1,721,022 research outputs found
Re: Challenging the dogma of simultaneous resection of bladder tumor and benign prostate
No full textRandomized trial on the efficacy of tamsulosin, nifedipine and phloroglucinol in medical-expulsive therapy of distal ureteral calculi.
No full textPurpose: Recent studies show the interesting efficacy of different drug combinations for the
spontaneous expulsion of distal ureteral stones. We performed a randomized, prospective study
to assess and compare the efficacy of 3 drugs as medical expulsive therapy for distal ureteral
calculi.
Materials and Methods: A total of 210 symptomatic patients with distal ureteral calculi greater
than 4 mm were randomly allocated to home treatment with phloroglucinol, tamsulosin or
nifedipine (groups 1 to 3, respectively). Each group was given a corticosteroid drug and antibiotic
prophylaxis with an injectable nonsteroidal anti-inflammatory drug was also used on demand.
The primary end point was the expulsion rate and the secondary end points were expulsion time,
analgesic use, need for hospitalization and endoscopic treatment as well as the number of
workdays lost, quality of life and drug side effects
Results: The expulsion rate was significantly higher in group 2 (97.1%) than in groups 1
(64.3%, p 0.0001) or 3 (77.1%, p 0.0001). Group 2 significantly achieved stone passage in a
shorter time than the other 2 groups and showed a significantly decreased number of hospitalizations
as well as a better decrease in endoscopic procedures performed to remove the stone. The
control of renal colic pain was significantly superior in group 2 compared with the other groups,
resulting in fewer workdays lost. Group 3 showed lower analgesic use and decreased workdays
lost compared with group 1. No difference in side effects was observed among the groups.
Conclusions: Medical expulsive therapy should be considered for distal ureterolithiasis without
complications before ureteroscopy or extracorporeal lithotripsy. The use of tamsulosin in this
treatment regimen produced stone expulsion in almost all cases in a short time, allowing
complete home patient treatment
Medical-expulsive therapy for distal ureterolithiasis: a randomized prospective study on the role of corticosteroids used in combination with tamsulosin. Simplified treatment regimen and health-related quality of life.
No full textObjectives. To assess the clinical efficacy of the addition of a corticosteroid drug to tamsulosin in the
medical-expulsive therapy of distal ureterolithiasis.
Methods. Sixty consecutive patients with a symptomatic distal ureteral stone were included in our study
and randomized to one of two home treatment groups. Group 1 patients (n 30) received tamsulosin (0.4
mg daily), and group 2 patients (n 30) were treated with a corticosteroid drug (deflazacort, 30 mg daily)
plus tamsulosin. The treatment duration was until stone expulsion or 28 days, whichever came first. The
primary endpoint of the study was the stone expulsion rate. The secondary endpoints were the expulsion
time; use of analgesics; number of emergency room admissions, hospitalizations, and workdays lost; drug
side effects; and quality of life of the patients (EuroQol questionnaire, EQ-5D) during treatment.
Results. The two groups had a similar expulsion rate (90% for group 1 and 96.7% for group 2; P 0.612),
but the expulsion time was significantly reduced in group 2 patients (P 0.036). During the treatment
period, we did not observe significant differences between the two groups in the number of emergency room
visits or hospitalizations, analgesic use, number of workdays lost, or incidence of drug side effects. The
quality of life of the patients during therapy, as determined using the EQ-5D, was similar in both groups.
Conclusions. The use of a corticosteroid drug in association with tamsulosin seemed to induce more rapid
stone expulsion. In addition, tamsulosin alone as medical-expulsive therapy for distal ureteral calculi had
excellent expulsive effectiveness
A Bladder Stone 28 Years After Burch Colposuspension
No full textAn 86-year-old lady was referred for a 3-cm bladder stone 28 years after Burch colposuspension. Cystoscopy showed a stone over a nonabsorbable suture, eroding from the right anterolateral bladder wall. The patient underwent a transurethral holmium laser lithotripsy and thulium laser removal of the eroded bladder wall. A high index of suspicion of suture erosion should always be present in case of de novo symptoms in women who underwent colposuspension, even in the long-term period
Correlation between ultrasound alterations of the preprostatic sphincter and symptoms in patients with chronic prostatitis-chronic pelvic pain syndrome
No full textPURPOSE: We investigated ultrasound alterations of the preprostatic sphincter in patients with chronic prostatitis-chronic pelvic pain syndrome. We evaluated the frequency of these alterations, standardized their ultrasound measurement and correlated them with symptoms in patients with chronic prostatitis-chronic pelvic pain syndrome.
