Why Alfoo?1
Alpha-blockers are used in the management of LUTS due to Benign Prostatic Hyperplasia (BPH). However, they are likely to cause Ejaculatory Dysfunction (EjD).
Alfoo improves Lower Urinary Tract Symptoms (LUTS) due to BPH with minimal effect on the Ejaculatory Function.
1. Van Moorselaar RJ et al. ALF-ONE Study Group. Alfuzosin 10 mg once daily improves sexual function in men with lower urinary tract symptoms and concomitant sexual dysfunction. BJU Int. 2005 Mar;95(4):603-8.
Mode of Action of Alfuzosin
- The smooth muscle tone is regulated by alpha-adrenergic receptors.
- Blockade of these adrenoreceptors results in smooth muscle in the bladder neck and prostate to relax, further resulting in an improvement in urine flow and a reduction in symptoms of LUTS due to BPH.
- Alfuzosin is a selective antagonist of post-synaptic alpha1-adrenoreceptors, which are located in the prostate, bladder base, bladder neck, prostatic capsule, and prostatic urethra.2
- Alfuzosin’s α1-uroselectivity seems to produce less EjD compared to its counterparts that also affect vascular smooth muscle tone.3
2. Mari A et al. Alfuzosin for the medical treatment of benign prostatic hyperplasia and lower urinary tract symptoms: a systematic review of the literature and narrative synthesis. Ther Adv Urol. 2021 Apr 12;13:1756287221993283. 3. Haywood E. L. Yeung, et al: Alfuzosin and Its Effect on Ejaculatory Dysfunction: A Systematic Review. World J Mens Health. 2021 Apr;39(2):186-194.
What are the Side Effects?4
Postural Hypotension with or without symptoms (e.g. dizziness) may develop within a few hours following administration of Alfuzosin. As with all alpha-blockers, there is a potential for syncope.
- IFIS observed during cataract surgery in some patients on or previously treated with alpha-1 blockers.
- The risk of this event with Alfuzosin appears very low.
- Ophthalmic surgeons should be informed in advance of cataract surgery of current or past use of alpha-1-blockers as IFIS may lead to increased procedural complications.
- The Ophthalmologists should be prepared for possible modifications to their surgical technique.
IFIS: Intraoperative Floppy Iris Syndrome
4. Product information Alfuzosin
Safety Advice4
Patients should be warned of the possible occurrence of syncope and should avoid situations where injury could result in syncope. Care should be taken when Alfuzosin is administered to patients with symptomatic Hypotension or patients who have had a hypotensive response to other medications.
Alfuzosin HCl is contraindicated:
- In patients with moderate or severe hepatic insufficiency
- When administered with potent CYP3A4 inhibitors and therefore, should not be used in combination with drugs such as Ketoconazole, Itraconazole and Ritonavir.
- Pregnancy and Lactation
- Known hypersensitivity to Alfuzosin or any other ingredients of the formulation
- History of Orthostatic Hypotension
4. Product information Alfuzosin
Usage4
- Alfuzosin is used for the treatment of symptomatic BPH.
- The recommended dosage is 10 mg Alfuzosin daily to be taken immediately after the same meal each day. The tablets should not be chewed or crushed.
4. Product information Alfuzosin
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Safety and efficacy of either mirabegron, silodosin, or both in the expulsion of distal ureteric stones
Safety and efficacy of either mirabegron, silodosin, or both in the expulsion of distal ureteric stones
A recent study demonstrated that lower ureteric stones can be effectively treated with both silodosin and mirabegron. Furthermore, when these medications are used together, they have been found to increase the rate of stone expulsion and reduce the duration of expulsion. This study’s findings were published in the journal, International Urology and Nephrology.
This study included 105 patients, aged 20 to 56 years, who were diagnosed with a single radiopaque distal ureteral stone measuring ≤ 10 mm. The individuals were randomly allocated into three groups, each group containing 35 participants. Group A received an 8 mg daily dose of silodosin, group B was given 50 mg of mirabegron once daily, and group C received a combination of both medications. Treatment was given until the stone passed or for a maximum of four weeks. The stone-free rate was assessed by analyzing KUB films with or without ultrasonography.
Stone expulsion rate was higher in group C in comparison to groups A and B. The mean (standard deviation) time for expulsion of the stone in group A, group B, and group C was 14 ± 2.3 days, 11 ± 3.1 days, and 7 ± 2.2 days, respectively. Group C exhibited a significantly shorter stone expulsion time when compared to groups A and B. The incidence of renal colic in group C was significantly lower than that in groups A and B, leading to a decreased need for analgesics. Anejaculation was significantly more frequent in the silodosin group (73.9%) and combination group (84%) than in the mirabegron group.
