Efficacy of Tamsulosin 0.4 mg versus 0.8 mg in the treatment of lower urinary tract symptoms associated with benign prostatic enlargement

According to a new study, Tamsulosin 0.8 mg has demonstrated superior efficacy in managing lower urinary tract symptoms caused by benign prostatic enlargement compared to Tamsulosin 0.4 mg, and it is well tolerated by patients. This study was published in the journal, International Urology and Nephrology. 
In this study, ninety-three patients who met the criteria were allocated randomly into two groups: Group A, who received Tamsulosin 0.4 mg/day, and Group B, who received Tamsulosin 0.8 mg/day. The post void residual urine volume, international prostate symptom score and maximum flow rate of urine were measured before and after 4 weeks of treatment
Both study groups exhibited a notable decline in storage sub-score but only Group B demonstrated a significant decrease in frequency (P < 0.001).Tamsulosin 0.8 mg was found to be superior to Tamsulosin 0.4 mg in terms of voiding sub-score, except for straining (P = 0.325). The total international prostate symptom score exhibited a significant improvement in Group B when compared to Group A (P < 0.001). Additionally, maximum flow rate and post-void residual urine volume were notably improved in Group B when compared to Group A (P < 0.001).
Thus, it can be concluded that Tamsulosin 0.8 mg is more effective than Tamsulosin 0.4 mg in addressing lower urinary tract symptoms caused by benign prostatic enlargement, and patients tolerate it well. 

Patients who receive a double J substitution with a pigtail suture stent experience a reduction in symptoms associated with the stent

According to a recent study, patients who were treated with double J (DJ) substitution utilizing a pigtail suture stent (PSS) subsequent to the ureteroscopy (URS) procedure experienced a significant alleviation of stent-related symptoms (SRS). Urologists could consider the placement of PSS after URS in patients who have been pre-stented to mitigate the effects of SRS. The results of the study were documented in the World Journal of Urology.

This study enrolled 93 patients with DJ stents undergoing URS for stone management. The Ureteral Symptom Score Questionnaire (USSQ) was submitted at three distinct time points: two weeks after the DJ stent insertion, two weeks following the PSS placement, and four weeks after the PSS removal [baseline]. The primary endpoint of the study was to compare the Urinary Symptom Index Score and the prevalence of pain in patients two weeks after the DJ and PSS procedures. The secondary endpoints included comparing various USSQ scores and single responses two weeks after the DJ and PSS placements, as well as evaluating the USSQ scores for both DJ and PSS in relation to the baseline measurements.

The results indicated a significant improvement in the Urinary Symptom Index Score after two weeks (p value < 0.001), along with a notable difference in the percentage of patients experiencing pain (60.2% for PSS compared to 88.2% for DJ, p value < 0.001), both of which favored PSS. The two-week scores revealed significant enhancements with PSS relative to DJ in various indices: Pain Index (p value < 0.001), General Health Index (p value < 0.001), VAS (p value < 0.001), and Work Performance Index (p value < 0.001). All urinary symptoms were significantly alleviated with PSS, including renal pain during urination and pain affecting quality of life. The Pain Index Score (p value = 0.622) and VAS (p value = 0.169) were similar to baseline with PSS, differing with the results observed with DJ.

Therefore, patients who underwent DJ substitution with PSS after URS demonstrated a significant decrease in SRS. Urologists could consider PSS following URS for patients who have previously been pre-stented to alleviate stent-related symptoms.

Low-intensity shockwave therapy for managing persistent storage symptoms following transurethral surgery for benign prostatic obstruction

A recent study demonstrated that low-intensity shockwave therapy (Li-SWT) improves long-lasting storage symptoms and enhances quality of life (QoL) following transurethral surgery (TUS) for benign prostatic obstruction (BPO), showing similar effectiveness and superior tolerability in comparison to solifenacin. The results of this study were published in the journal Prostate Cancer and Prostatic Diseases.

A total of 137 patients experiencing persistent storage symptoms, with urgency episodes of at least one per day and daytime frequency of at least eight for a period of at least three months after TUS for BPO were included. They were then randomized to receive Li-SWT, sham treatment, or solifenacin 10 mg/day in a ratio of 3:1:1. The primary endpoint of the study was the percentage reduction from baseline in overactive bladder symptom score (OABSS) at the three month follow-up. Changes in voiding diary parameters over three days, quality of life score, peak flow rate, and residual urine at three-and six-months were also compared. Treatment-related adverse effects were assessed as well.

The baseline data were similar across all groups. At the three-month follow-up, the reduction in OABSS from baseline was significantly greater in the Li-SWT group compared to the sham group (-55% vs. -11%), while it was similar between Li-SWT and solifenacin-10 (-55% vs. -60%). Similar to solifenacin-10, Li-SWT demonstrated a significant improvement in three-day voiding diary parameters and quality of life score at the three-month follow-up. This improvement was comparable between Li-SWT and solifenacin-10 at the six-month follow-up, with no adverse effects related to Li-SWT except for manageable pain during the procedure. However, solifenacin-10 was correlated with bothersome adverse effects in 73% of patients, leading to an 11.5% discontinuation rate.

The above study demonstrated that Li-SWT enhances QoL and improves long-term storage symptoms after TUS for BPO, showing comparable efficacy and better tolerability than solifenacin.

Stent on a string: a potential new gold standard for postureteroscopy ureteral drainage

A recent study indicated that stent on string (SOS) is a great alternative following ureteroscope (URS), particularly for patients without intraoperative complications, and they are typically inserted as a routine based on surgeon preference. These stents decrease pain, cost, dwell time, risks, and the suffering associated with prolonged stenting, and most patients are satisfied to remove them at home. While their use is currently limited in endourology practices, they are expected to become the standard for routine URS in the future. The findings of this study were published in the Journal of Endourology.

An extensive systematic review was carried out across several databases, utilizing the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. This review targeted studies published in English that involved patients of all age groups with SOS after undergoing ureteroscopy (URS) for the management of stone disease. A total of 22 studies (20 involving adults and 2 involving pediatric patients) were included from the 1210 records identified, including 8382 patients. Among these patients, 3427 (40.9%) had stent on string inserted and 434 (11%) were in the pediatric age group.

Study results showed that SOS presents several advantages, and when compared with stents without strings (SWOSs), they were implanted for a shorter period, with no significant differences in complications such as urinary tract infection or urinary symptoms. Moreover, SOS showed notable cost savings, decreased pain upon removal, and a high incidence of successful home removal, with more than 90% of patients indicating their readiness to remove their SOSs at home. However, it is important to consider the minor risk of stent dislodgment when deciding on SOS placement post-URS.

The above study demonstrated that SOS is an excellent option after URS, especially for patients who do not experience intraoperative complications. Surgeons typically insert these stents based on their preference as part of routine practice. The use of these stents reduces cost, pain dwell time, risks, and the discomfort associated with prolonged stenting. Many patients are happy to have them removed at home. The use of SOS is currently limited in endourology, it is anticipated that they will become the gold standard for routine ureteroscope in the future.