MATERIALS AND METHODS: In 37 patients with chronic prostatitis-chronic pelvic pain syndrome and 23 healthy volunteers certain parameters were measured by transrectal ultrasound, including prostate volume, hypoechoic periurethral zone volume, posterior prostate lip thickness, bladder neck thickness, detrusor thickness and the degree of echogenicity of the anterior fibromuscular stroma. All patients were evaluated with the International Prostate Symptom Score and National Institutes of Health Chronic Prostatitis Symptom Index. Urinary flow rate and post-void residual urine volume were also considered in each patient. All assessments were done independently and consecutively by 3 operators.
RESULTS: A hypoechoic periurethral zone volume was found in 36 of 37 patients with chronic prostatitis-chronic pelvic pain syndrome. No significant intra-observer and interobserver differences were found in ultrasound parameter measurements. In the chronic prostatitis-chronic pelvic pain syndrome group ultrasound findings showed greater post-void residual urine volume, detrusor thickness and hypoechoic periurethral zone volume, increased posterior prostate lip thickness and bladder neck thickness, and greater anterior fibromuscular stroma hyperechogenicity. On multivariate analysis hypoechoic periurethral zone volume was an independent predictive factor for worse National Institutes of Health Chronic Prostatitis Symptom Index pain, urinary and total scores. Posterior prostate lip thickness was the only factor predictive of a worse International Prostate Symptom Score in patients with chronic prostatitis-chronic pelvic pain syndrome. A hypoechoic periurethral zone volume, posterior prostate lip thickness and bladder neck thickness with calculated threshold values revealed fair to excellent accuracy for identifying a patient with chronic prostatitis-chronic pelvic pain syndrome.
CONCLUSIONS: Ultrasound evaluation of the bladder neck-posterior urethra in patients with chronic prostatitis-chronic pelvic pain syndrome led us to identify a set of lesions that cannot be found in healthy subjects. The measurement of hypoechoic periurethral zone volume, posterior prostate lip thickness and bladder neck thickness could be useful for following patients with chronic prostatitis-chronic pelvic pain syndrome and maybe for better understanding the complicated pathophysiological mechanisms of chronic nonbacterial prostatitis
Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life
No full textOncological safety and quality of life in men undergoing simultaneous transurethral resection of bladder tumor and prostate: results from a randomized controlled trial
No full textPurpose: To assess oncological safety and quality of life (QL) of men undergoing simultaneous transurethral resection of bladder tumor (TURBT) and transurethral resection of the prostate (TURP) for symptomatic benign prostatic hyperplasia (BPH). Methods: Ninety-five men with a new diagnosis of bladder cancer (BC) and symptomatic BPH were randomized to receive TURBT + tamsulosin (Group 1) or TURBT + TURP (Group 2). Inclusion criteria were age ≤ 75 years, first diagnosis of BC up to 4 cm, and prostate volume ≤ 80 ml. All patients were evaluated preoperatively with digital rectal examination, PSA, maximal urine flow rate (Qmax), and International Prostate Symptom Score (IPSS). IPSS and Qmax were repeated at 1-year follow-up. QL was evaluated at 1 year using a modified version of the self-report bladder cancer subscale of the Functional Assessment of Cancer Therapy. Results: Eighty-five men completed the study (43 in Group 1 and 42 in Group 2). Adjuvant instillation therapy was given to 26 patients in Group 1 and to 27 in Group 2. Average time to the first recurrence was 16.64 months in Group 1 and 17.7 in Group 2. Total recurrences were 27 in Group 1 and 22 in Group 2. Bladder neck/prostatic urethra recurrences were 9 in Group 1 vs. 8 in Group 2. QL, IPSS, and Qmax 12 months after surgery were better in Group 2. Conclusion: Concomitant TURBT and TURP appear to be oncologically safe procedures in terms of total and prostatic urethra recurrence, and improve QL in men with BC who require surgery for symptomatic BPH
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