Thus, it can be concluded that both silodosin and mirabegron are effective treatments for lower ureteric stones. Additionally, when these medications are utilized in combination, they have been shown to increase the rate of stone expulsion and decrease the duration of expulsion.
Safety and efficacy of either mirabegron, silodosin, or both in the expulsion of distal ureteric stones
Safety and efficacy of either mirabegron, silodosin, or both in the expulsion of distal ureteric stones
A recent study demonstrated that lower ureteric stones can be effectively treated with both silodosin and mirabegron. Furthermore, when these medications are used together, they have been found to increase the rate of stone expulsion and reduce the duration of expulsion. This study’s findings were published in the journal, International Urology and Nephrology.
This study included 105 patients, aged 20 to 56 years, who were diagnosed with a single radiopaque distal ureteral stone measuring ≤ 10 mm. The individuals were randomly allocated into three groups, each group containing 35 participants. Group A received an 8 mg daily dose of silodosin, group B was given 50 mg of mirabegron once daily, and group C received a combination of both medications. Treatment was given until the stone passed or for a maximum of four weeks. The stone-free rate was assessed by analyzing KUB films with or without ultrasonography.
Stone expulsion rate was higher in group C in comparison to groups A and B. The mean (standard deviation) time for expulsion of the stone in group A, group B, and group C was 14 ± 2.3 days, 11 ± 3.1 days, and 7 ± 2.2 days, respectively. Group C exhibited a significantly shorter stone expulsion time when compared to groups A and B. The incidence of renal colic in group C was significantly lower than that in groups A and B, leading to a decreased need for analgesics. Anejaculation was significantly more frequent in the silodosin group (73.9%) and combination group (84%) than in the mirabegron group.
Thus, it can be concluded that both silodosin and mirabegron are effective treatments for lower ureteric stones. Additionally, when these medications are utilized in combination, they have been shown to increase the rate of stone expulsion and decrease the duration of expulsion.
Impact of focal zone size on treatment outcomes and renal injury subsequent to extracorporeal shockwave lithotripsy for renal calculi
Impact of focal zone size on treatment outcomes and renal injury subsequent to extracorporeal shockwave lithotripsy for renal calculi
A recent study showed that the standard narrow focal zone (FZ) demonstrates similar safety and superior treatment efficacy when compared to the extended FZ during extracorporeal shockwave lithotripsy (SWL) for renal stones. This study’s findings were published in Journal of Endourology.
In this prospective randomized study, 276 patients diagnosed with renal stones were assigned to receive SWL using either standard or extended FZ. The treatment was administered using a Modulith SLX-F2 lithotripter, delivering a maximum of 3000 shocks at a frequency of 1.5 Hz. The primary outcome of the study assessed the success of the treatment 12 weeks after a single SWL session, which was determined by the absence of a stone or stone fragment smaller than 4 mm on computed tomography. Secondary outcomes included the incidence of the stone-free rate (SFR), perinephric hematoma, and changes in the levels of acute renal injury markers in the urine.
Similar baseline parameters were observed in both groups. The standard FZ group achieved a significantly higher treatment success rate (74.3%) than the extended FZ group (59.3%). Additionally, standard FZ exhibited a significantly better SFR (Grade-A, 36.8% vs. 23.0%,) and lower post-treatment pain levels. Both groups had comparable rates of perinephric hematoma formation, changes in urinary acute renal injury markers, and unplanned hospital admissions.
The above results demonstrated that the standard narrow FZ shows comparable safety and improved treatment efficacy in comparison to the extended FZ in extracorporeal SWL for renal stones.
Impact of focal zone size on treatment outcomes and renal injury subsequent to extracorporeal shockwave lithotripsy for renal calculi
Impact of focal zone size on treatment outcomes and renal injury subsequent to extracorporeal shockwave lithotripsy for renal calculi
A recent study showed that the standard narrow focal zone (FZ) demonstrates similar safety and superior treatment efficacy when compared to the extended FZ during extracorporeal shockwave lithotripsy (SWL) for renal stones. This study’s findings were published in Journal of Endourology.
In this prospective randomized study, 276 patients diagnosed with renal stones were assigned to receive SWL using either standard or extended FZ. The treatment was administered using a Modulith SLX-F2 lithotripter, delivering a maximum of 3000 shocks at a frequency of 1.5 Hz. The primary outcome of the study assessed the success of the treatment 12 weeks after a single SWL session, which was determined by the absence of a stone or stone fragment smaller than 4 mm on computed tomography. Secondary outcomes included the incidence of the stone-free rate (SFR), perinephric hematoma, and changes in the levels of acute renal injury markers in the urine.
Similar baseline parameters were observed in both groups. The standard FZ group achieved a significantly higher treatment success rate (74.3%) than the extended FZ group (59.3%). Additionally, standard FZ exhibited a significantly better SFR (Grade-A, 36.8% vs. 23.0%,) and lower post-treatment pain levels. Both groups had comparable rates of perinephric hematoma formation, changes in urinary acute renal injury markers, and unplanned hospital admissions.
