ABSTRACT Objective To investigate the effect of a 5mg daily tadalafil treatment on the ejaculation time, erectile function and lower urinary tract symptoms (LUTS) in patients with erectile dysfunction. Materials and Methods A total of 60 patients diagnosed with erectile dysfunction were retrospectively evaluated using the international index of erectile function questionnaire-5 (IIEF-5), intravaginal ejaculatory latency time (IELT) and international prostate symptoms scores (IPSS). After the patients were treated with 5mg tadalafil once a day for three months, their erection, ejaculation and LUTS were assessed again. The fasting levels of blood glucose, total testosterone, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and total cholesterol were measured. The independent-samples t-test was used to compare the pre- and post-treatment scores of the patients. Results The mean age of the 60 participants was 50.4±7.9 and the mean baseline serum total testosterone, total cholesterol, and fasting blood sugar were 444.6±178.6ng dL-1, 188.7±29.6mg/dL-1,104 (80-360) mg dL-1, respectively. The mean baseline scores were 2.2±1.4 min for IELT, 9.5±3.7 for IIEF-5 and 14.1±4.5 for IPSS. Following the three-month daily 5mg tadalafil treatment, the scores were found to be 3.4±1.9 min, 16.1±4.7, and 10.4±3.8 for IELT, IIEF and IPSS, respectively. When the baseline and post-treatment scores were compared, a statistically significant increase was observed in the IELTs and IIEF-5 values whereas there was a significant decrease in IPSS (p<0.01). Conclusion A daily dose of 5mg tadalafil can be safely used in the treatment of erectile dysfunction and LUTS, that prolongs the ejaculatory latency time.

Asunto(s)

Humanos , Masculino , Adulto , Anciano , Erección Peniana/efectos de los fármacos , Eyaculación/efectos de los fármacos , Inhibidores de Fosfodiesterasa 5/administración & dosificación , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Eyaculación Prematura/tratamiento farmacológico , Tadalafilo/administración & dosificación , Disfunción Eréctil/tratamiento farmacológico , Testosterona/sangre , Factores de Tiempo , Glucemia/análisis , Erección Peniana/fisiología , Esquema de Medicación , Colesterol/sangre , Encuestas y Cuestionarios , Estudios Retrospectivos , Resultado del Tratamiento , Estadísticas no Paramétricas , Eyaculación/fisiología , Síntomas del Sistema Urinario Inferior/fisiopatología , Eyaculación Prematura/fisiopatología , Disfunción Eréctil/fisiopatología , Persona de Mediana Edad

Asunto(s)

Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Hiperplasia Prostática/tratamiento farmacológico , Inhibidores de 5-alfa-Reductasa/uso terapéutico , Antagonistas Adrenérgicos alfa/uso terapéutico , Agonistas de Receptores Adrenérgicos beta 3/uso terapéutico , Quimioterapia Combinada , Humanos , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/prevención & control , Masculino , Antagonistas Muscarínicos/uso terapéutico , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Fitoterapia , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/prevención & control , Calidad de Vida

RESUMEN

PURPOSE: To investigate the lower urinary tract changes in mice treated with L-NAME, a non-selective competitive inhibitor of nitric oxide synthase (NOS), or aminoguanidine, a competitive inhibitor of inducible nitric oxide synthase (iNOS), after 5 weeks of partial bladder outlet obstruction (BOO), in order to evaluate the role of constitutive and non-constitutive NOS in the pathogenesis of this experimental condition. MATERIALS AND METHODS: C57BL6 male mice were partially obstructed and randomly allocated into 6 groups: Sham, Sham + L-NAME, Sham + aminoguanidine, BOO, BOO + L-NAME and BOO + aminoguanidine. After 5 weeks, bladder weight was obtained and cystometry and tissue bath contractile studies were performed. RESULTS: BOO animals showed increase of non-voiding contractions (NVC) and bladder capacity, and also less contractile response to Carbachol and Electric Field Stimulation. Inhibition of NOS isoforms improved bladder capacity and compliance in BOO animals. L-NAME caused more NVC, prevented bladder weight gain and leaded to augmented contractile responses at muscarinic and electric stimulation. Aminoguanidine diminished NVC, but did not avoid bladder weight gain in BOO animals and did not improve contractile responses. CONCLUSION: It can be hypothesized that chronic inhibition of three NOS isoforms in BOO animals leaded to worsening of bladder function, while selective inhibition of iNOS did not improve responses, what suggests that, in BOO animals, alterations are related to constitutive NOS.

