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Comparison of the Efficacy and Safety of Alfuzosin and Tamsulosin In Joodi A Jalo (2020): Effect of selective and nonselective alpha blocking agents in Iraqi patients with BPH Oct 2020 Vol. 23 Issue 14 Comparison of the efficacy and safety of alfuzosin and tamsulosin in relieving lower urinary tract symptoms in Iraqi patients with benign prostatic hyperplasia (BPH): Observational case reference study Mohammed Ridha Joodi A. Jalo*M.B.ch.B/ FICMS (uro.) 1. Department of Surgery, College of Medicine ,University of Babylon, Hilla, Iraq *Corresponding author Dr. Mohammed Ridha Joodi A. Jalo Department of Surgery, College of Medicine, University of Babylon, Hilla, Iraq. E-mail: [email protected] Phone number: 009647809113938 Abstract Background:The main stay in non-surgical management of benign prostatic hyperplasia (BPH) includes the use of “5-alpha reductase inhibitors” which act by inhibition of the production of dihydroxy testosterone, the active metabolite of testosterone with high affinity to androgen receptors. In addition selective and non-selective alpha receptors inhibitors are also used in the medical treatment of BPH. The basis behind using of alpha blocker is that a substantial proportion of prostatic enlargement is due to stromal hyperplasia containing a principal element of smooth muscle fibers that produce dynamic obstruction. Objectives: The current study was aiming at comparing the effect of selective and nonselective alpha blocking agents, tamsulosin and alfuzosin on size of prostate and “lower urinary tract symptoms” in a sample of Iraqi patients with BPH. Patients and methods: The current observational case reference study was conductedat the department of urology at Al-Hilla teaching hospital, Babylon province, Iraq. The work with this study started on September the 1st 2018 through July the 15th 2019. Three groups were included each one enrolled 20 patients with a diagnosis of BPH. The first group included patients who were recently diagnosed to have symptomatic BPH (n = 37) and are on no medical treatment or surgical intervention till time of starting the study. The second group included 45 patients already on medical treatment with the non-selective alfuzosin alpha blocking agent and the third group included 41 patients on the selective tamsulosin alpha blocking agent. Patients were included based on taking the treatment for at least one month duration. Results: The mean size of the prostate gland of patients within groups 1 and 2 was significantly less than that belonging to control category (P< 0.05). However, there has beeninsignificant variation in the mean size of the prostate gland between group 1 and group 2 (P> 0.05). Moreover, the mean IPSS of patients within groups 1 and 2 was significantly less than that belonging to control group (P< 0.05). However, there has been an insignificant variation in mean IPSS between group 1 and group 2 (P> 0.05).Conclusion: Based on data obtained from the current study and some previous reports, both alfuzosin and tamsulosin appear to be equally effective and safe in treating lower urinary tract symptoms in patients with BPH. Keywords: alfuzosin, tamsulosin, lower urinary tract symptoms, BPH, Iraq How to cite this article: Joodi A Jola MR (2020: Comparison of the efficacy and safety of alfuzosin and tamsulosin in relieving lower urinary tract sysmtoms in Iraqu with benign prostatic hyperplasia (BPH): Observational case reference study, Ann Trop Med & Public Health; 23(S14): SP231434. DOI: http://doi.org/10.36295/ASRO.2020.231434 Introduction One of the common medical conditions affecting elderly men is benign prostatic hyperplasia (BPH)(1). The disease is a form of a benign growth and hyperplasia affecting both glandular epithelium and stromal elements leading to enlargement of prostate size in different shapes and configuration with resultant “lower urinary tract symptoms” in Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2020.231434 Joodi A Jalo (2020): Effect of selective and nonselective alpha blocking agents in Iraqi patients with BPH Oct 2020 Vol. 23 Issue 14 significant proportion of elderly men (2).The etiology of the disease is rarely understood; however, a number of risk factors have identified in association with BPH (3). The prevalence of this condition has been observed to increase markedly with age based on observational epidemiological studies (4, 5) and autopsy studies (6). On the other hand it has been demonstrated that the size of the prostate gland becomes more with increasing age (7, 8). The association between incidence of BPH and race is not clear and researches with this regards have shown conflicting data. Some reports favored higher incidence rate among black race in comparison with white race (9); others denied such an observation and suggested lower incidence rate in Asian men in comparison with white race (10). Genetic predisposition has been suggested by some authors based on observation of BPH in relatively young men with lower urinary tract symptoms necessitating