Clinical effect of naftopidil on the quality of life of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a prospective study. Naftopidil for the treatment of urinary symptoms in patients with benign prostatic hyperplasia Comparison of 25 and 75 mg/day naftopidil for lower urinary tract symptoms associated with benign prostatic hyperplasia: a prospective, randomized controlled study. Naftopidil and propiverine hydrochloride for treatment of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia and concomitant overactive bladder: A prospective randomized controlled study Crossover comparison study on the therapeutic effects of tamsulosin hydrochloride and naftopidil in lower urinary tract symptoms associated with benign prostatic hyperplasia. Ejaculatory Disorders Caused by Alpha-1 Blockers for Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: Comparison of Naftopidil and Tamsulosin in a Randomized Multicenter Study A Prospective, Randomized, Controlled, Multicenter Study of Naftopidil for Treatment of Male Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia: 75 mg Once Daily in the Evening Compared to 25 mg Thrice Daily [Comparison of naftopidil and silodosin in the treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, crossover study]. Self-management for men with lower urinary tract symptoms Clinical Feature of Men Who Benefit from Dose Escalation of Naftopidil for Lower Urinary Tract Symptoms: A Prospective Study Silodosin versus naftopidil in Japanese patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized multicenter study. Short-term efficacy and long-term compliance/treatment failure of the alpha1 blocker naftopidil for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. [A Crossover Comparison Study on Lower Urinary Tract Symptoms with Overactive Bladder Secondary to Benign Prostatic Hyperplasia: Naftopidil versus Tamsulosin with Solifenacin]. α1D/A-adrenoceptor antagonist naftopidil for the male lower urinary tract symptoms associated with benign prostatic hyperplasia: efficacy of dose increase therapy. Tamsulosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effects. Update on AUA guideline on the management of benign prostatic hyperplasia. Silodosin versus naftopidil for the treatment of benign prostatic hyperplasia: a multicenter randomized trial. Combination therapy with doxazosin and tenoxicam for the management of lower urinary tract symptoms. Efficacy and safety of combined therapy with terazosin and tolteradine for patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: a prospective study The effect of benign lower urinary tract symptoms on subsequent prostate cancer testing and diagnosis. Clinical efficacy of a loading dose of naftopidil for patients with benign prostate hyperplasia Effects of distance learning on clinical management of LUTS in primary care: a randomised trial. Sildenafil citrate in combination with tamsulosin versus tamsulosin monotherapy for management of male lower urinary tract symptoms due to benign prostatic hyperplasia: A randomised, double-blind, placebo-controlled trial
OBJECTIVES To investigate the benefit of alpha1-adrenoceptor antagonist naftopidil on the quality of life ( QOL ) of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia ( BPH/LUTS ) . METHODS A total of 99 men with BPH/LUTS were prospect ively recruited . The Short Form-8 ( SF-8 ) was used for generic QOL assessment and each parameter was compared with the norm in these patients . Longitudinal changes were evaluated using the SF-8 and the International Prostatic Symptoms Score ( I-PSS ) at baseline , 4 and 8 weeks after naftopidil administration . The relationship between SF-8 and I-PSS was analyzed . RESULTS Five of eight components in the SF-8 were significantly lower than the Japanese national norm at baseline . SF-8 score was improved by naftopidil at 4 and 8 weeks in general health ( GH ) and physical component summary ( PCS ) in the patients in their 70s . Mental health ( MH ) and mental component summary ( MCS ) were improved at 8 weeks in patients in their 60s . When analyzing the whole cohort , SF-8 GH , role emotional ( RE ) and MH had improved at 8 weeks , which was similar to the norm , and bodily pain ( BP ) results were better . Compared with the baseline , total I-PSS , storage/voiding symptoms and QOL index scores improved significantly under naftopidil . Each component of I-PSS ( except for hesitancy ) correlated with SF-8 sub-scales ( except for BP ) to some extent . CONCLUSIONS BPH/LUTS impairs generic QOL , which is improved by naftopidil treatment . SF-8 can be a useful instrument to assess the efficacy of BPH/LUTS treatment because its simplicity to complete and analyze , and its meaningful relationship to I-PSS Naftopidil , approved only in Japan , is an α1-adrenergic receptor antagonist ( α1-blocker ) used to treat lower urinary tract symptoms ( LUTS ) suggestive of benign prostatic hyperplasia ( BPH ) . Different from tamsulosin