Asunto(s)

Inhibidores Enzimáticos/farmacología , Guanidinas/farmacología , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , NG-Nitroarginina Metil Éster/farmacología , Óxido Nítrico Sintasa/antagonistas & inhibidores , Óxido Nítrico/antagonistas & inhibidores , Obstrucción del Cuello de la Vejiga Urinaria/tratamiento farmacológico , Animales , Inhibidores Enzimáticos/uso terapéutico , Guanidinas/uso terapéutico , Masculino , Ratones Endogámicos C57BL , Contracción Muscular/efectos de los fármacos , NG-Nitroarginina Metil Éster/uso terapéutico , Presión , Distribución Aleatoria , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento , Vejiga Urinaria/efectos de los fármacos , Vejiga Urinaria/fisiopatología , Obstrucción del Cuello de la Vejiga Urinaria/fisiopatología , Micción/efectos de los fármacos , Micción/fisiología

RESUMEN

OBJECTIVE: To investigate the effect of a 5mg daily tadalafil treatment on the ejaculation time, erectile function and lower urinary tract symptoms (LUTS) in patients with erectile dysfunction. MATERIALS AND METHODS: A total of 60 patients diagnosed with erectile dysfunction were retrospectively evaluated using the international index of erectile function questionnaire-5 (IIEF-5), intravaginal ejaculatory latency time (IELT) and international prostate symptoms scores (IPSS). After the patients were treated with 5mg tadalafil once a day for three months, their erection, ejaculation and LUTS were assessed again. The fasting levels of blood glucose, total testosterone, low-density lipoprotein cholesterol, highdensity lipoprotein cholesterol and total cholesterol were measured. The independentsamples t-test was used to compare the pre- and post-treatment scores of the patients. RESULTS: The mean age of the 60 participants was 50.4±7.9 and the mean baseline serum total testosterone, total cholesterol, and fasting blood sugar were 444.6±178.6ng dL-1, 188.7±29.6mg/dL-1,104 (80-360) mg dL-1, respectively. The mean baseline scores were 2.2±1.4 min for IELT, 9.5±3.7 for IIEF-5 and 14.1±4.5 for IPSS. Following the three-month daily 5mg tadalafil treatment, the scores were found to be 3.4±1.9 min, 16.1±4.7, and 10.4±3.8 for IELT, IIEF and IPSS, respectively. When the baseline and post-treatment scores were compared, a statistically significant increase was observed in the IELTs and IIEF-5 values whereas there was a significant decrease in IPSS (p<0.01). CONCLUSION: A daily dose of 5mg tadalafil can be safely used in the treatment of erectile dysfunction and LUTS, that prolongs the ejaculatory latency time.

Asunto(s)

Eyaculación/efectos de los fármacos , Disfunción Eréctil/tratamiento farmacológico , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Erección Peniana/efectos de los fármacos , Inhibidores de Fosfodiesterasa 5/administración & dosificación , Eyaculación Prematura/tratamiento farmacológico , Tadalafilo/administración & dosificación , Adulto , Anciano , Glucemia/análisis , Colesterol/sangre , Esquema de Medicación , Eyaculación/fisiología , Disfunción Eréctil/fisiopatología , Humanos , Síntomas del Sistema Urinario Inferior/fisiopatología , Masculino , Persona de Mediana Edad , Erección Peniana/fisiología , Eyaculación Prematura/fisiopatología , Estudios Retrospectivos , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Testosterona/sangre , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

