TERAZOSIN TREATMENT OF PATIENTS WITH LUTS/BPH. DOES IT IMPROVE THE FLOW?

Objective To evaluate flowmetry changes associated with a significant symptomatic improvement in patients with benign prostatic hyperplasia (BPH) / lower urinary tract symptoms (LUTS) treated with terazosin. Patients and Methods The study included 588 patients with BPH / LUTS treated with terazosin in a dose of 5 mg HS (Group I) and 121 patients with BPH / LUTS subjected to watchful waiting serving as a control group (Group II). All patients underwent digital rectal examination (DRE), International Prostate Symptoms Score (IPSS) and prostate specific antigen (PSA) evaluation to exclude cancer of the prostate. Further investigations included flowmetry and measurement of post-voiding residual urine. All patients were followed-up for at least 12 months. Results The pretreatment assessment showed an average IPSS of 15.7 (range 9 26), a quality of life assessment (QLA) average score of 4.3 (range 4 6), an average volume of the prostate of 39 26.7 gm, an average PSA value of 1.9 n/ml and a normal serum creatinine in all patients. The pretreatment mean peak urinary flow rate (Qmax) was 9.7 ml/s, average flow rate (Qave) was 5.1 ml/s and post-void residual (PVR) was 74.9 ml. At 3 months follow-up, 499 (85%) patients of Group I reported satisfaction and continued treatment. At one year, 436 (74%) out of these patients showed an improvement >30% in IPSS and QLA and had a mean Qmax of 12.0 ml/s (+ 2.3 ml/s), a mean Qave of 6.1 ml/s (+ 1.0 ml/s) and a mean PVR of 46.7 ml (- 28.2 ml). However, the change in Qmax ranged from 35.5% to + 100% with a positive change in 76% and a negative change in 24%. Of the patients with symptomatic improvement, only 40% showed an increase in Qmax >30%, while 4.8% showed a decrease in Qmax of more than 30%. In the control group only 37 patients showed a symptomatic improvement >30% with only one patient showing an improvement of Qmax >30%, which is statistically significantly less than in the active treatment group. Conclusion In spite of a significant symptomatic improvement in 74% of the patients treated with terazosin at one year follow-up, only 40% showed an improvement of Qmax >30%. An actual deterioration >30% of the Qmax was seen in 4.8% of the symptomatically improved patients which denotes that the symptomatic improvement does not parallel flowmetry improvement. Le Traitement par la Terozosine chez les Patients Présentant des Signes dObstruction du Bas Appareil Urinaire/HBP. Améliore-t-il le Débit Urinaire? Objectif Evaluer les variations de la débimétrie associées à une amélioration significative des symptômes chez des patients présentant une hypertrophie bénigne de la prostate ou des signes dobstruction du bas appareil urinaire traités par la térazosine. Patients et Méthodes Létude a porté sur une série de 588 patients présentant une HBP/LUTS traitée par térazosine à la dose de 5 mg HS (Group I) et 121 patients présentant les mêmes symptômes et soumis à une surveillance comme group témoin (Groupe II). Tous les patients ont bénéficié dun toucher rectal, remplissage dun questionnaire IPSS et dosage du taux sanguin de PSA afin dexclure un cancer de la prostate. Des investigations plus approfondies incluant une débimétrie et une mesure du résidu post-mictionnel ont été réalisées. Tous les patients ont été suivis pendant au moins 12 mois. Résultats Lévaluation pré-thérapeutique a montré un score IPSS moyen de 15,7 (extrêmes de 9 et 26), un score moyen de qualité de vie de 4,3 (extrêmes de 4 et 6), un poids moyen de la prostate de 39 26,7 gm, un taux moyen de PSA de 1,9 ng/ml et une créatininémie normale chez tous les patients. Le débit maximal (Qmax) avant traitement était en moyenne de 9,7 ml/s, le débit moyen (Qave) était de 5,1 ml/s. Le résidu post-mictionnel était en moyenne de 74,9 ml. Après un suivi de 3 mois, 499 (84%) de ces patients ont montré une amélioration >30% de leur score IPSS et score qualité de vie (QoL) et ont eu un Qmax moyen de 12 ml/s (+2,3 ml/s), un débit moyen de 6,1 ml/s (+1,0 ml/s) et résidu post-mictionnel moyen de 46,7 ml (-28,2 ml). Cependant, les modifications du Qmax variaient de 35,5% à +100% avec un changement positif dans 76% et un changement négatif dans 24%. Parmi les patients qui ont eu une amélioration des symptômes, seuls 40% ont montré une augmentation du Qmax >30%, tandis que 4,8% ont montré une diminution de Qmax de plus de 30%. Dans le groupe contrôle, seuls 37 patients ont montré une amélioration des symptômes de plus de 30% avec un seul patient montrant une amélioration de plus de 30%, ce qui est statistiquement moins significatif que dans le groupe sous traitement. Conclusion En dépit dune amélioration symptomatique chez 74% des patients traités par la térazosine, seuls 40% ont montré une augmentation de Qmax de plus de 30% après un an de suivi. Une détérioration de Qmax >30% a été trouvée chez 4,8% des patients dont les symptômes ont été améliorés, ci qui dénote quil ny a pas de parallélisme entre lamélioration des symptômes et celle de la débimétrie. African Journal of Urology Vol.8(2) 2002: 62-6