The above results demonstrated that the standard narrow FZ shows comparable safety and improved treatment efficacy in comparison to the extended FZ in extracorporeal SWL for renal stones.
Combination of co-trimoxazole and NAC effective in reducing bacterial adherence on ureteral stent surfaces
Combination of co-trimoxazole and NAC effective in reducing bacterial adherence on ureteral stent surfaces
According to a recent study, a combination of co-trimoxazole and N-acetylcysteine (NAC) is more effective in reducing bacterial adherence on ureteral stent surfaces than either alone. This study was published in the journal, Urolithiasis.
This prospective randomized study included 636 patients, who underwent double J ureteral stent insertion after various urological procedures. Patients were randomized into four groups: no antibiotics or mucolytics during stent indwelling in group A (n = 165); oral NAC (200 mg/day for children aged < 12 years old and 600 mg/day for adults) during stent indwelling in group B (n = 153), oral co-trimoxazole (2 mg TMP/kg/day) during stent indwelling in group C (n = 162), and both oral NAC and co-trimoxazole during stent indwelling in group D (n = 156).
After a duration of two weeks from the insertion of the double J stent (JJ stent), a urinalysis was conducted on all patients and on the day of double J stent removal, a urine culture was carried out for all the patients. 2-weeks postoperatively, the stent was removed, and a stent segment sized 3-5 cm from the bladder segment of the stent was sent for culture. It was found that 63.6%, 43.1%, 37%, and 19.2% patients of groups A, B, C, and D, respectively had positive stent cultures. The most commonly isolated organism from the stent culture in all groups was E. coli.
The above findings suggest that the combination of co-trimoxazole and NAC is more effective in reducing bacterial adherence on ureteral stent surfaces than either alone.
Combination of co-trimoxazole and NAC effective in reducing bacterial adherence on ureteral stent surfaces
Combination of co-trimoxazole and NAC effective in reducing bacterial adherence on ureteral stent surfaces
According to a recent study, a combination of co-trimoxazole and N-acetylcysteine (NAC) is more effective in reducing bacterial adherence on ureteral stent surfaces than either alone. This study was published in the journal, Urolithiasis.
This prospective randomized study included 636 patients, who underwent double J ureteral stent insertion after various urological procedures. Patients were randomized into four groups: no antibiotics or mucolytics during stent indwelling in group A (n = 165); oral NAC (200 mg/day for children aged < 12 years old and 600 mg/day for adults) during stent indwelling in group B (n = 153), oral co-trimoxazole (2 mg TMP/kg/day) during stent indwelling in group C (n = 162), and both oral NAC and co-trimoxazole during stent indwelling in group D (n = 156).
After a duration of two weeks from the insertion of the double J stent (JJ stent), a urinalysis was conducted on all patients and on the day of double J stent removal, a urine culture was carried out for all the patients. 2-weeks postoperatively, the stent was removed, and a stent segment sized 3-5 cm from the bladder segment of the stent was sent for culture. It was found that 63.6%, 43.1%, 37%, and 19.2% patients of groups A, B, C, and D, respectively had positive stent cultures. The most commonly isolated organism from the stent culture in all groups was E. coli.
The above findings suggest that the combination of co-trimoxazole and NAC is more effective in reducing bacterial adherence on ureteral stent surfaces than either alone.
Effectiveness of antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy for staghorn calculi
Effectiveness of antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy for staghorn calculi
A recent study suggests the use of antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy (aPNL) led to an increased stone-free rate (SFR) in cases of staghorn calculi, necessitated fewer percutaneous tracts, decreased the necessity for staged surgery, and resulted in a shorter operative duration compared to single percutaneous nephrolithotomy (sPNL ). The study findings were published in the journal, Urolithiasis.
A total of 160 patients were included in this prospective randomized controlled study, with 81 patients in the sPNL group and 79 patients in the aPNL group. Initially, the study focused on comparing the overall differences between sPNL and aPNL. Subsequently, the patients were categorized into two subgroups: Group 1 (patients with < 5 stone branches) and Group 2 (patients with ≥ 5 stone branches). The differences between these two subgroups were analyzed.
The study results revealed that aPNL exhibited a higher SFR and required fewer percutaneous tracts, with a shorter operation time compared to sPNL. Additionally, aPNL reduced the need for staged surgery, especially in patients with ≥ 5 stone branches. There were no significant variances in hemoglobin level changes and the requirement for blood transfusions between the sPNL and aPNL groups, and the frequency of multiple tracts was lower in the aPNL group.