AIMS: To systematically review the management of lower urinary tract symptoms (LUTS) in patients with dementia and associated disorders. METHODS: This systematic review was performed according to the PRISMA statement. Studies were identified by electronic search of Embase and Medline databases (last search August 2015) and by screening of reference lists and reviews. RESULTS: Of 1,426 abstracts that were screened, 102 full-text articles were identified and assessed for eligibility. Seventy-six articles were then included in the quantitative synthesis. Urinary incontinence (UI) prevalence rates in dementia patients have varied considerably, ranging from 11 to 93%. In Alzheimer's disease patients, UI usually correlates with disease progression (late-stage dementia). In contrast, LUTS usually precede severe mental failure in Lewy body disease and in vascular dementia. Behavioral therapy, including toilet training and prompted voiding, may be especially useful in patients with unawareness UI. High-quality data to guide the choice of treatment strategies in this population are lacking. Current evidence suggests that antimuscarinics, especially oxybutynin, can be associated with cognitive worsening, due to the blockade of M1 receptors. Thus, the use of antimuscarinics that do not easily cross the blood-brain barrier or are more M2/M3 selective should be considered. No data are available for beta-3 agonists so far. CONCLUSION: Different types of dementia cause different LUTS at varying time points during the disease process and need singular therapeutic approaches. Treatment of LUTS should be tailored to individual patient needs and disease status, considering factors like mobility, cognitive function, and general medical condition. Neurourol. Urodynam. 36:245-252, 2017. © 2015 Wiley Periodicals, Inc.

Asunto(s)

Enfermedad de Alzheimer/complicaciones , Demencia/complicaciones , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Antagonistas Muscarínicos/uso terapéutico , Manejo de la Enfermedad , Humanos , Síntomas del Sistema Urinario Inferior/complicaciones

RESUMEN

OBJECTIVE: To assess the impact of Doxazosin Oral Intake Therapy on urinary symptoms and pain in patients with indwelling ureteral stents Patients and Methods: A total of 239 patients with ureteral stone-related hydronephrosis who underwent a double-J stent insertion after ureteroscopic lithotripsy were enrolled. Patients were randomized to receive doxazosin cotrolled release 4 mg once daily for 4 weeks or matching placebo. Patients completed the brief-form Chinese version Ureteric Stent Symptom Questionnaire (USSQ) and quality of life (QoL) score 2 weeks and 4 weeks after stent placement and 4 weeks after stent withdrawal. The analgesic use was also recorded during the stenting period. RESULTS: Patients in Doxazosin Oral Intake Therapy group, in the first 2 weeks and second 2 weeks with the stent in situ, expressed significant lower daytime frequency (p=0.028 and p=0.038), nocturia (p=0.021 and p=0.008) and urgency (p=0.012 and p=0.014), respectively. Similarly, flank pain score, QoL score and analgesic use were also significant less in the stenting period. There was no significant difference in scores of urinary symptoms, pain and QoL during the post-stent period between two cohorts. CONCLUSIONS: Doxazosin Oral Intake Therapy reduced stent-related urinary symptoms, pain and the negative impact on QoL.

Asunto(s)

Antagonistas de Receptores Adrenérgicos alfa 1/administración & dosificación , Doxazosina/administración & dosificación , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Dolor/tratamiento farmacológico , Calidad de Vida , Stents/efectos adversos , Administración Oral , Adulto , Anciano , Femenino , Humanos , Litotricia/métodos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento , Ureteroscopía/efectos adversos

RESUMEN

ABSTRACT Objective: To assess the impact of Doxazosin Oral Intake Therapy on urinary symptoms and pain in patients with indwelling ureteral stents Patients and Methods: A total of 239 patients with ureteral stone-related hydronephrosis who underwent a double-J stent insertion after ureteroscopic lithotripsy were enrolled. Patients were randomized to receive doxazosin cotrolled release 4 mg once daily for 4 weeks or matching placebo. Patients completed the brief-form Chinese version Ureteric Stent Symptom Questionnaire (USSQ) and quality of life (QoL) score 2 weeks and 4 weeks after stent placement and 4 weeks after stent withdrawal. The analgesic use was also recorded during the stenting period. Results: Patients in Doxazosin Oral Intake Therapy group, in the first 2 weeks and second 2 weeks with the stent in situ, expressed significant lower daytime frequency (p=0.028 and p=0.038), nocturia (p=0.021 and p=0.008) and urgency (p=0.012 and p=0.014), respectively. Similarly, flank pain score, QoL score and analgesic use were also significant less in the stenting period. There was no significant difference in scores of urinary symptoms, pain and QoL during the post-stent period between two cohorts. Conclusions: Doxazosin Oral Intake Therapy reduced stent-related urinary symptoms, pain and the negative impact on QoL.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Anciano , Dolor/tratamiento farmacológico , Calidad de Vida , Stents/efectos adversos , Doxazosina/administración & dosificación , Antagonistas de Receptores Adrenérgicos alfa 1/administración & dosificación , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Periodo Posoperatorio , Litotricia/métodos , Administración Oral , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento , Ureteroscopía/efectos adversos , Persona de Mediana Edad

RESUMEN

INTRODUCTION AND OBJECTIVE: Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. METHODS: Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. Once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. RESULTS: Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. CONCLUSIONS: Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.