hydrochloride and silodosin , in that it has higher and extremely higher affinity respectively , for the α1A-adrenergic receptor subtype than for the α1D type , naftopidil has distinct characteristics because it has a three times greater affinity for the α1D-adrenergic receptor subtype than for the α1A subtype . Although well- design ed large-scale r and omized controlled studies are lacking and the optimal dosage of naftopidil is not always completely determined , previous reports from Japan have shown that naftopidil has superior efficacy to a placebo and comparable efficacy to other α1-blockers such as tamsulosin . On the other h and , the incidences of ejaculatory disorders and intraoperative floppy iris syndrome induced by naftopidil may be lower than for tamsulosin and silodosin having high affinity for the α1A-adrenergic receptor subtype . However , it remains unknown if the efficacy and safety of naftopidil in Japanese is applicable to white , black and Hispanic men having LUTS/BPH in western countries BACKGROUND The present study investigated the efficacy , safety , and utility of starting an alpha(1d)-selective antagonist , naftopidil , at 75 or 25 mg/day in patients with lower urinary tract symptoms ( LUTS ) associated with benign prostatic hyperplasia ( BPH ) . METHODS In this prospect i ve comparative study , the subjects comprised 153 patients with LUTS associated with BPH . Patients were r and omized to receive either 25 mg/day ( Group LD ) or 75 mg/day ( Group HD ) of naftopidil for 4 weeks . The lower urinary tract disease symptom score ( LUTDSS ) , the International Prostate Symptom Score ( IPSS ) , the Quality of life assessment index , the maximum flow rate ( Q(max ) ) , and the residual urine volume were compared between the groups . RESULTS In both groups , the LUTDSS and the IPSS were significantly improved at the endpoint and no significant intergroup differences were identified . However , the improvement in the Q(max ) was significantly better for Group HD than for Group LD . The overall efficacy did not differ significantly between the groups . The degree of improvement in voiding symptoms and LUTDSS among patients with moderate symptoms was significantly greater for Group HD than for Group LD . The frequency of adverse reactions did not differ significantly between the groups . CONCLUSIONS Starting administration at 75 mg/day rather than 25mg/day is helpful for LUTS associated with BPH for patients with moderate symptoms , particularly in improving voiding symptoms . The 75 mg/day administration was considered to be a recommendable therapeutic dose in some patients Objective . To assess the efficacy and safety of propiverine hydrochloride ( antimuscarinic ) , naftopidil ( α1-adrenoceptor antagonist ) or both in patients with male lower urinary tract symptoms ( LUTS ) suggestive of benign prostatic hyperplasia and concomitant overactive bladder ( OAB ) . Material and methods . Men aged at least 50 years who had a total International Prostate Symptom Score ( IPSS ) of 8 or higher and bladder dairy documenting micturition frequency ( more than eight micturitions/24 h ) and urgency ( more than one episode/24 h ) , with or without urgency urinary incontinence were r and omized into three groups : group N , naftopidil ( 50 mg once daily ) only ; group P , propiverine hydrochloride ( 20 mg once daily ) ; and group NP , naftopidil ( 50 mg once daily ) plus propiverine hydrochloride ( 20 mg once daily ) for a 4-week treatment regimen . Results . A total of 66 men , including 20 in group N , 23 in group P and 23 in group NP , were treated and 58 ( 87.9 % ) completed the 4 weeks of treatment . IPSS improved significantly in groups N and NP . Urinary frequency improved significantly in groups P and NP . Postvoid residual urine volume increased significantly in groups P and NP . Significant improvements in urgency episodes were noted in each group . One patient in group P required catheterization owing to acute urinary retention and another stopped medication because of difficulty in voiding . Conclusion . These results suggest that each treatment showed effectiveness for male LUTS with OAB . However , there are some possibilities of adverse effects with propiverine hydrochloride monotherapy There is no consensus on the evaluated efficacy of individual alpha(1)-blockers in the treatment of lower urinary tract symptoms ( LUTS ) associated with benign prostatic hyperplasia ( BPH ) . This study compared the clinical benefits of tamsulosin hydrochloride with those of naftopidil in BPH . Men aged 54 - 84 years with a main complaint of BPH were r and omly assigned to receive consecutive treatment with tamsulosin then naftopidil ( T-N group , 25 patients ) , or naftopidil then tamsulosin hydrochloride ( N-T group , 20 patients ) . The therapeutic effects were compared in a crossover design . Administration was continued for 28 days in each treatment period . Both groups showed similar improvements during the first treatment period . However , during the second treatment period after crossover , therapeutic effects were greater in the N-T group . Tamsulosin was more effective than naftopidil on intermittency , nocturia and quality of life scores .  