Medical therapy for clinical benign prostatic hyperplasia(BPH)has advanced significantly in the last 2 decades.Many new a1 antagonists and 5a reductase inhibitors(5ARi)are now commercially available.The practicing uro...Medical therapy for clinical benign prostatic hyperplasia(BPH)has advanced significantly in the last 2 decades.Many new a1 antagonists and 5a reductase inhibitors(5ARi)are now commercially available.The practicing urologist must decide on the most appropriate medication for his patients,taking into consideration various factors like efficacy,dosing regime,adverse effects,cost,patient’s socioeconomic background,expectations,drug availability and his own clinical experience.The use of combination therapy added further to the complexity in clinical judgment when prescribing.We highlight some of the key points in prescribing a1 antagonists,5ARi and their combination,based on our viewpoints and experience as urologists in an Asian clinical setting.展开更多
This study was undertaken to determine the impact on ejaculatory function of tamsulosin （0.2 mg） given once daily （OD） for 12 weeks and to identify risk factors for ejaculatory dysfunction in patients undergoing t...This study was undertaken to determine the impact on ejaculatory function of tamsulosin （0.2 mg） given once daily （OD） for 12 weeks and to identify risk factors for ejaculatory dysfunction in patients undergoing this treatment. Males with an International Prostatic Symptom Score （IPSS） ≥ 8 were enrolled in this study. All participants completed questionnaires, including the IPSS and the Male Sexual Health Questionnaire （MSHQ）, and serum prostate-specific antigen, transrectal ultrasound and uroflowmetry with post-void residual were measured. After initiating 0.2 mg OD tamsulosin, patients were re-evaluated on the fourth and twelfth weeks of medication. The chi-squared test, the independent t-test and one-way ANOVA were used to compare means. Binary logistic regression analysis was used to calculate the odds ratio for all risk factors. A total of 177 men constituted the study cohort. No significant difference was observed between baseline and follow-up for the erectile function, ejaculatory function, satisfaction, sexual activity and desire domains （EFD, EjFD, SDA and ADD） or for erectile or ejaculatory bother mean scores. After 12 weeks, the overall incidence of ejaculatory dysfunction （EjD） was 13.4%. Incidences of the seven different types of EjD （decreased frequency, delay, dryness, decreased strength/force, decreased volume, decreased pleasure and pain at ejaculation） were 2.4%, 3.1%, 3.9%, 3.9%, 6.3%, 7.1% and 3.1%, respectively. Baseline EjFD scores were higher for I PSS responders than for non-responders （26.09 vs. 24.06, P=0.03）. An EjFD score reduction was more frequent in IPSS responders. The incidence of EjD was small, but not negligible and was more frequent in patients with less lower urinary tract symptoms, a smaller prostate, higher baseline MSHQ totals and higher EjFD scores.展开更多
AIM: To present the frequency of intraoperative floppy iris syndrome(IFIS) in cataract patients who taking alpha 1-a receptor antagonist(ARA) drugs, and evaluate the predictive value of pupil diameter(PD) changes in I...AIM: To present the frequency of intraoperative floppy iris syndrome(IFIS) in cataract patients who taking alpha 1-a receptor antagonist(ARA) drugs, and evaluate the predictive value of pupil diameter(PD) changes in IFIS patients.METHODS: Male cataract patients who are under treatment with alpha-1 a-ARAs(alfuzosin, tamsulosin) intraoperatively were evaluated and were grouped as with/without IFIS. The preoperative PD values were compared with controls. Also, the intraoperative manipulations and early/late complications were recorded.RESULTS: A total of 77 patients(77 eyes) of 94 benign prostate hyperplasia(BPH) patients have been defined as IFIS(81.91%) and 40 patients(40 eyes) were taking tamsulosin and 37 patients(37 eyes) were taking alfuzosin. During the cataract surgery, the rate of posterior capsular rupture(P=0.754), vitreous loss(P=0.585), iris tears(P=0.004), and iris catching(P=0.000) were higher in IFIS group, but the difference was significant only in the iris catching. At the postoperative first-month visit, persistent IOP rise and iris stromal tears were more frequent in IFIS group, but the difference was not significant(P=0.311, P=0.146;respectively). In contrast, Descemet membrane detachment was insignificantly more frequent in controls(P=0.311). In IFIS and control patients, PDs were 9.54±1.78 and 9.72±1.57 mm(P=0.255) under scotopic illumination, 8.54±1.43 and 8.74±1.25 mm(P=0.289) under mesopic illumination, 6.99±1.35 and 7.27±1.39 mm(P=0.662) under photopic illumination, respectively. However PDs were lower in IFIS under all illumination degrees, no significant difference was detected between groups.CONCLUSION: IFIS is a significant clinical syndrome with an increased intraoperative/postoperative complication ratio. The prediction of this syndrome is important because of prevention required precautions against possible complications. There is no association between IFIS and preoperative PD.展开更多
文摘Medical therapy for clinical benign prostatic hyperplasia(BPH)has advanced significantly in the last 2 decades.Many new a1 antagonists and 5a reductase inhibitors(5ARi)are now commercially available.The practicing urologist must decide on the most appropriate medication for his patients,taking into consideration various factors like efficacy,dosing regime,adverse effects,cost,patient’s socioeconomic background,expectations,drug availability and his own clinical experience.The use of combination therapy added further to the complexity in clinical judgment when prescribing.We highlight some of the key points in prescribing a1 antagonists,5ARi and their combination,based on our viewpoints and experience as urologists in an Asian clinical setting.
