Issue 2: April 2009

UIJ Volume 2 Issue 2 April 2009

Evaluation of Selective and Non-Selective Alpha-Andrenergic Blockers in the Treatment of Distal Ureteral Stones

ABSTRACT

Objective: To evaluate the efficacy of selective and non-selective alpha-adrenergic blockers in enhancing lower ureteral stone passage and shortening stone passage time in comparison to the standard medical treatment of only high fluid intake and analgesic and anti-inflammatory drugs before rushing into invasive intervention.

Patients and Methods: Our study consisted of 45 patients suffering from lower ureteral stones (not more than 10 mm in diameter) divided into 3 groups each consisting of 15 patients. The 3 groups were subjected to 3 different regimens of medical therapy for a maximum of 30 days.

Patients in Group 1 were given the standard treatment of high fluid intake, phytotherapy, and analgesic and anti-inflammatory drugs. In addition to the standard treatment, patients in Group 2 were given the non-selective α1-adrenergic receptor blocker Terazosin (2 mg) once daily before bed for 4 days and then 5 mg once daily before bed. Patients in Group 3 were given the selective α1a-adrenergic receptor blocker Tamsulosin (0.4 mg) once daily in addition to the standard treatment.

All the patients were subjected to clinical assessment including history and examination. Laboratory investigations (complete urine analysis, urine culture and sensitivity if needed, serum creatinine) and imaging studies (plain X-ray, excretory urogram) were obtained for all patients.

Results: There was a higher combined incidence of stone passage in Groups 2 and 3 (73.4%) than in Group 1 (53.3%) and a more rapid combined stone passage (14.4 days vs. 18.25 days). Patients in Group 3 demonstrated a higher incidence of stone passage (80%) than patients in Group 2 (66.7%) and more rapid stone passage (9.58 days vs. 19.20 days).

Conclusion: The use of alpha adrenergic blockers is recommended in patients with uncomplicated lower ureteral stones. Selective α1a-adrenergic receptor blockers show better results because of their higher efficacy, minimum side effects, and excellent patient satisfaction. Further clinical research in this field is needed, and larger multicenter trials are awaited to formulate a standard regimen.

Keywords: Lower ureteral stones, Alpha blockers, Medical treatment

Correspondence: Ahmed Abdelbary, Urology Department, Bani Swef University Hospital, Bani Sweif, 11371, Egypt,

To Cite this Article: El-Batanouny A, Abdelbary A, Massoud A, Abdel-Mohsen M, Hegazy AR. Evaluation of Selective and Non-Selective Alpha-Andrenergic Blockers in the Treatment of Distal Ureteral Stones. UIJ. 2009 Apr;2(2). doi:10.3834/uij.1944-5784.2009.02.02

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Splenogonadal Fusion: A Case Report

ABSTRACT

Splenogonadal fusion is a rare congenital anomaly in which there is fusion between the spleen and gonad, epididymis, or vas deferens. The abnormal splenic tissue may or may not be continuous with the orthotopic spleen. The diagnosis is most often made when an extratesticular scrotal mass is noted or a lesion is discovered during orchiopexy.

We reviewed the medical record of a 26-year-old male medical student with splenogonadal fusion diagnosed during surgical exploration for cryptorchidism.

Keywords: Splenogonadal, Cryptorchidism, Undescended testicle, Congenital anomalies

Correspondence: Stavros N. Charalambous, Ippokratio General Hospital, 49 Konstantinoupoleos Street, Thessaloniki, 54642, Greece,

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A Randomized Controlled Study of Posterior Tibial Nerve Stimulation for Overactive Bladder

(No Abstract)

INTRODUCTION

The aim of this study was to evaluate the safety and efficacy of electrical stimulation of the posterior tibial nerve (PTNS) in women with overactivity bladder symptoms (OAB) and to assess the impact on the quality of life (QoL) using the Overactivity Bladder Questionnaire (OABq-SF).

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Efficacy and Tolerability of Add-On Trospium Chloride in Patients with Benign Prostate Syndrome and Overactive Bladder: A Noninterventional Trial Showing Use of Flexible Dosing

ABSTRACT

OBJECTIVE: This study was performed to elucidate efficacy and tolerability of an oral add-on therapy with trospium chloride in patients with benign prostate syndrome (BPS) without obstruction who showed International Prostate Symptom Score (IPSS) ≥ 8 and distinctive overactive bladder (OAB) symptoms under α-receptor blocker therapy.