Tamsulosin and naftopidil have different efficacy profiles for LUTS associated with BPH Introduction : To investigate the incidence of ejaculatory disorders caused by naftopidil and tamsulosin in patients with lower urinary tract symptoms ( LUTS ) suggestive of benign prostatic hyperplasia ( BPH ) . Material s and Methods : Ninety-five patients with LUTS/BPH who had International Prostate Symptom Scores ( IPSS ) of 8 or more were r and omly assigned to receive naftopidil ( 50 mg/day , n = 48 ) or tamsulosin ( 0.2 mg/day , n = 47 ) . Before and 12 weeks after treatment , a question naire was used to evaluate ejaculation . Results : Among men who had sexual activity during the 12 weeks , the proportion who reported an abnormal feeling on ejaculation was higher in the tamsulosin group ( 16.7 % ) than in the naftopidil group ( 7.4 % ) , although the difference was not significant ( p = 0.402 ) . The proportion of men who reported reduced ejaculatory volume after treatment was significantly higher in the tamsulosin group ( 96.0 % ) than in the naftopidil group ( 73.1 % , p = 0.0496 ) . On the other h and , the improvements in IPSS and the quality of life index were significantly higher in the tamsulosin group than in the naftopidil group . Conclusions : Tamsulosin may cause a higher incidence of ejaculatory disorders than naftopidil , although the efficacy of 0.2 mg tamsulosin may be better than that of 50 mg naftopidil Introduction : We examined the tolerability of dosage methods of naftopidil in the treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia ( BPH/male LUTS ) . Patients and Methods : A total of 80 patients with BPH/male LUTS who had an International Prostate Symptom Score ( IPSS ) ≧8 and IPSS quality of life ( QoL ) ≧2 were enrolled and r and omly administered naftopidil for 8 weeks at either 75 mg once daily ( OD ) in the evening ( group O ; n = 41 ) or 25 mg thrice daily ( TID ) in the morning , afternoon and evening ( group T ; n = 39 ) . Results : IPSS total score , IPSS-QoL and BPH impact index ( BII ) were significantly improved for both groups at 8 weeks after starting treatment compared to baseline . IPSS total score and daytime and 24-hour voiding frequencies were significantly improved at 8 weeks after starting treatment for group O in comparison to group T. Group O showed a significantly better degree of change in BII in comparison to group T. Conclusions : Naftopidil 75 mg OD in the evening was better tolerated than naftopidil 25 mg TID for the objective parameter and BII We compared the efficacy , safety , and patient preferences for two α1-adrenoceptor ( AR ) antagonists with different affinity for AR subtypes , naftopidil ( Naf ) and silodosin ( Silo ) , for the treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia ( male LUTS/BPH ) . New patients diagnosed with male LUTS/BPH were r and omly divided into either the Naf-Silo group or the Silo-Naf group ( Naf : 50 - 75 mg once daily for 2 weeks followed by 75 mg once daily for 4 weeks ; Silo : 2 - 4 mg twice daily for 2 weeks followed by 4 mg twice daily for 4 weeks ) . A survey was conducted to evaluate patient drug preferences after completion of the study and the reasons for the preferences . Naf and Silo  improved the total International Prostate Symptom Score ( IPSS ) compared with baseline . There was no significant difference between Naf and Silo in improvement in the IPSS total score . Adverse effects were more frequent with Silo than with Naf ( P=0 . 002 ) . No significant difference in patient preference for the drugs was observed . These findings indicate that Naf and Silo provide similar clinical efficacy , with no difference in patient preference for the drugs , although adverse effects were significantly more frequent with Silo than with Naf Treatment for men with lower urinary tract symptoms ( LUTS ) has developed into a “ cascade ” that escalates from watchful waiting through medical treatment to surgery . Self-management can help men to adopt lifestyle and behavioral modifications that will avoid or delay an escalation in treatment and reduce symptoms . Although many of these interventions are advised to men with LUTS , it is usually in a nonst and ardized and un systematic way . Recent work in this area has defined a self-management program for men with uncomplicated LUTS using formal methods and assessed its effectiveness in a r and omized controlled trial . Self-management significantly reduced the frequency of escalation through the treatment cascade and reduced urinary symptoms ( as effective as medication ) , suggesting that self-management could be considered as first-line treatment for men with LUTS Objectives . To examine the feature