PURPOSE: We evaluated the effect of tamsulosin and nifedipine on expulsion of ureteral stones after extracorporeal shock wave lithotripsy(ESWL). MATERIALS AND METHODS: We evaluated 96 upper or lower ureteral stone patients. All patients received a single session of ESWL with a piezolith- 3000 and received twice-a-day oral treatment of 5mg trospium chloride. The patients were randomly divided into three groups. Group 1 received once a day oral therapy of 0.2mg tamsulosin. Group 2 received once a day oral therapy of 30mg nifedipine. Group 3 was used as the control group. All patients took oral medication for 2 weeks, and then we analyzed the stone expulsion rate, side effects, and mean numbers of emergency room(ER) visits for pain control. RESULTS: There were no differences in the 3 groups in stone size, location, age, and sex. The total stone expulsion rate was significantly higher in group 1(84.4%) compared with group 3(60.6%)(p=0.032). Patients with lower ureteral stones in group 1 showed a higher expulsion rate(94.1%) than those of group 3(66.7%)(p=0.042). There was no difference in stone expulsion rates between group 2(67.7%) and group 3(60.6%). CONCLUSIONS: These result suggest that adjunctive medical therapy with tamsulosin after an ESWL increased the stone expulsion rate of ureteral stones, especially lower ureteral stones.
Benzilates ; Emergencies ; Humans ; Lithotripsy ; Nifedipine ; Nortropanes ; Shock ; Sulfonamides ; Ureter

PURPOSE: The aim of this study was to evaluate whether low-dose anticholinergics combined with an alpha1-receptor antagonist would continue the effect of an alpha-blocker, decrease the side effects of anticholinergics, and improve the symptoms of lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). MATERIALS AND METHODS: Two hundred nine men with LUTS/BPH with storage symptoms (International Prostate Symptom Score [IPSS] > or =12; storage symptoms > or =4) were randomly assigned in a prospective, multicentered, and single-blind fashion to either the control group (alfuzosin 10 mg, once daily) or the combined group (alfuzosin 10 mg, once daily, and propiverine 10 mg, once daily) for 2 months. IPSS, maximal urinary flow rate (Qmax), and postvoid residual volume (PVR) were used to grade symptoms, side effects, and the impact on quality of life (QoL) at the start of the study and after 1 and 2 months. RESULTS: There were no significant differences in patient background, including age, prostate size, Qmax, and PVR, between the control group and the combined group. In the combined group, the IPSS total score and the IPSS storage symptom score were significantly improved compared with the control group. The IPSS voiding symptom score, QoL, Qmax, and PVR did not differ significantly. There were no serious side effects in either group. CONCLUSIONS: Management with an alpha1-receptor antagonist combined with a low-dose anticholinergic improved the total score and storage symptom score of the IPSS compared with alpha1-receptor antagonist only group without causing serious side effects. This initial combination medication can be considered an effective and safe treatment modality for LUTS/BPH patients with storage symptoms.
Benzilates ; Cholinergic Antagonists ; Humans ; Male ; Prospective Studies ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Residual Volume ; Urinary Tract

PURPOSE: Typically in Korea, for a standard dose (0.4 mg) of tamsulosin, two low doses (0.2 mg) are administered. The aim of this study was to evaluate and compare the efficacy of tamsulosin (0.2 mg and 0.4 mg) and alfuzosin (10 mg) in the treatment of lower ureteral stones. MATERIALS AND METHODS: A total of 141 patients presenting with a single 4- to 10-mm sized lower ureteral stone were randomly assigned to 4 groups. Patients in group 1 (n=41) and group 2 (n=30) received an oral dose of 0.2 mg tamsulosin once and twice daily, respectively, and patients in group 3 (n=36) received a daily oral dose of 10 mg alfuzosin. Patients in group 4 (n=34) received trospium chloride only. The spontaneous passage of stones, the stone expulsion time, and adverse effects were evaluated. RESULTS: There were no significant differences in patient background, including age, sex, BMI, stone size, stone side, and symptom duration. The spontaneous stone passage rate through the ureter was higher and the stone expulsion time was faster in groups 1, 2, and 3 than in group 4. There were no statistically different changes in groups 1, 2, and 3. The adverse effects observed in all groups were comparable and were mild. CONCLUSIONS: Tamsulosin at 0.2 mg and 0.4 mg and alfuzosin (10 mg) proved to be safe and effective. A first cycle of medical expulsive therapy with tamsulosin 0.2 mg could be considered as an option in the management of single lower ureteral stone.
Benzilates ; Humans ; Korea ; Nortropanes ; Prospective Studies ; Quinazolines ; Sulfonamides ; Ureter ; Ureteral Calculi

