New medical treatments for lower urinary tract symptoms due to benign prostatic hyperplasia and future perspectives

Background: Lower Urinary Tract Symptoms (LUTS) in men are a common clinical problem in urology and have been historically strictly linked to benign prostatic hyperplasia (BPH), which may lead to bladder outlet obstruction (BOO). New molecules have been approved and have entered the urologists' armamentarium, targeting new signaling pathways and tackling specific aspects of LUTS. Objective of this review is to summarize the evidence regarding the new medical therapies currently available for male non-neurogenic LUTS, including superselective α1-antagonists, PDE-5 inhibitors, anticholinergic drugs and intraprostatic onabotulinum toxin injections. Methods: The National Library of Medicine Database was searched for relevant articles published between January 2006 and December 2015, including the combination of "BPH", "LUTS", "medical" and "new". Each article's title, abstract and text were reviewed for their appropriateness and their relevance. One hundred forty eight articles were reviewed. Results: Of the 148 articles reviewed, 92 were excluded. Silodosin may be considered a valid alternative to non-selective α1-antagonists, especially in the older patients where blood pressure alterations may determine major clinical problems and ejaculatory alterations may be not truly bothersome. Tadalafil 5 mg causes a significant decrease of IPSS score with an amelioration of patients' QoL, although with no significant increase in Qmax. Antimuscarinic drugs are effective on storage symptoms but should be used with caution in patients with elevated post-void residual. Intraprostatic injections of botulinum toxin are well-tolerated and effective, with a low rate of adverse events; however profound ameliorations were seen also in the sham arms of RCTs evaluating intraprostatic injections. Conclusion: New drugs have been approved in the last years in the medical treatment of BPH-related LUTS. Practicing urologists should be familair with their pharmacodynamics and pharmacokinetics

Sildenafil citrate use and the incidence of nonarteritic anterior ischemic optic neuropathy

Nonarteritic anterior ischemic optic neuropathy (NAION) has been reported rarely in men after taking sildenafil or other phosphodiesterase 5 inhibitors for erectile dysfunction (ED). The incidence of NAION in men receiving sildenafil treatment for ED was estimated using pooled safety data from global clinical trials and European observational studies. Based on clinical trial data in more than 13,000 men and on more than 35,000 patient-years of observation in epidemiologic studies, we estimated an incidence of 2.8 cases of NAION per 100,000 patient-years of sildenafil exposure. This is similar to estimates reported in general US population samples (2.52 and 11.8 cases per 100,000 men aged ≥50 years). The data cited herein do not suggest an increased incidence of NAION in men who took sildenafil for ED

Comment appréhender les troubles de l’érection en 2005

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Cure d’Incontinence urinaire à l’effort par bandelettes sous urétrales: TVT ou TOT ?

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Commentaire à pose d'implants UroLift(®) intraprostatiques pour hyperplasie bénigne de la prostate.

Journal ArticleSCOPUS: ar.jSCOPUS: no.jinfo:eu-repo/semantics/publishe

Les nouvelles strategies thérapeutiques dans le traitement de l'hypertrophie bénigne de la prostate.

The benign hypertrophy of prostate (BPH) is a progressive disease which can assign all the men to various degrees, involving an unquestionable repercussion on the quality of life. The two types of drugs commonly used for the treatment of the symptomatic BPH are the inhibitors of 5-alpha-reductase and the alpha-blockers. They last one relatively long action, making it possible to prevent occurred of complications like the acute urinary retention or the prostatic recourse to the surgery. A risk of progression and development of urinary complications can require an association of these two therapeutic agents in order to obtain a faster and durable improvement of symptomatology. The results of various studies are reported which highlight the interest of this therapeutic combination and underline the contribution of an inhibitor of 5-alpha-reductase among patients presenting a significant prostatic volume and a high PSA. Taking into account the risk of bad compliance and side effects with the long course, after a treatment combined for six months by tamsulosine and dutasteride, the stop of the alpha-blocker allows a maintenance of the situation obtained. Lastly, several clinical studies made it possible to draw the attention to the potentially preventive action of the inhibitors of 5-alpha-reductase in the development of the prostate cancer by its action to the DHT. These observational studies left the place to the PCPT study which made it possible to confirm a reduction in the prevalence of the cancer of prostate in a group of patients treated by finasteride compared with a placebo group. Currently, the preventive potential role of the dutasteride is also the subject of a study (REDUCE). These results are necessary in order to better define the interest and the role of the inhibition of 5-alpha-reductase in a strategic attitude of prostate cancer prevention.English AbstractJournal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Prévalence et prise en charge de la Dysfonction Erectile chez les patients Traumatisés Médullaires

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L’essor de la Laparoscopie en Urologie

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Quel choix de prothèse dans la chirurgie du prolapsus génital?

Genital prolapse is an increasingly frequent condition and surgical repair is associated with a high recurrence rate. Many technical modifications have been proposed in order to improve these results. Synthetic and biological prostheses have been developed and marketed often in the absence of well conducted randomized controlled studies, and simply claiming the ease of use of a new material. However, urologists must be well informed about the efficacy of these prostheses, their potential limitations and the associated morbidity. The authors report the currently known characteristics of prostheses for genital prolapse repair. There is a consensus in favour of large pore size polypropylene monofilament mesh. Biomaterials are still under investigation for their applications in urology. Randomized, prospective, controlled trials must be conducted to determine the long-term efficacy and potential morbidity of the various materials used. Morbidity is also related to surgical technique and the use of prostheses does not eliminate the need for expertise in prolapse surgery.English AbstractJournal ArticleReviewSCOPUS: re.jinfo:eu-repo/semantics/publishe