of men who benefit from dose escalation of naftopidil for lower urinary tract symptoms ( LUTSs ) . Methods . Based on the IPSS , men reporting LUTS were prospect ively studied using 50 mg/day of naftopidil for the first 4 weeks ; satisfied patients continued its 50 mg/day ( n = 11 ) , and those reporting unsatisfactory improvement received its 75 mg/day ( n = 35 ) for the next 4 weeks . Results . The 75 mg group showed improvement in the total IPSS and QOL score in a dose-dependent manner ( at 4 weeks : P < .001 , at 4 weeks versus 8 weeks : P < .05 ) . In the 50 mg group , both scores reduced at 4 weeks , thereafter unchanged . The baseline slow stream score alone was higher in the 75 mg group ( P = .013 ) . The rate of change in the QOL score during the initial 4 weeks ( ΔQOL ) and Δnocturia was smaller in the 75 mg group ( P < .05 ) . Conclusions . Men with high slow stream score and unsatisfactory improvement in nocturia may benefit from dose escalation of naftopidil OBJECTIVES Silodosin is a novel drug that is highly selective to subtype alpha 1A and , since 2006 , has been used in Japan for treating benign prostatic hyperplasia . This study aim ed to compare the clinical effects of the alpha-adrenoceptor antagonist , silodosin , with those of naftopidil in patients presenting lower urinary tract symptoms associated with benign prostatic hyperplasia . METHODS This was a r and omized , open-label , controlled multicenter study carried out in Japan . Overall , 121 participants with lower urinary tract symptoms associated with benign prostatic hyperplasia were r and omized to receive silodosin ( 4 mg twice daily ) or naftopidil ( 50 mg once daily ) for 4 or 8 weeks . Patients were divided into four groups : the alpha-blocker-naive groups received silodosin ( 35 patients ) or naftopidil ( 33 patients ) and the drug-switching groups changed from tamsulosin to silodosin ( 26 patients ) or naftopidil ( 27 patients ) . The outcomes parameters were the International Prostate Symptom Score , quality of life , maximum urinary flow rate and post-void residual urine volume . P < 0.05 was considered statistically significant by using the Wilcoxon signed-rank and rank-sum tests , and analysis of covariance . RESULTS In all the groups , silodosin and naftopidil significantly improved the total International Prostate Symptom Score and quality of life . However , silodosin obtained significantly better improvement in total International Prostate Symptom Score in the alpha-blocker-naive patients at 4 and 8 weeks . The maximum urinary flow rate and residual urine did not change significantly in all the treatment groups . CONCLUSIONS The present study confirms the clinical usefulness of silodosin in the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia OBJECTIVE To evaluate treatment failure during a 4-year follow-up period after administration of naftopidil for patients with lower urinary tract symptoms ( LUTS ) suggestive of benign prostatic hyperplasia ( BPH ) in real-life clinical practice . MATERIAL AND METHODS A total of 247 patients with LUTS/BPH who had an International Prostate Symptom Score ( IPSS ) of > or = 8 were enrolled in the study .  Naftopidil , 50 mg/day , was given to the patients . They were followed for 4 years with periodic evaluation . Treatment failure was defined as conversion to other medical treatment or to surgery . RESULTS Of the 247 patients , treatment failure occurred in 42 ( 17.0 % ) during the 4-year follow-up period . The 4-year treatment failure rate was on the Kaplan-Meier curve 35.0 % . Among parameters assessed at baseline , prostate volume ( PV ) was the only significant determinant of treatment failure : patients with a PV of > or = 35 ml had a 2.1 times higher hazard of treatment failure than those with a PV of < 35 ml ( 95 % CI 1.06 - 4.33 ; p=0.03 ) . Patients with a severe IPSS at 12 weeks after administration of naftopidil had a 3.5 times higher hazard than those having a mild/moderate IPSS ( 95 % CI 1.34 - 9.26 ; p=0.01 ) . After 4 years , 200 patients ( 81 % ) had stopped taking naftopidil because of adverse events , treatment failure , loss to follow-up , etc . CONCLUSIONS There were significant improvements in IPSS and urinary flow rate with naftopidil although it is unknown whether these improvements were significantly larger than the placebo effect as the study was non-r and omized . However , only 19 % of patients were known to have continued with the same medication for 4 years in real-life clinical practice . Patients who have a large prostate at baseline and a severe IPSS at 12 weeks after treatment are more likely to have treatment failure , although a prospect i ve study is needed to confirm this We compared the efficacy of naftopidil monotherapy with combination therapy using tamsulosin hydrochloride and solifenacin succinate in the treatment of lower urinary tract symptoms ( LUTS ) with overactive bladder ( OAB ) secondary to benign prostatic