PURPOSE: Antimuscarinic therapy remains one of the most common forms of therapy for overactive bladder (OAB) in children. However, few clinical studies on the outcomes of antimuscarinics in children with OAB have been published. Therefore, we evaluated the efficacy and safety of propiverine, which is frequently prescribed for the treatment of pediatric OAB. MATERIALS AND METHODS: We retrospectively reviewed children with OAB treated with propiverine within the past 5 years. The response rates were compared between the non-urge incontinence (non-UI) and urge incontinence (UI groups). The cumulative response rate by treatment duration was also compared between the two groups. RESULTS: Among a total of 68 children, 50 children (73.5%) experienced UI. The overall response rate was 86.8%. Functional bladder capacity after treatment was 150 ml, which represented an increase compared with the value (140 ml) before treatment. The voiding frequency per day decreased from 14.0 to 8.5 times. The overall response rate (88.0%) in the non-UI group was not significantly different from that seen in the UI group (83.3%; p>0.05). In non-UI children, the cumulative response rates were 36.0%, 54.0%, 68.0%, 74.0%, 76.0%, and 78.0% at 4, 8, 12, 16, 20, and 24 weeks, respectively. The cumulative response rates in the UI children were 11.1%, 33.3%, 44.4%, 50.0%, 50.0%, and 55.6%, respectively during the same respective time periods. Adverse effects were identified in only two (2.9%) patients, and neither case was severe. CONCLUSIONS: Propiverine is effective and well tolerated as a treatment for children suffering from OAB with or without UI.
Benzilates ; Child ; Humans ; Muscarinic Antagonists ; Retrospective Studies ; Stress, Psychological ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence, Urge

PURPOSE: We evaluated the efficacy and safety of combined therapy with an alpha-blocker (tamsulosin 0.2 mg) and low-dose anti-cholinergics (propiverine HCl 10 mg) in patients with benign prostatic hyperplasia (BPH) accompanied by overactive bladder (OAB) symptoms. MATERIALS AND METHODS: This prospective study enrolled 119 male patients with lower urinary tract symptoms (LUTS) with prostate volume of 20 ml or greater, International Prostate Symptom Score (IPSS) of more than 8, and OAB symptoms from May 2007 to April 2008. Patients with post-void residual volume (PVR) over 100 ml were excluded. Among these patients, 74 patients were treated with tamsulosin 0.2 mg plus propiverine HCl 10 mg (group A) and 45 patients were treated with tamsulosin 0.2 mg only (group B). The clinical parameters, including IPSS, quality of life (QoL) score, uroflowmetry, and PVR were re-evaluated after 3 months. RESULTS: A total of 115 patients, including 70 in group A and 45 in group B, completed the study. IPSS, QoL score, voided volume, maximum flow rate (Qmax), and PVR showed significant improvement after 3 months of treatment (p<0.05). Baseline characteristics between the 2 groups were not significantly different for any parameter (p>0.05). Changes in the QoL score were -1.9+/-1.1 and -1.5+/-0.9 for group A and group B, respectively (p=0.043). Changes in all other parameters were not significantly different between the 2 groups (p>0.05). CONCLUSIONS: For those patients with LUTS due to BPH and concomitant OAB, combination therapy with an alpha-blocker (tamsulosin 0.2 mg) and low-dose anti-cholinergics (propiverine HCl 10 mg) may be a reasonable and effective therapeutic option as an initial therapy.
Benzilates ; Cholinergic Antagonists ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prospective Studies ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Residual Volume ; Sulfonamides ; Urinary Bladder, Overactive

PURPOSE: We investigated the effect of propiverine on cystometric parameters based on intraabdominal pressure (IAP) in awake rats in an overactive bladder (OAB) model induced by intravesical instillation of prostaglandin E2 (PGE2). MATERIALS AND METHODS: Twenty-two female Sprague-Dawley rats were used. Polyethylene catheters were implanted into the bladder to record the intravesical pressure (IVP) and into the femoral artery to administer medication. A balloon-fitted catheter was positioned in the abdominal cavity to record the IAP. Awake cystometries were performed before and after intraarterial administration of propiverine 1 mg/kg (n=6), intravesical administration of 50microM PGE2 only (n=6), or intravesical PGE2 plus 1 mg/kg (n=4) or 3 mg/kg (n=6) of intraarterial propiverine. Cystometric pressure and volume parameters and variables related to detrusor overactivity (DO) were investigated. RESULTS: Rats administered intravesical PGE2 showed increased pressure parameters and decreased volume parameters comparable to the DO model, which was effectively prevented by propiverine (1 or 3 mg/kg). Typical DO shown during the filling phase was decreased by intraarterial propiverine (3 mg/kg) injection. After propiverine (3 mg/kg) injection, IAP was increased at the time of micturition pressure with or without threshold pressure (p<0.05, p<0.01) depending on the dose administered. CONCLUSIONS: Propiverine improved pressure- and volume-related parameters in an OAB model. Furthermore, it also decreased the frequency of DO. However, higher concentrations of propiverine induced straining voiding.
Abdominal Cavity ; Administration, Intravesical ; Animals ; Benzilates ; Catheters ; Dinoprostone ; Female ; Femoral Artery ; Humans ; Polyethylene ; Prostaglandins ; Rats ; Rats, Sprague-Dawley ; Sprains and Strains ; Urinary Bladder ; Urinary Bladder, Overactive ; Urination ; Urodynamics