surgical intervention since follow reveals that their siblings are at much higher risk of developing BPH in comparison with general population (11).Some reports have shown that dietary habits may be associated with higher or lower risk of developing BPH (12-14). The molecular mechanism that underlies the development of BPH is till now incompletely understood; however, the role of androgens and estrogens is well established (15 -17). In normal physiological conditions, the regulation of prostate growth and function is greatly determined by sex steroid hormones. Both androgen and estrogen receptors have been found to be expressed by prostatic cells (17, 18). Nevertheless the variation in the level of expression of these receptors between normal prostate and BPH is controversial (17, 18). However, evidences for the role of androgen and estrogen signaling in the pathogenesis of BPH are supported by both animal experimental studies and studies on human being (17-10). Therefore, the main stay in non-surgicaltherapy of BPH include the use of “5-alpha reductase inhibitors” which act by inhibition of the production of dihydroxy testosterone, the active metabolite of testosterone with high affinity to androgen receptors (21). In addition selective and non-selective alpha receptors inhibitors are also used in the medical management of BPH. The basis behind using alpha blocker is that a substantial proportion of prostatic enlargement is due to stromal hyperplasia containing principal element of smooth muscle fibers that produce dynamic obstruction (22). The current study aims to comparing the effect of selective and nonselective alpha blocking agents, tamsulosin and alfuzosin on size of prostate and “lower urinary tract symptoms” in a sample of Iraqi patients with BPH. Patients and Methods The current observational case reference study was conductedat the department of urology at Al-Hilla teaching hospital, Babel province, Iraq. The work with this study started on September the 1st 2018 through July the 15th 2019. Three groups were included each one enrolled 20 patients with a diagnosis of BPH. The first group included patients who were recently diagnosed to have symptomatic BPH (n = 37) and are on no medical treatment or surgical intervention till time of starting the study. The second group included 45 patients already on medical treatment with the non-selective alfuzosin Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2020.231434 Joodi A Jalo (2020): Effect of selective and nonselective alpha blocking agents in Iraqi patients with BPH Oct 2020 Vol. 23 Issue 14 alpha blocking agent and the third group included 41 patients on the selective tamsulosin alpha blocking agent. Patients were included based on taking the treatment for at least one month duration. The main variables included in the current study included ultrasound assessment of size of prostate, age of patients, serum prostatic specific antigen (PSA), “International Prostate Symptom Score (IPSS), serum testosterone, serum estrogen and serum testosterone to estrogen ratio. The study was approved by the ethical approval committee of the institute and every patient was informed about the aim and the procedure of the current study and all patients gave verbal consent. The statistical workup was based on the statistical package for social science (SPSS) provided by (IBM, Chicago, USA, version 23). Qualitative variables were presented as number and percentage. The quantitative variables were presented as mean, range and standard deviation. One way ANOVA was used to assess difference in mean values among groups followed by post-hoc LSD test. The significance level was set at P ≤ 0.05. Results The characteristics of individualsparticipating in this study are demonstrated in table 1. Therewas no significant difference in mean age among groups (P> 0.05), 74.24 ±7.27 versus 75.09 ±6.93 versus 73.90 ±8.71 years, for control group, group 1 (patients on the non-selective alpha blocker, alfuzosin) and group 2 (patients on the selective alpha blocker, tamsulosin) respectively. There has been however, significant variation in mean prostate size among groups. The mean size of prostate gland of patients within group 1 was significantly lower than that of control group, 43.47 ±8.12 ml versus 45.65 ±5.60 ml, respectively (P< 0.05). Similarly, the mean size of prostate gland of patients within group 2 has been significantly less than that belonging to control group, 42.46 ±5.37 ml versus 45.65 ±5.60 ml, respectively (P< 0.05). However, there has been insignificant variation in mean size of prostate gland between group 1 and group 2 (P> 0.05). Moreover, there was significant difference in mean IPSS among groups. The mean IPSS of patients within group 1 was significantly lower than that of control group, 18.09 ±4.87 versus 22.95 ±5.19, respectively (P< 0.05). Similarly, the mean IPSS of patients within group 2 was significantly lower than that of control group, 17.61 ±4.59 versus 22.95 ±5.19, respectively (P< 0.05).
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