hyperplasia ( BPH ) . Thirty one patients were enrolled in a r and omized crossover study . Fourteen patients were initially prescribed naftopidil 75 mg ( N ) for 8 weeks , followed by tamsulosin 0.2 mg and solifenacin 5 mg ( TS ) for 8 weeks ( group N ) ; another 17 were initially prescribed TS , followed by N ( group TS ) . The efficacy variables were the changes in international prostate symptom score ( I-PSS ) , quality of life ( QOL ) score , overative bladder symptom score ( OABSS ) , and post-void residual ( PVR ) urine volume . After the study , a question naire survey was carried out about the choice of treatment . After treatment with each agent , total I-PSS , storage symptom score , QOL score and OABSS except for the daytime frequency were significantly improved from baseline . PVR was significantly increased after TS treatment . There were no significant differences between the two treatments except for PVR . As a result of the question naire survey , 13 patients chose N and 17 chose TS . In conclusion , N monotherapy can be expected to have an equal effect in the treatment of LUTS with OAB secondary to BPH in comparison with TS combination therapy OBJECTIVES To examine the efficacy of dose increase therapy in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia who responded poorly to 50 mg/day of naftopidil .  METHODS A total of 95 patients received 50 mg/day of naftopidil for 8 weeks . After this treatment period , they were divided into two groups : the poor responders were defined as those who either had an International Prostate Symptom Score- Quality of Life ≥ 4 or with an International Prostate Symptom Score- Quality of Life of 3 whose International Prostate Symptom Score- Quality of Life improved < 2 points ( group A ) . All other patients were defined as responders to naftopidil 50 mg/day ( group B ) . The dose of naftopidil was increased to 75 mg/day in group A , and maintained at 50 mg/day in group B. The treatment was continued for a further 8 weeks . RESULTS The prostate volume at the baseline was significantly larger in group A than group B. The improvement of International Prostate Symptom Score total score , International Prostate Symptom Score- Quality of Life , and voided volume after 8 weeks was significantly better in group B than in group A. However , there was no significant difference in the changes of all parameters between the two groups after 16 weeks . CONCLUSIONS A dose increase to 75 mg/day is an effective treatment strategy in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia who responded poorly to an initial dose of 50 mg/day of naftopidil . Furthermore , a starting dose of 75 mg/day should be considered in patients with a large prostate volume , as this is a predictive factor for dose increase PURPOSE We systematic ally review ed the effectiveness and adverse effects of tamsulosin for lower urinary tract symptoms compatible with benign prostatic obstruction . MATERIAL S AND METHODS Studies were included in analysis when they involved a r and omized trial of at least 1 month in duration , men with lower urinary tract symptoms and a comparison of tamsulosin with placebo or an active control . Study , patient and outcome data were extracted onto st and ard forms using a prospect i ve protocol . RESULTS Of the series 13 involving 3,418 men with a mean age of 64 years met our inclusion criteria . Study duration was 4 to 26 weeks . Baseline symptom scores and flow rates showed moderate lower urinary tract symptoms . Tamsulosin improved symptoms and peak urine flow compared with placebo . The weighted mean difference in the mean change from baseline for the Boyarsky symptom score for 0.4 and 0.8 mg . tamsulosin versus placebo was -1.1 ( 95 % confidence interval [ CI ] -1.49 to -0.72 or 12 % improvement ) and -1.6 points ( 95 % CI -2.3 to -1.0 or 16 % improvement ) , respectively . The weighted mean difference in the mean change from baseline in peak urine flow was 1.1 ( 95 % CI 0.59 to 1.51 ) and 1.1 ml . per second ( 95 % CI 0.65 to 1.48 ) for 0.4 and 0.8 mg . , respectively . The 0.2 to 0.4 mg . tamsulosin dose was as effective as other alpha-antagonists for improving symptoms and the flow rate , although the doses of all alpha-antagonists evaluated may not have been optimal . Treatment withdrawals and adverse effects increased markedly as the tamsulosin dose increased . CONCLUSIONS Tamsulosin improves lower urinary tract symptoms and flow . Its effectiveness was similar to that of other alpha-antagonists , increasing slightly at higher doses . Adverse effects were generally mild but the incidence , including treatment withdrawals , increased substantially at higher doses PURPOSE To revise the 2003 version of the American Urological Association 's ( AUA ) Guideline on the management of benign prostatic hyperplasia ( BPH ) . MATERIAL S AND METHODS From MEDLINE ® search es of English language publications ( January 1999 through February 2008 ) using