RESEARCH DESIGN AND METHODS: This was a multicenter, open, non-interventional, prospective study performed in private urology practices. Only patients with OAB and BPS who were insufficiently treated with α-receptor blockers were eligible to participate. Patients received trospium chloride coated tablets* as oral add-on therapy. Dosing and duration of treatment were not predetermined; however, reference was made to the respective details in the product's package leaflet, and a minimal treatment period of 4 weeks was suggested.

MAIN OUTCOME MEASURES: Core symptoms of BPS, IPSS, overactive bladder symptoms, and Quality of Life (QoL) score were assessed at the beginning and end of the observation period. Adverse events and withdrawals, as well as the dosage regimens chosen, were documented at the end of the study. Furthermore, doctors and patients were requested to rate efficacy and tolerability of the treatment. All data were evaluated solely in an exploratory way.

*Trospium chloride coated tablets (Spasmex 30), Dr. R. Pfleger GmbH, D-96045 Bamberg, Germany

RESULTS: In total, 4104 cases fulfilled the predetermined criteria for the evaluation of efficacy; all 4382 cases were included in the safety analysis. After a mean (SD) treatment period of 40 (17.9) days with trospium chloride as add-on therapy, all core symptoms of BPS had improved: The mean daily micturition frequency was reduced from 11.8 (3.5) to 8.5 (2.5). The percentage of continent patients increased from 66.6% to 83.1%, and the proportion of patients requiring incontinence pads was almost halved from 19.9% to 11.7%. The median IPSS score was reduced from 18 to 12, and the QoL score improved from 4 to 2. Treatment tolerability was assessed as very good or good by 94.2% of the doctors. There were 121 (2.8%) early treatment withdrawals, and 35 (0.8%) patients experienced adverse events.

CONCLUSIONS: Patients with moderate to severe lower urinary tract symptoms due to BPS and OAB syndrome who were insufficiently treated with an α-receptor blocker may benefit from add-on therapy with trospium chloride, a compound generally well tolerated by the vast majority of the patients.

KEYWORDS: α-Receptor-blocker; Overactive bladder; Benign prostate syndrome; Trospium chloride

CORRESPONDENCE: Ulrich Schwantes, PhD, Head Medical Science/Clinical Research, Dr. R. Pfleger GmbH, D-96045 Bamberg.

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Tubeless Percutaneous Nephrolithotomy

ABSTRACT

Objective: To evaluate the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL).

Patients and Methods: We studied 43 patients with kidney stones who underwent tubeless PCNL. All procedures were done in a 1-stage operation. Patients with ureteropelvic junction (UPJ) obstruction and a stone burden less than 2 cm were excluded from the study. Double puncture was performed in 6 patients, and each puncture was closed separately. The ureteric catheter was left indwelling for a period of 24 to 48 hours. This was compared to a control group of 45 patients who underwent standard PCNL.

Results: Of the 43 patients who underwent tubeless PCNL, 29 were males and 14 were females. Their age ranged from 17 to 45 years. Ureteric catheters were left in for 24 hours in 37 patients and for about 48 hours in 6 patients. The hospital stay ranged from 36 hours to 2 days. The mean (SD) hospital stay was 34.65 (5.37) hours. This was compared to the mean hospital stay of the control group 118.5 (45.15) (P = .000068). There was no bleeding from the nephrostomy site and no urine leakage in any of the patients. Some experienced mild hematuria but none required blood transfusion. There were no residual stones in any patients and mild pain in 5 cases who respond well to anti-inflammatory drugs.

Conclusion: Tubeless PCNL is suitable for any patient who can be rendered stone-free with a single procedure, as it decreases the hospital stay, recovery time and cost, and improves the quality of life.

Keywords: Tubeless percutaneous nephrolithotomy

Correspondence: Ahmed Shelbaia, Department of Urology, Cairo University, Borg El Atbaa, Faisal Street, Giza, Egypt,

To Cite this Article: Shelbaia A, Rahman SA, Hussein A. Tubeless Percutaneous Nephrolithotomy. UIJ. 2009 Apr;2(2). doi:10.3834/uij.1944-5784.2009.02.04

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