Thus, it can be concluded that aPNL led to an increased SFR in staghorn calculi, necessitated fewer percutaneous tracts, minimized the requirement for staged surgery, and had a shorter operative duration compared to PNL alone. This was particularly notable in patients with ≥ 5 stone branches.
Effectiveness of antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy for staghorn calculi
Effectiveness of antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy for staghorn calculi
A recent study suggests the use of antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy (aPNL) led to an increased stone-free rate (SFR) in cases of staghorn calculi, necessitated fewer percutaneous tracts, decreased the necessity for staged surgery, and resulted in a shorter operative duration compared to single percutaneous nephrolithotomy (sPNL ). The study findings were published in the journal, Urolithiasis.
A total of 160 patients were included in this prospective randomized controlled study, with 81 patients in the sPNL group and 79 patients in the aPNL group. Initially, the study focused on comparing the overall differences between sPNL and aPNL. Subsequently, the patients were categorized into two subgroups: Group 1 (patients with < 5 stone branches) and Group 2 (patients with ≥ 5 stone branches). The differences between these two subgroups were analyzed.
The study results revealed that aPNL exhibited a higher SFR and required fewer percutaneous tracts, with a shorter operation time compared to sPNL. Additionally, aPNL reduced the need for staged surgery, especially in patients with ≥ 5 stone branches. There were no significant variances in hemoglobin level changes and the requirement for blood transfusions between the sPNL and aPNL groups, and the frequency of multiple tracts was lower in the aPNL group.
Thus, it can be concluded that aPNL led to an increased SFR in staghorn calculi, necessitated fewer percutaneous tracts, minimized the requirement for staged surgery, and had a shorter operative duration compared to PNL alone. This was particularly notable in patients with ≥ 5 stone branches.
Semirigid ureteroscopy and tamsulosin therapy for dilation prior to flexible ureteroscopy
Semirigid ureteroscopy and tamsulosin therapy for dilation prior to flexible ureteroscopy
According to a recent study, the utilization of tamsulosin therapy and semirigid ureteroscopy for dilation prior to flexible ureteroscopy enhanced the success of primary flexible ureteroscopy advancement to the renal collecting system. This study's findings were published in the World journal of urology.
This prospective study included 170 patients who were randomly divided into two groups who had renal stones < 2 cm and underwent retrograde flexible ureteroscopy and laser lithotripsy. Group A (n=85), was administered a placebo for a duration of one week before the flexible ureteroscopy. On the other hand, group B (n=85), received a daily dosage of 0.4 mg tamsulosin for one week prior to the surgery. Additionally, they underwent active dilatation using semirigid ureteroscopy before the flexible ureteroscopy procedure. The ability of the flexible ureteroscope to reach the collecting system in both groups was evaluated during the same operative session. The operative outcomes and complications for both groups were also collected and analyzed.
The flexible ureteroscope demonstrated successful access to the kidney in 61 patients within group B, while in group A, it was only successful in 28 cases (71.4% vs 32.9%). Within group A, 33 patients (38.8%) reported lower urinary tract symptoms, while only 17 patients (20.2%) in group B experienced the same.
It can be concluded that using tamsulosin therapy and semirigid ureteroscopy as dilatation methods prior to flexible ureteroscopy may improve the success of primary flexible ureteroscopy in advancing to the renal collecting system.
Semirigid ureteroscopy and tamsulosin therapy for dilation prior to flexible ureteroscopy
Semirigid ureteroscopy and tamsulosin therapy for dilation prior to flexible ureteroscopy
According to a recent study, the utilization of tamsulosin therapy and semirigid ureteroscopy for dilation prior to flexible ureteroscopy enhanced the success of primary flexible ureteroscopy advancement to the renal collecting system. This study's findings were published in the World journal of urology.
This prospective study included 170 patients who were randomly divided into two groups who had renal stones < 2 cm and underwent retrograde flexible ureteroscopy and laser lithotripsy. Group A (n=85), was administered a placebo for a duration of one week before the flexible ureteroscopy. On the other hand, group B (n=85), received a daily dosage of 0.4 mg tamsulosin for one week prior to the surgery. Additionally, they underwent active dilatation using semirigid ureteroscopy before the flexible ureteroscopy procedure. The ability of the flexible ureteroscope to reach the collecting system in both groups was evaluated during the same operative session. The operative outcomes and complications for both groups were also collected and analyzed.
The flexible ureteroscope demonstrated successful access to the kidney in 61 patients within group B, while in group A, it was only successful in 28 cases (71.4% vs 32.9%). Within group A, 33 patients (38.8%) reported lower urinary tract symptoms, while only 17 patients (20.2%) in group B experienced the same.
It can be concluded that using tamsulosin therapy and semirigid ureteroscopy as dilatation methods prior to flexible ureteroscopy may improve the success of primary flexible ureteroscopy in advancing to the renal collecting system.
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