relevant MeSH terms , articles concerning the management of the index patient , a male ≥45 years of age who is consulting a healthcare provider for lower urinary tract symptoms ( LUTS ) were identified . Qualitative analysis of the evidence was performed . Selected studies were stratified by design , comparator , follow-up interval , and intensity of intervention , and meta-analyses ( quantitative synthesis ) of outcomes of r and omized controlled trials were planned . Guideline statements were drafted by an appointed expert Panel based on the evidence . RESULTS The studies varied as to patient selection ; r and omization ; blinding mechanism ; run-in periods ; patient demographics , comorbidities , prostate characteristics and symptoms ; drug doses ; other intervention characteristics ; comparators ; rigor and intervals of follow-up ; trial duration and timing ; suspected lack of applicability to current US practice ; and techniques of outcomes measurement . These variations affected the quality of the evidence review ed making formal meta- analysis impractical or futile . Instead , the Panel and extractors review ed the data in a systematic fashion and without statistical rigor . Diagnosis and treatment algorithms were adopted from the 2005 International Consultation of Urologic Diseases . Guideline statements concerning pharmacotherapies , watchful waiting , surgical options and minimally invasive procedures were either up date d or newly drafted , peer review ed and approved by AUA Board of Directors . CONCLUSIONS New pharmacotherapies and technologies have emerged which have impacted treatment algorithms . The management of LUTS/BPH continues to evolve This was a multicenter r and omized trial to investigate the clinical efficacy and the impact on sexual function of alpha-1A selective silodosin and alpha-1D selective naftopidil for treatment of benign prostatic hyperplasia . A total of 97 patients with lower urinary tract symptoms/benign prostatic hyperplasia who had an International Prostate Symptom Score of 8 or more were r and omly assigned to receive silodosin ( 8 mg/day , n = 53 ) or naftopidil ( 75 mg/day , n = 44 ) . Before and 4 , 8 and 12 weeks after treatment , International Prostate Symptom Score and its quality of life score were used to assess lower urinary tract symptoms . Also , International Index of Erectile Function-5 , and an original question naire were used to evaluate erectile function and ejaculation for sexually active patients , respectively . The silodosin group showed advantages in terms of voiding symptoms and quality of life of International Prostate Symptom Score when compared with the naftopidil group . Both silodosin and naftopidil showed no significant effect on International Index of Erectile Function-5 . A total of 23 sexually active patients in the silodosin group experienced more ejaculatory impairment than 21 patients in the naftopidil group , with a decrease of ejaculation volume ( 87 % vs 40 % , P = 0.003 ) , prolonged time to ejaculation ( 56 % vs 33 % , P = 0.027 ) and decrease of orgasm ( 50 % vs 39 % , P = 0.027 ) . These results suggest that alpha-1A selective blockers are more effective for voiding symptoms , whereas alpha-1D selective blockers offer a minor degree of ejaculatory dysfunction OBJECTIVE To compare the efficacy and safety of a combination therapy , doxazosin plus tenoxicam , and doxazosin alone for lower urinary tract symptoms ( LUTS ) caused by benign prostatic hyperplasia ( BPH ) , as various combination therapies increase the efficacy of medical therapy . Alpha blocker agents have been widely used for the treatment of LUTS secondary to BPH . METHOD Fifty-seven patients complaining of LUTS secondary to BPH were enrolled in this clinical trial . Patients were r and omly assigned to receive doxazosin 4 mg or doxazosin 4 mg plus tenoxicam 20 mg treatment . Patients were evaluated for BPH according to the European Association of Urology and American Urological Association clinical guidelines . In addition , patients were assessed with Overactive Bladder Symptom Score ( OABSS ) and International Index of Erectile Function ( IIEF ) . Patients were reevaluated after a 6-week treatment course . The International Prostatic Symptom Score ( IPSS ) , IPSS- Quality of Life ( IPSS-QoL ) , maximal urinary flow rates ( Q(max ) ) , and average urinary flow rates ( AFR ) were determined at baseline and again at 6 weeks as efficacy parameters . RESULTS The total IPSS , IPSS-QoL , and OABSS decreased significantly in both tenoxicam plus doxazosin group and doxazosin alone group compared with baseline ( P < .01 ) . Also , Q(max ) and AFR significantly improved in both groups ( P < .01 ) . The improvements in IPSS , IPSS-QoL , and OABSS were significantly better in patients treated with combination therapy ( P < .05 ) . CONCLUSIONS COX-2 inhibitors in combination with an alpha blocker may increase the effectiveness of the therapy for LUTS secondary to BPH