Asunto(s)

Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Síntomas del Sistema Urinario Inferior/etiología , Ácidos Mandélicos/uso terapéutico , Stents/efectos adversos , Sulfonamidas/uso terapéutico , Agentes Urológicos/uso terapéutico , Adulto , Análisis de Varianza , Quimioterapia Combinada , Femenino , Humanos , Síntomas del Sistema Urinario Inferior/prevención & control , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Reproducibilidad de los Resultados , Método Simple Ciego , Encuestas y Cuestionarios , Tamsulosina , Factores de Tiempo , Resultado del Tratamiento , Uréter , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/terapia , Ureteroscopía

RESUMEN

ABSTRACT Introduction and objective Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. Methods Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. Results Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. Conclusions Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Sulfonamidas/uso terapéutico , Stents/efectos adversos , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Agentes Urológicos/uso terapéutico , Ácidos Mandélicos/uso terapéutico , Calidad de Vida , Factores de Tiempo , Uréter , Obstrucción Ureteral , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/terapia , Método Simple Ciego , Estudios Prospectivos , Encuestas y Cuestionarios , Reproducibilidad de los Resultados , Análisis de Varianza , Resultado del Tratamiento , Quimioterapia Combinada , Síntomas del Sistema Urinario Inferior/prevención & control , Persona de Mediana Edad

RESUMEN

INTRODUCTION: Tadalafil (TAD) 5 mg coadministered with finasteride (FIN) 5 mg significantly improves lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) and prostatic enlargement. However, its effects on erectile/sexual function have yet to be fully described. AIM: Assess the effects of TAD/FIN coadministration (compared with placebo [PBO]/FIN) on erectile and sexual function in sexually active men with LUTS and prostatic enlargement secondary to BPH with or without baseline comorbid erectile dysfunction (ED). METHODS: A randomized, double-blind, PBO-controlled study of 695 men (610 sexually active; 450 with baseline ED; 404 sexually active with baseline ED) conducted at 70 sites in 13 countries. TAD 5 mg or PBO once daily coadministered with FIN 5 mg once daily for 26 weeks. MAIN OUTCOME MEASURES: International Index of Erectile Function (IIEF) domain and single-item scores; proportions of patients who demonstrated minimal clinically important differences (MCIDs) in IIEF-Erectile Function domain scores (IIEF-EF; MCID defined as ≥4-point improvement); and sexual dysfunction adverse events (AEs). RESULTS: Compared with PBO/FIN, TAD/FIN resulted in improvements for all IIEF domain and single-item scores assessed among patients with baseline ED (P ≤ 0.002 for all measures) and among patients without baseline ED (P ≤ 0.041 for all measures). Compared with PBO/FIN, significantly larger percentages of sexually active men with baseline ED treated with TAD/FIN achieved an IIEF-EF MCID after 4, 12, and 26 weeks of therapy (P < 0.001 for odds ratio comparisons between TAD/FIN and PBO/FIN at all 3 three postbaseline timepoints). The incidence of sexual AEs was low: five TAD/FIN patients and seven PBO/FIN patients reported sexual AEs, including ED, decreased/lost libido, and ejaculation disorders. CONCLUSIONS: TAD/FIN coadministration for the treatment of men with LUTS and prostatic enlargement secondary to BPH concurrently leads to statistically significant improvements in erectile/sexual function and is well-tolerated, regardless of the presence/absence of ED at treatment initiation.

