Tamsulosin 200microgram oral powder sachets

BackgroundUreteral stent insertion, crucial for managing ureteral obstructions, often results in stent-related symptoms (SRSs) adversely affecting patient quality of life. This meta-analysis compares the effectiveness of tamsulosin or mirabegron versus placebo in alleviating these symptoms.MethodsFollowing PRISMA guidelines, we systematically reviewed randomized controlled trials (RCTs) comparing mirabegron or tamsulosin to placebo in managing SRSs. Data sources included PubMed, Embase, Web of Science and CENTRAL, up to November 2023. The inclusion criteria focused on studies reporting on Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), quality of life (QoL) assessments, analgesic usage and adverse events. Meta-analysis employed a random-effects model, assessing heterogeneity and publication bias. For assessing the risk of bias in the included randomized trials, we employed the Cochrane Collaboration's tool. This protocol was registered at the International Prospective Register of Systematic Reviews (registration number: CRD42024511842).ResultsSixteen RCTs with 1635 patients met the inclusion criteria. Tamsulosin significantly improved body pain (MD -1.80; 95% CI -3.53 to -0.07; p = 0.04), sexual function (MD -0.63; 95% CI -1.16 to -0.10; p = 0.02) and improved quality of life score (MD -2.36; 95% CI -3.56 to -1.17; p = 0.0001), while mirabegron was more effective in reducing urinary symptoms (MD -8.71; 95% CI -15.81 to -1.61; p = 0.02), enhancing general health (MD -2.58; 95% CI -3.78 to -1.37; p p = 0.008). Both medications significantly reduced total International Prostate Symptom Score (Tamsulosin MD -8.4; 95% CI -15.63 to -1.22; p = 0.02; Mirabegron MD -6.29; 95% CI -8.50 to -4.08; p p = 0.42 and OR 0.93; 95% CI 0.30-2.88; p = 0.89).ConclusionsTamsulosin and mirabegron effectively manage SRSs, with distinct benefits in different symptom domains. This suggests a potential for complementary therapeutic strategies. Future high-quality RCTs are needed to explore their combined efficacy.

Abstract licence: CC BY

PurposeAlpha-blockers and 5-alpha reductase inhibitors (5ARIs) are well-established treatments for symptoms of benign prostatic hyperplasia (BPH). Despite their therapeutic benefits, concerns have been raised regarding a potential association between these medications and an increased risk of dementia. However, current evidence remains inconsistent, highlighting the need for further evaluation. This study aims to assess the potential dementia risk among patients receiving alpha-blockers and 5ARIs.MethodsFollowing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines (PROSPERO CRD42025643431), 7 databases were systematically searched through December 2024 for studies examining the association between alpha-blockers or 5ARIs and dementia risk in patients with BPH. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool. A Bayesian network meta-analysis was performed to estimate risk ratios with 95% credible intervals and to generate surface under the cumulative ranking curve (SUCRA) values.ResultsFive multicenter studies involving 3,650,434 patients (mean age, 71.1 years) and demonstrating an overall low risk of bias were included. The network analysis indicated that neither alpha-blockers nor 5ARIs were significantly associated with an increased risk of dementia compared with no treatment. However, SUCRA values suggested a relatively higher probability of dementia risk for 5ARIs (finasteride and dutasteride), followed by tamsulosin, doxazosin, terazosin, and alfuzosin.ConclusionThis study found no significant association between the use of alpha-blockers or 5ARIs and increased dementia risk. These findings may assist clinicians in making more informed prescribing decisions, particularly for older male patients with BPH. Further large-scale research with extended follow-up periods is needed to strengthen the evidence across all BPH medications.

Abstract licence: CC BY-NC