without significant effects on side effect profile Background The primary objectives of the treatment for the  lower urinary tract symptoms ( LUTS ) associated with benign prostatic hyperplasia ( BPH ) are to produce rapid , sustained , and safe improvements in the symptoms that affect the quality of life in the majority of men over 50 . In this study , we evaluated the efficacy and safety of the combined therapy with terazosin ( & agr;1‐adrenergic receptor antagonist ) and tolterodine ( anticholinergic agent ) for LUTS associated with BPH . Methods This combination study included 69 patients diagnosed with LUTS associated with BPH based on the International Prostate Symptom Scores ( IPSS ) , urinary flow rate , prostate volume , urinary residual , and their serum prostate‐specific antigen levels .  Initially , 191 patients were treated with terazosin 2 mg once daily for one week . Those patients with continued LUTS after the initial treatment were allocated r and omly into two groups : terazosin group ( n=36 ) in which patients were treated with terazosin 2 mg once daily for six weeks , and combination group ( n=33 ) in which patients were treated with both terazosin 2 mg once daily and tolterodine 2 mg twice daily for 6 weeks . Results The IPSS were significantly improved in both groups after treatment , and the reduction of IPSS in the combination group was significantly greater than that in the terazosin group ( P<0.01 ) . A decrease in urgency , frequency and nocturia were the main contributory factors causing the reduction of IPSS in the combination group . The differences about the peak urinary flow rate and the residual urine from the baseline values were noted in both groups after treatment , but were not significant between the two groups . The incidence of adverse effects in the combination group was higher than that in the terazosin group . As expected the most common adverse effect was mouth dryness which was associated with anticholinergic drugs such as tolterodine . Conclusions Patients with LUTS associated BPH appear the improved IPSS after combined therapy with terazosin and tolterodine . This study , although short term and limited numbers of patients , provides evidence that the combined therapy with terazosin plus tolterodine is a good approach for meeting the objectives of rapid , sustained , and safe improvements in the LUTS associated with BPH . And the profile of patients in this study might be used as the indication of such combined therapy for LUTS associated with BPH without urodynamic evaluation BACKGROUND Lower urinary tract symptoms ( LUTS ) are common and have been associated with the subsequent diagnosis of prostate cancer ( PCa ) in population cohorts . OBJECTIVE To determine whether the association between LUTS and PCa is due to the intensity of PCa testing after LUTS diagnosis . DESIGN , SETTING , AND PARTICIPANTS We prospect ively followed a representative , population -based cohort of 1922 men , aged 40 - 79 yr , from 1990 until 2010 with interviews , question naires , and abstract ing of medical records for prostate outcomes . Men were excluded if they had a previous prostate biopsy or PCa diagnosis .  Self-reported LUTS was defined as an American Urological Association symptom index score > 7 ( n=621 ) . Men treated for LUTS ( n=168 ) were identified from review of medical records and /or self report . Median follow-up was 11.8 yr ( interquartile range : 10.7 - 12.3 ) . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Associations between self-reported LUTS , or treatment for LUTS , and risk of subsequent prostate biopsy and PCa were estimated using Cox proportional hazard models . RESULTS AND LIMITATIONS Fifty-five percent of eligible men enrolled in the study . Men treated for LUTS were more likely to undergo a prostate biopsy ( hazard ratio [ HR ] : 2.4 ; 95 % confidence interval [ CI ] , 1.7 - 3.3 ) . Men younger than 65 yr who were treated for LUTS were more likely to be diagnosed with PCa ( HR : 2.3 , 95 % CI , 1.5 - 3.5 ) , while men aged > 65 yr were not ( HR : 0.89 , 95 % CI , 0.35 - 1.9 ) . Men with self-reported LUTS were not more likely to be biopsied or diagnosed with PCa . Neither definition of LUTS was associated with subsequent intermediate- to high-risk cancer . The study is limited by lack of histologic or prostate-specific antigen level data for the cohort . CONCLUSIONS These results indicate that a possible cause of the association between LUTS and PCa is increased diagnostic intensity among men whose LUTS come to the attention of physicians . Increased symptoms themselves were not associated with intensity of testing or diagnosis Purpose The efficacy of a loading dose of α1-adrenoreceptor antagonist for patients with benign prostate hyperplasia who did not improve at a low dose has not been determined . We performed a prospect i ve study to estimate the efficacy of incremental naftopidil administration . Methods The efficacy of naftopidil