Tubeless percutaneous nephrolithotomy with and without a hemostatic product: A prospective, randomized study

INTRODUCTION: Guidelines for the use of topical hemostatic products have not been established and their necessity for every case is not determined. The purpose of the present prospective, randomized study was to compare the outcomes of tubeless percutaneous nephrolithotomy (PNL) with and without a hemostatic agent. METHODS: A total of 48 patients with lower calyceal, middle calyceal, or pelvic renal stones ≤ 3 cm were randomly divided into 2 equal groups. All patients received single-stage tubeless PNL through 1 access tract. Group 1 had no local hemostatic agent; group 2 had oxidized regenerated cellulose (Surgicel; Ethicon Inc, Somerville, NJ, USA). Plain kidney, ureter, bladder X-ray and renal ultrasound were performed at the frst postoperative day to evaluate the stone-free rate and detect any perinephric hematoma. Postoperative urinary leakage and postoperative hemoglobin (Hb) were also measured. Patients had ultrasound to determine the amount of the perinephric collection before being discharged. RESULTS: No postoperative urinary leakage through the percutaneous tract was detected in either group. The mean (standard deviation) postoperative reduction in Hb concentration was 1.13 g/dL (1.11) for patients in group 1 and 1 g/dL (0.76) for patients in group 2; the group difference was not signifcant (P =.20). Most patients had no postoperative perinephric collection; minimal collection of 1 cm x 0.5 cm was detected in 2 cases in group 1 and 3 cases in group 2 (P =.30). No patient in either group had perinephric hematoma. Most patients were stone free: 22 patients (91.7%) in group 1; 20 patients (83.3%) in group 2. CONCLUSIONS: Topical hemostatic agents may not be needed after an uncomplicated percutaneous renal procedure. © 2010 UroToday International Journal

Diclofenac and Meloxicam Exhibited Anti-Virulence Activities Targeting Staphyloxanthin Production in Methicillin-Resistant <i>Staphylococcus aureus</i>

Staphylococcus aureus (S. aureus) is a worldwide leading versatile pathogen that causes a wide range of serious infections. The emergence of antimicrobial resistance against S. aureus resulted in an urgent need to develop new antimicrobials in the new era. The methicillin-resistant S. aureus (MRSA) prevalence in hospital and community settings necessitates the discovery of novel anti-pathogenic agents. Staphyloxanthin (STX) is a key virulence factor for the survival of MRSA against host innate immunity. The current work aimed to demonstrate the anti-virulence properties of meloxicam (MXM) as compared to diclofenac (DC), which was previously reported to mitigate the virulence of multidrug-resistant Staphylococcus aureus and test their activities in STX production. A total of 80 S. aureus clinical isolates were included, wherein a qualitative and quantitative assessment of STX inhibition by diclofenac and meloxicam was performed. The quantitative gene expression of STX biosynthetic genes (crtM, crtN and sigB) and hla (coded for α-hemolysin) as a virulence gene with and without DC and MXM was conducted, followed by molecular docking analysis for further confirmation. DC and MXM potently inhibited the synthesis of STX at 47 and 59 µg/mL to reach 79.3–98% and 80.6–96.7% inhibition, respectively. Treated cells also revealed a significant downregulation of virulence genes responsible for STX synthesis, such as crtM, crtN and global transcriptional regulator sigB along with the hla gene. Furthermore, computational studies unveiled strong interactions between the CrtM binding site and DC/MXM. In conclusion, this study highlights the potential role and repurposing of DC and MXM as adjuvants to conventional antimicrobials and as an anti-virulent to combat MRSA infections

Diclofenac and Meloxicam Exhibited Anti-Virulence Activities Targeting Staphyloxanthin Production in Methicillin-Resistant Staphylococcus aureus

Staphylococcus aureus (S. aureus) is a worldwide leading versatile pathogen that causes a wide range of serious infections. The emergence of antimicrobial resistance against S. aureus resulted in an urgent need to develop new antimicrobials in the new era. The methicillin-resistant S. aureus (MRSA) prevalence in hospital and community settings necessitates the discovery of novel anti-pathogenic agents. Staphyloxanthin (STX) is a key virulence factor for the survival of MRSA against host innate immunity. The current work aimed to demonstrate the anti-virulence properties of meloxicam (MXM) as compared to diclofenac (DC), which was previously reported to mitigate the virulence of multidrug-resistant Staphylococcus aureus and test their activities in STX production. A total of 80 S. aureus clinical isolates were included, wherein a qualitative and quantitative assessment of STX inhibition by diclofenac and meloxicam was performed. The quantitative gene expression of STX biosynthetic genes (crtM, crtN and sigB) and hla (coded for &alpha;-hemolysin) as a virulence gene with and without DC and MXM was conducted, followed by molecular docking analysis for further confirmation. DC and MXM potently inhibited the synthesis of STX at 47 and 59 &micro;g/mL to reach 79.3&ndash;98% and 80.6&ndash;96.7% inhibition, respectively. Treated cells also revealed a significant downregulation of virulence genes responsible for STX synthesis, such as crtM, crtN and global transcriptional regulator sigB along with the hla gene. Furthermore, computational studies unveiled strong interactions between the CrtM binding site and DC/MXM. In conclusion, this study highlights the potential role and repurposing of DC and MXM as adjuvants to conventional antimicrobials and as an anti-virulent to combat MRSA infections