High blood pressure. Causes, symptoms, treatments

The efficacy of norfloxacin in the treatment of chronic bacterial prostatitis refractory to trimethoprim-sulfamethoxazole and/or carbenicillin.

2017-04-12

To provide clinical evidence that ejaculation disorder caused by selective alpha(1A)-blockers may be associated with larger symptomatic improvements in patients with benign prostatic hyperplasia.

Spontaneous passage was observed in 22 of the 30 patients in group 1 (73.3%) and 26 of the 30 patients in group 2 (86.6%). The difference within groups 1 and 2 was not significant (P=0.196). The difference between both groups was not statistically significant either, with the stone diameter being 6 mm (P=0.635) or >6 mm (P=0.407). As group 1 patients were passing their stones, they had more ureteral colic episodes than group 2 patients. This difference was statistically significant and correlated well with the administration of tamsulosin (P=0.038). Group 1 patients reported higher scores according to a visual analog scale than group 2 patients. Also, this difference was statistically significant (P=0.000).

A total of 100 men diagnosed with CP/CPPS were randomly allocated to receive either 0.2 mg of tamsulosin daily or placebo for 6 months. Patients were followed up at 3, 6, 12, 18 and 30 months after initiation of treatment. The primary outcome variable was the change from baseline in the total and domain scores of the NIH-CPSI. Secondary variables used to evaluate efficacy of treatment included the following: peak urinary flow rate, post-voiding residual (PVR) volume and the International Index of Erectile Function (IIEF).

Of 293 medical professionals, 114 (39%) were urologists, 55 (48%) of which were fellowship trained in endourology. Fifty-six (19%) were emergency medicine physicians, 22 (8%) were family practitioners, and 19 (7%) were internists and other primary care physicians. Other physician subspecialists and medical paraprofessionals comprised the remaining 34%. Overall 27% of respondents were unfamiliar with MET for expulsion of uncomplicated ureteral stones, including 13% of staff physicians, 21% of emergency medicine doctors, 56% of family practitioners, 40% of internists, and 43% of other primary care providers. The overall prevalence of use of MET was 45%. All urologists were familiar with MET, but 31% rarely, never, or only sometimes used this therapy. Specifically, urologists, emergency physicians, family practitioners, internists, and other providers, usually or always used MET 69%, 55%, 16%, 16%, and 27%, of the time, respectively. In academic institutions, 71.6% use MET usually or almost always compared to 36% in military healthcare settings and 47% in other practice settings. Tamsulosin is the most widely used medication for MET, accounting for 57% of MET use. Factors identified that inhibit more widespread use of MET include, physician unfamiliarity with MET (72%), the belief that MET is not effective (10%), patient unwillingness to undergo MET (5%), and medications not covered by insurance plans (4%).

Twenty-nine trials with a total of 2,763 patients met the inclusion criteria. The pooled analysis showed a 19% improvement in stone clearance with tamsulosin. According to the doses of tamsulosin, the pooling effects of tamsulosin were analyzed, with a higher expulsion rate obtained than in controls. Compared with calcium channel blockers, there was a higher stone expulsion rate in tamsulosin. In addition, a shorter expulsion time, fewer colic episodes and adverse effects were observed.

Approximately 25% of men over 40 or 50 suffer from lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). The bothersomeness of the symptoms varies considerably from one individual to the other and can fluctuate with time. Symptoms tend to gradually worsen as time goes on through. Surprisingly, there appears to be no particular relationship between symptoms and the overall prostate size and weight. Symptoms of BPH are divided in obstructive (voiding) and irritative (storage) symptoms, of which the irritative are the most bothersome. Until recently, surgery (open or transurethral resection) was the only treatment option. Nowadays, a range of less invasive treatments and pharmacological therapies are available to relieve BPH symptoms. Finasteride, for instance, reduces the prostate size by blocking 5-alpha-reductase, the enzyme which plays a role in the growth of the prostate. It takes however a long time before a clinically significant effect is noticed: +/- 6 to 12 months. Then, there are alpha 1-blockers. These agents result in relaxation of prostatic and bladder neck smooth muscle. alpha 1-blockers act relatively fast. Most alpha 1-blockers used in the treatment of symptomatic BPH were originally developed to treat hypertension. The adverse events most commonly associated with alpha 1-blockers, such as dizziness, headache, asthenia, tachycardia/palpitation, postural hypotension and syncope are possibly related to the blood pressure lowering effect. This stimulated the search for more selective alpha-blockers which act predominantly on the prostate and have less effect on the blood levels (afluzosin: Xatral and tamsulosin: Omic). Presently, alpha-blockers have become the first-line drugs in the medical treatment of symptomatic BPH. Surgery (open or TURP) is limited to patients with recurrent infections, large residue (> 200 ml), recurrent hematuria, bladder stones. New alternative and minimally invasive treatment such as TUNA generate necrotic lesions within the prostate through needle introduced endoscopically. This leads also to marked improvement in patients symptomatology.