was examined based on changes in the International Prostate Symptom Score ( IPSS ) . We defined a “ responder ” as a patient who improved by ≥5 points in IPSS total score . All patients were administered naftopidil at 50 mg/day for 12 weeks , and nonresponders at 50 mg/day were increased to 75 mg/day . Efficacy was finally evaluated after an additional 12 weeks of administration at 75 mg/day . Results Among 122 patients whose data could be analyzed , the efficacy rate after administration at 50 mg/day was 52.5 % . In all IPSS items except urgency score , the responders had significantly higher ( poorer ) values than nonresponders before the start of treatment . Of 40 patients whose dose was increased to 75 mg/day and whose data could be analyzed  , prostate volume in the responder group ( 9 patients ) was significantly smaller than that in the nonresponder group ( 31 patients ) . Multivariate analysis showed that patients with improved IPSS total score , voiding symptoms , urgency , and weak stream after administration of 50 mg/day naftopidil were more likely to improve after a dose increase . Conclusions A dose increment of naftopidil to 75 mg/day may be useful in patients with BPH who did not improve at 50 mg/day AIM To determine the effect of a distance learning programme on general practice management of men with lower urinary tract symptoms ( LUTS ) . METHODS A cluster r and omised controlled trial was performed . General practitioners ( GPs ) were r and omised to a distance learning programme accompanied with educational material s or to a control group only receiving mailed clinical guidelines on LUTS . Clinical management was considered as outcome . RESULTS Sixty-three GPs registered care management of 187 patients older than 50 years attending the practice because of LUTS . The intervention group showed a lower referral rate to a urologist ( OR : 0.08 ( 95 % CI : 0.02 - 0.40 ) ) , but no effect on PSA testing or prescription of medication . PSA testing tended to be requested more frequently by intervention group GPs . Secondary analysis showed patients in the intervention group received more educational material s ( OR : 75.6 ( 95 % CI : 13.60 - 419.90 ) ) . CONCLUSIONS The educational programme had impact on clinical management without changing PSA testing . Distance learning is an promising method for continuing education . PRACTICE IMPLICATION S Activating distance learning packages are a potentially effective method for improving professional performance . Emotional matters as PSA testing probably need a more complex approach Abstract Objective : To assess the additive effect of sildenafil citrate to tamsulosin in the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia ( LUTS/BPH ) in men with or without erectile dysfunction ( ED ) . Patients and methods : In all , 150 men with untreated LUTS/BPH with or without ED were r and omised to receive sildenafil 25 mg once daily ( OD ) or placebo OD ( night time ) combined with tamsulosin 0.4 mg OD ( day time ) for 6 months . Changes from pre-treatment scores in International Prostate Symptom Score ( IPSS ) , IPSS- quality of life ( QoL ) score , maximum urinary flow rate ( Qmax ) , and the five-item version of the International Index of Erectile Function question naire ( IIEF-5 ) were assessed at 3 and 6 months . Safety profiles were assessed by physical examination and monitoring clinical adverse events . Results : Group A comprised of men who received tamsulosin and sildenafil ( 75 men ) , whilst those in Group B received tamsulosin and placebo ( 75 ) . The IPSS was significantly improved in Group A compared to Group B , at −29.3 % vs −13.7 % ( P = 0.039 ) at 3 months and −37 % vs −19.6 % ( P = 0.043 ) at 6 months after treatment . Qmax significantly improved in both groups compared with before treatment ( P < 0.001 ) . The IIEF-5 scores improved more in Group A than in Group B , at 58.7 % vs 11.7 % at 3 months and 62.4 % vs 12.4 % at 6 months after treatment ( both P < 0.001 ) . Conclusion : Sildenafil citrate combined with tamsulosin  improved LUTS , erectile function , and patient QoL more than tamsulosin monotherapy with the merit of a comparable safety profile in patients with LUTS/BPH
Although additional well design ed , worldwide , placebo-controlled and r and omized studies are necessary to confirm the long-term outcomes of naftopidil pharmacotherapy , current data suggest that naftopidil administration in BPH patients provides comparable improvements in total IPSS , QoL , and urinary symptoms from baseline relative to 0.2 mg/d tamsulosin and 8 mg/d silodosin .
However , improvements in Qmax are generally less with naftopidil than with tamsulosin .
Reported adverse effects related to naftopidil administration are negligible and usually mild .
OBJECTIVES The aim of the study was to systematic ally review the effects of the adrenoreceptor A1D antagonist naftopidil in the management of  lower urinary tract symptoms ( LUTS ) .