Silodosin is effective for treatment of LUTS in men wii BPH： a systematic review

The aim of this study was to systematically review the evidence on the efficacy and safety of silodosin treatments on lower urinary tract symptoms （LUTS） in men with benign prostatic hyperplasia （BPH） from randomized controlled trials. We searched PubMed （1966- December 2011）, Embase （1974-December 2011） and the Cochrane Library Database （2011, Issue 12）. The assessed outcome measures were the change from baseline for the International Prostate Symptom Score （IPSS）, quality of life （QoL） score, peak urine maximum flow rate （Qmax）, QoL related to urinary symptoms and adverse effects. Two authors independently assessed the study quality and extracted data. All data were analysed using RevMan 5.1. The meta-analysis included four randomized controlled trials with a total of 2504 patients. The study durations were each 12 weeks. At the follow-up end points, the pooled results showed that the change from baseline for the silodosin group was significantly higher than the placebo group for the IPSS, QoL score and Qmax（mean difference （MD）=-2.78, P〈O.O0001; MD=-O.42, P--O.O04; MD= 1.17, P〈O.OOOOl,respectively） and patients felt more satisfied with QoL related to urinary symptoms in the silodosin group than the placebo group. Ejaculation disorder was the most commonly reported adverse effect. The pooled results also showed that the silodosin group was superior to the 0.2 mg tamsulosin group with respect to the IPSS and QoL score （IPSS： MD=- 1.14, P=O.02; QoL score： MD=-0.26, P=O.02） and inferior to the 0.2 mg tamsulosin group with respect to Qmax （MD=-0.85, P=O.01）. In contrast, there was no significant difference in the incidence of ejaculation disorder and dizziness between the silodosin and 0.2 mg tamsulosin groups. The current meta-analysis suggested that silodosin is an effective therapy for LUTS in men with BPH and is not inferior to 0.2 mg tamsulosin.

在一项以社区为基础的大规模韩国人群筛选队列研究中把血清前列腺特异性抗原作为前列腺体积和下尿路症状的一个预测指标

The aim of this study is to assess the ability of serum prostate-specific antigen （PSA） to predict prostate volume （PV） and lower urinary tract symptoms （LUTS） represented by the international prostate symptom score （IPSS）. From January 2001 to December 2011, data were collected from men who first enrolled in the Korean Prostate Health Council Screening Program. Patients with a serum PSA level of 10 ng ml^-1 or age 〈40 years were excluded. Accordingly, a total of 34 857 men were included in our study, and serum PSA, PV and the IPSS were estimated in all patients. Linear and age-adjusted multivariate logistic analyses were used to assess the potential association between PSA and PV or IPSS. The predictive value of PSA for estimating PV and IPSS was assessed based on the receiver operating characteristics-derived area under the curve （AUC）. The mean PV was 29.9 ml, mean PSA level was 1.49 ng ml^-1 and mean IPSS was 15.4. A significant relationship was shown between PSA and PV, and the IPSS and PSA were also significantly correlated after adjusting by age. The AUCs of PSA for predicting PV ~20 ml, 〉25 ml and 〉35 ml were 0.722, 0.728 and 0.779, respectively. The AUCs of PSA for predicting IPSS 〉 7, 〉 13 and 〉 19 were 0. 548, 0.536 and 0. 537, respectively. Serum PSA was a strong predictor of PV in a community-based cohort in a large-scale screening study. Although PSA was also significantly correlated with IPSS, predictive values of PSA for IPSS above the cutoff levels were not excellent. Further investigations are required to elucidate the exact interactions between PSA and LUTS and between PSA and PV in prospective controlled studies. Such studies may suggest how PSA can be used to clinically predict PV and the IPSS.

Patient-reported ejaculatory function and satisfaction in men with lower urinary tract symptoms/benign prostatic hyperplasia

This study aimed to investigate perceived ejaculatory function/satisfaction before treatment for lower urinary tract symptoms （LUTS）/benign prostatic hyperplasia （BPH） and to identify associations between specific categories of ejaculatory dysfunctions （EjDs） and LUTS. A total of 1574 treatment-naive men with LUTS/BPH were included in this study. All patients underwent routine evaluation for LUTS/BPH including the International Index of Erectile Function and a 5-item questionnaire developed to assess ejaculatory volume/force/pain/satisfaction/latency time. Patients who had sexual intercourse over the past 4 weeks were classified as sexually active group. A total of 783 patients were categorized as sexually active group. Decreased ejaculatory volume and force were reported by 53.4% and 55.7% of 783 sexually active men, respectively, There was a strong correlation between ejaculatory volume and force. Ejaculatory pain/discomfort, premature ejaculation （PE）, and delayed ejaculation （DE） were reported in 41,0%, 16.3%, and 41.4% of the patients, respectively. Over 40.0% of men without decreased ejaculation volume/force were satisfied with ejaculatory function, whereas approximately 6.0% of men with decreased volume/force were satisfied with ejaculatory function. About 30.0% of men with decreased volume/force had orgasmic dysfunction, while approximately 10.0% of men without decreased volume/force did. Decreased ejaculatory volume or force was associated with LUTS severity after adjusting for other influential factors including testosterone level, erectile function, and prostate size on ultrasonography, but PE or DE or ejaculatory pain/discomfort was not. In conclusion, a considerable portion of men with LUTS/BPH appear to have a variety of EjDs. Ejaculatory volume/force and satisfaction/orgasm do not always appear to be concordant. Ejaculatory volume or force is independently associated with LUTS severity, whereas PE or DE or ejaculatory pain/discomfort is not.