PURPOSE: Central nervous system (CNS) and cardiovascular system (CVS) side effects of anticholinergic agents used to treat overactive bladder (OAB) are underreported. Hence, this review aimed to focus on the mechanisms of CNS and CVS side effects of anticholinergic drugs used in OAB treatment, which may help urologists in planning the rationale for OAB treatment. MATERIALS AND METHODS: PubMed/MEDLINE was searched for the key words "OAB," "anticholinergics," "muscarinic receptor selectivity," "blood-brain barrier," "CNS," and "CVS side effects." Additional relevant literature was determined by examining the reference lists of articles identified through the search. RESULTS: CNS and CVS side effects, pharmacodynamic and pharmacokinetic properties, the metabolism of these drugs, and the clinical implications for their use in OAB are presented and discussed in this review. CONCLUSIONS: Trospium, 5-hydroxymethyl tolterodine, darifenacin, and solifenacin seem to have favorable pharmacodynamic and pharmacokinetic properties with regard to CNS side effects, whereas the pharmacodynamic features of darifenacin, solifenacin, and oxybutynin appear to have an advantage over the other anticholinergic agents (tolterodine, fesoterodine, propiverine, and trospium) with regard to CVS side effects. To determine the real-life situation, head-to-head studies focusing especially on CNS and CVS side effects of OAB anticholinergic agents are urgently needed.
Benzhydryl Compounds ; Benzilates ; Benzofurans ; Cardiovascular System* ; Central Nervous System* ; Cholinergic Antagonists* ; Cresols ; Mandelic Acids ; Metabolism ; Pyrrolidines ; Quinuclidines ; Receptors, Muscarinic ; Tetrahydroisoquinolines ; Urinary Bladder, Overactive* ; Solifenacin Succinate

OBJECTIVETo provide a useful biological index for clinical diagnosis of Alzheimer's disease (AD) by determination the functional changes in the central cholinergic nerve and their effects on the peripheral lymphatic system.

METHODSThe learning and memory impairment model was established through intraventricular injecting quinolinic acid (QA) repeatedly.

RESULTSThere was a significant decline of cholineacetyltransferase (ChAT) in cerebral cortex and hippocampus after QA injection. The significantly lower binding activities of acetylcholine muscarinic (M) and nicotinic (N) cholinergic receptors in the hippocampus and cortex in the QA group were found as compared with the sham-operated group (P < 0.01). Similar changes were found in the binding activities of M-and N-receptors on spleen lymphocytes.

CONCLUSIONCertain lesion of the central nervous system can be reflected in peripheral spleen lymphocytes, which may be an important reference to diagnose the changes of the central nervous system.

Alzheimer Disease ; etiology ; Animals ; Brain ; drug effects ; Choline O-Acetyltransferase ; metabolism ; Disease Models, Animal ; Learning ; drug effects ; Male ; Memory ; drug effects ; Nicotine ; metabolism ; Quinolinic Acid ; toxicity ; Quinuclidinyl Benzilate ; metabolism ; Rats ; Rats, Wistar ; Receptors, Cholinergic ; analysis ; drug effects

OBJECTIVETo investigate the changes of spontaneous and cognitive behavior, and cholinergic M receptors in the brain of mice subjected to chronic mild stress (CMS), and to determine the effect of Ning Shen Ling Granule (NSL) and dehydroepiandrosterone (DHEA) on them.

METHODSCMS model mice were established by applying stress every day for 3 consecutive weeks with 7 kinds of unforeseeable stress sources, and they were medicated for 1 week beginning at the 3rd week of modeling. The changes in behavior were determined by Morris Water Maze and spontaneous movement test, and M-receptor binding activity in cerebral cortex, hippocampus and hypothalamus were measured by radioactive ligand assay with 3H-QNB.

RESULTS(1) The spontaneous movement in CMS model mice was significantly reduced, with the latency for searching platform in Morris Water Maze obviously prolonged (P<0.01), and these abnormal changes in behavior were improved in those treated with NSL and DHEA. (2) The binding ability of M-receptor in cerebral cortex and hippocampus of CMS mice was significantly decreased as compared with those in the control group (P<0.05), but could be restored to the normal level after intervention with NSL or DHEA.

CONCLUSIONThe decline of spontaneous movement and spatial learning and memory ability could be induced in animals by chronic mild stress, and that may be related to the low activity of central cholinergic M-receptors. Both NSL and DHEA could effectively alleviate the above-mentioned changes.

Animals ; Cerebral Cortex ; metabolism ; Chronic Disease ; Cognition ; drug effects ; Dehydroepiandrosterone ; pharmacology ; Drugs, Chinese Herbal ; pharmacology ; Male ; Maze Learning ; drug effects ; Memory ; drug effects ; Mice ; Mice, Inbred Strains ; Movement ; drug effects ; Quinuclidinyl Benzilate ; metabolism ; Receptors, Muscarinic ; metabolism ; Severity of Illness Index ; Stress, Physiological ; metabolism ; physiopathology ; psychology ; Swimming