文摘This study was undertaken to determine the impact on ejaculatory function of tamsulosin （0.2 mg） given once daily （OD） for 12 weeks and to identify risk factors for ejaculatory dysfunction in patients undergoing this treatment. Males with an International Prostatic Symptom Score （IPSS） ≥ 8 were enrolled in this study. All participants completed questionnaires, including the IPSS and the Male Sexual Health Questionnaire （MSHQ）, and serum prostate-specific antigen, transrectal ultrasound and uroflowmetry with post-void residual were measured. After initiating 0.2 mg OD tamsulosin, patients were re-evaluated on the fourth and twelfth weeks of medication. The chi-squared test, the independent t-test and one-way ANOVA were used to compare means. Binary logistic regression analysis was used to calculate the odds ratio for all risk factors. A total of 177 men constituted the study cohort. No significant difference was observed between baseline and follow-up for the erectile function, ejaculatory function, satisfaction, sexual activity and desire domains （EFD, EjFD, SDA and ADD） or for erectile or ejaculatory bother mean scores. After 12 weeks, the overall incidence of ejaculatory dysfunction （EjD） was 13.4%. Incidences of the seven different types of EjD （decreased frequency, delay, dryness, decreased strength/force, decreased volume, decreased pleasure and pain at ejaculation） were 2.4%, 3.1%, 3.9%, 3.9%, 6.3%, 7.1% and 3.1%, respectively. Baseline EjFD scores were higher for I PSS responders than for non-responders （26.09 vs. 24.06, P=0.03）. An EjFD score reduction was more frequent in IPSS responders. The incidence of EjD was small, but not negligible and was more frequent in patients with less lower urinary tract symptoms, a smaller prostate, higher baseline MSHQ totals and higher EjFD scores.
文摘AIM: To present the frequency of intraoperative floppy iris syndrome(IFIS) in cataract patients who taking alpha 1-a receptor antagonist(ARA) drugs, and evaluate the predictive value of pupil diameter(PD) changes in IFIS patients.METHODS: Male cataract patients who are under treatment with alpha-1 a-ARAs(alfuzosin, tamsulosin) intraoperatively were evaluated and were grouped as with/without IFIS. The preoperative PD values were compared with controls. Also, the intraoperative manipulations and early/late complications were recorded.RESULTS: A total of 77 patients(77 eyes) of 94 benign prostate hyperplasia(BPH) patients have been defined as IFIS(81.91%) and 40 patients(40 eyes) were taking tamsulosin and 37 patients(37 eyes) were taking alfuzosin. During the cataract surgery, the rate of posterior capsular rupture(P=0.754), vitreous loss(P=0.585), iris tears(P=0.004), and iris catching(P=0.000) were higher in IFIS group, but the difference was significant only in the iris catching. At the postoperative first-month visit, persistent IOP rise and iris stromal tears were more frequent in IFIS group, but the difference was not significant(P=0.311, P=0.146;respectively). In contrast, Descemet membrane detachment was insignificantly more frequent in controls(P=0.311). In IFIS and control patients, PDs were 9.54±1.78 and 9.72±1.57 mm(P=0.255) under scotopic illumination, 8.54±1.43 and 8.74±1.25 mm(P=0.289) under mesopic illumination, 6.99±1.35 and 7.27±1.39 mm(P=0.662) under photopic illumination, respectively. However PDs were lower in IFIS under all illumination degrees, no significant difference was detected between groups.CONCLUSION: IFIS is a significant clinical syndrome with an increased intraoperative/postoperative complication ratio. The prediction of this syndrome is important because of prevention required precautions against possible complications. There is no association between IFIS and preoperative PD.