Asunto(s)

Carbolinas/uso terapéutico , Coito , Disfunción Eréctil/tratamiento farmacológico , Finasterida/uso terapéutico , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Hiperplasia Prostática/tratamiento farmacológico , Comorbilidad , Método Doble Ciego , Quimioterapia Combinada , Disfunción Eréctil/etiología , Disfunción Eréctil/fisiopatología , Humanos , Síntomas del Sistema Urinario Inferior/complicaciones , Síntomas del Sistema Urinario Inferior/fisiopatología , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/fisiopatología , Tadalafilo , Resultado del Tratamiento

RESUMEN

PURPOSE: To evaluate the association between prostatic inflammation and lower urinary tract symptoms (LUTS), and to identify the effects of prostatic inflammation on the treatment with an alpha blocker. MATERIALS AND METHODS: 111 Participants who were aged ≥ 50 years, the presence of LUTS (maximal flow rate < 20 m/s, IPSS ≥ 11), and an elevated PSA level (3-20 ng/mL) were treated with tamsulosin 0.2mg once daily for 3 months after prostate biopsies. Prostatic inflammation was scored as none (0), mild (I), moderate (II), or marked (III). LUTS parameters including urine flow rates, IPSS, PSA, and prostate volume were evaluated. RESULTS: Inflammation grading resulted in 25, 60, and 26 patients that were grade 0, I, and II, respectively. Lower grade inflammation was related to higher urine flow rate at baseline. Patients with higher inflammation grades had larger prostate volumes, larger total and transitional zone volumes, and higher PSA levels. Overall, urine flow rates and residual urine volume were improved after 3 months of alpha blocker therapy. Eighty percent of patients with grade 0 inflammation, 73% of patients with grade I inflammation, and 92.3% of patients with grade II inflammation showed improvement of LUTS after treatment. Longer duration of treatment was related to a decreased chance of improvement of LUTS. Patients with increased IPSS voiding subscales could be predictive of improvement of LUTS. CONCLUSIONS: Patients with high grade inflammation had lower flow rates and higher prostatic volumes than patients with low grade inflammation. Inflammation grade did not affect the outcomes of alpha blocker treatment.

Asunto(s)

Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Hiperplasia Prostática/tratamiento farmacológico , Prostatitis/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Anciano , Biopsia , Progresión de la Enfermedad , Humanos , Síntomas del Sistema Urinario Inferior/patología , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Valor Predictivo de las Pruebas , Antígeno Prostático Específico/sangre , Hiperplasia Prostática/patología , Prostatitis/complicaciones , Prostatitis/patología , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Tamsulosina , Resultado del Tratamiento

RESUMEN

Purpose To evaluate the association between prostatic inflammation and lower urinary tract symptoms (LUTS), and to identify the effects of prostatic inflammation on the treatment with an alpha blocker. Materials and Methods 111 Participants who were aged ≥ 50 years, the presence of LUTS (maximal flow rate < 20 m/s, IPSS ≥ 11), and an elevated PSA level (3-20ng/mL) were treated with tamsulosin 0.2mg once daily for 3 months after prostate biopsies. Prostatic inflammation was scored as none (0), mild (I), moderate (II), or marked (III). LUTS parameters including urine flow rates, IPSS, PSA, and prostate volume were evaluated. Results Inflammation grading resulted in 25, 60, and 26 patients that were grade 0, I, and II, respectively. Lower grade inflammation was related to higher urine flow rate at baseline. Patients with higher inflammation grades had larger prostate volumes, larger total and transitional zone volumes, and higher PSA levels. Overall, urine flow rates and residual urine volume were improved after 3 months of alpha blocker therapy. Eighty percent of patients with grade 0 inflammation, 73% of patients with grade I inflammation, and 92.3% of patients with grade II inflammation showed improvement of LUTS after treatment. Longer duration of treatment was related to a decreased chance of improvement of LUTS. Patients with increased IPSS voiding subscales could be predictive of improvement of LUTS. Conclusions Patients with high grade inflammation had lower flow rates and higher prostatic volumes than patients with low grade inflammation. Inflammation grade did not affect the outcomes of alpha blocker treatment. .

Asunto(s)

Anciano , Humanos , Masculino , Persona de Mediana Edad , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Hiperplasia Prostática/tratamiento farmacológico , Prostatitis/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Biopsia , Progresión de la Enfermedad , Síntomas del Sistema Urinario Inferior/patología , Tamaño de los Órganos , Valor Predictivo de las Pruebas , Antígeno Prostático Específico/sangre , Hiperplasia Prostática/patología , Prostatitis/complicaciones , Prostatitis/patología , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Resultado del Tratamiento