Русский
Paradigm shift in combination therapy during the COVID-19 pandemic
DOI: https://dx.doi.org/10.18565/urology.2021.1.33-38
D.V. Ergakov, A.G. Martov
1) Department of Urology and Andrology (Head – prof. A.G. Martov) of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia; GBUZ “City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia; 2) Medical Research Center, M.V. Lomonosov Moscow State University, Moscow, Russia
Introduction. Insufficient efficiency of combination therapy with α-adrenergic blockers and 5α-reductase inhibitors with subsequent proceeding to surgical treatment in the absence of absolute indications is a prerequisite for poor postoperative results.
Aim: to evaluate the efficiency of changing standard combination therapy to α-adrenergic blockers + m-cholinoblockers instead of proceeding to surgical treatment.
Materials and methods. From January 2019 to December 2019, a total of 137 patients with lower urinary treatment were referred to the Pletnev City Clinical Hospital due to limited efficiency of combination therapy with α-adrenergic blockers and 5α-reductase inhibitors in order to undergone laser enucleation/vaporization of the prostate. After evaluation, 41 patients with absolute indications for surgical treatment or with suspected prostate cancer were excluded. After a comprehensive examination, 96 patients were prescribed tamsulosin 0.4 mg daily in combination with solifenacin 10 mg daily. All patients were followed up for 12 months.
Results. As a result of using solifenacin, better control over storage symptoms was achieved according to the I-PSS scale (-4 points), which also led to a significant decrease in the total I-PSS score after 12 months of therapy. There was an increase in the mean voided volume (by 53%) after 6 months. Neither Qmax, nor residual urine volume did not change significantly. According to the MIEF-5 scale, an improvement in erectile function was revealed. There was a slight decrease in the average prostate volume and an increase in the PSA level from 3.1 to 4.1 ng/ml. There was no acute urinary retention. However, 6 patients discontinued taking of m-cholinoblockers due to dry mouth.
Conclusions. If there are no absolute indications for surgical treatment, changing the combination of α-adrenergic blockers + 5α-Reductase inhibitors to a combination of α-adrenergic blockers + m-cholinoblockers results in a pronounced symptomatic improvement due to alleviation of storage symptoms.
Aim: to evaluate the efficiency of changing standard combination therapy to α-adrenergic blockers + m-cholinoblockers instead of proceeding to surgical treatment.
Materials and methods. From January 2019 to December 2019, a total of 137 patients with lower urinary treatment were referred to the Pletnev City Clinical Hospital due to limited efficiency of combination therapy with α-adrenergic blockers and 5α-reductase inhibitors in order to undergone laser enucleation/vaporization of the prostate. After evaluation, 41 patients with absolute indications for surgical treatment or with suspected prostate cancer were excluded. After a comprehensive examination, 96 patients were prescribed tamsulosin 0.4 mg daily in combination with solifenacin 10 mg daily. All patients were followed up for 12 months.
Results. As a result of using solifenacin, better control over storage symptoms was achieved according to the I-PSS scale (-4 points), which also led to a significant decrease in the total I-PSS score after 12 months of therapy. There was an increase in the mean voided volume (by 53%) after 6 months. Neither Qmax, nor residual urine volume did not change significantly. According to the MIEF-5 scale, an improvement in erectile function was revealed. There was a slight decrease in the average prostate volume and an increase in the PSA level from 3.1 to 4.1 ng/ml. There was no acute urinary retention. However, 6 patients discontinued taking of m-cholinoblockers due to dry mouth.
Conclusions. If there are no absolute indications for surgical treatment, changing the combination of α-adrenergic blockers + 5α-Reductase inhibitors to a combination of α-adrenergic blockers + m-cholinoblockers results in a pronounced symptomatic improvement due to alleviation of storage symptoms.
About the Autors
Corresponding author: D.V. Ergakov – Ph.D., associate professor at the Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia; e-mail: dergakov@mail.ru
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