tamsulosin (Hanmi Tams / tamsulosin, Hanmi / HIP 1402)

Efficacy of cetirizine, tamsulosin and their combination as medical expulsive therapy for distal ureteral stones: a prospective randomized study.

Hasan Ahmed Mahmoud AM, Ahmed Amr Alameldeen AA, Sayed Reham Farouk RF, AbdelRazek Mostafa M

Background The management of ureteral stones, particularly those measuring less than 10 mm, has garnered considerable attention in urological research, with the goal of enhancing non-invasive treatment methods. Medical expulsive therapy is notable for its low invasiveness and cost. To assess the efficacy and safety of tamsulosin alone, cetirizine alone, as well as their combination in treating distal ureteric stones sized 5-10 mm. Between March 2021 and March 2024, patients presented with lower ureteral stones 5-10 mm were randomly assigned to four groups: group A (121 patients) took tamsulosin 0.4 mg; group B (120 patients) took cetirizine 5 mg; group C (119 patients) took a combination of tamsulosin 0.4 mg and cetirizine 5 mg; and group D (120 patients) received analgesics on demand as a control group. We evaluated stone passage rates, time required for stone expulsion, total analgesic dosage, and any recorded side effects. All outcomes were recorded and analyzed accordingly. Group C exhibited the highest rate of stone expulsion among all groups (85.8% vs. 67%, 55%, and 25% in groups A, B, and D respectively, p = 0.0001). Group C had a substantially shorter time required for stone expulsion in comparison with groups A, B, and D (13.15 ± 5.3 days vs. 14.95 ± 6.95, 17.57 ± 6.21, and 20.94 ± 5.58 days respectively, p < 0.0001). A statistically significant reduction in the total analgesic requirements was demonstrated in group C (p < 0.0001). Except for retrograde ejaculation which was evident in groups A and C (40 %, 37.7 % respectively versus 0% in the other groups, p < 0.0001), no substantial variations regarding the side effects were observed among the groups. Combined therapy with tamsulosin and cetirizine significantly improves stone expulsion rate, shortens expulsion time, and reduces analgesic requirements compared with either therapy alone.

Author's Response to "Letter to the Editor: Sex Imbalance and the Interpretation of Tamsulosin Efficacy in Hip Fracture Surgery".

Tripathy Sujit Kumar SK, Varghese Paulson P, Khan Shahnawaz S, Patel Ranjan Kumar RK et al.

Postoperative urinary retention (POUR) is a clinically relevant complication following hip-fracture surgery. In response to concerns regarding the marked sex imbalance between treatment groups in the TamPOUR-Hip randomized trial, we further examined the influence of sex on the observed treatment effect of perioperative tamsulosin. Although the crude incidence of POUR was lower in the tamsulosin group than in the placebo group (16.7% vs 33.3%), adjustment for potential confounders demonstrated no independent protective effect of tamsulosin (adjusted odds ratio 0.99, 95% confidence interval 0.16-5.82; P = 0.990). Female sex emerged as a strong independent predictor of POUR. Overall, POUR occurred in 24 of 54 women (44.4%) compared with 6 of 66 men (9.1%), while sex-stratified analyses showed no significant treatment effect within either subgroup. Previous studies have similarly reported a relatively high incidence of urinary retention among women undergoing hip-fracture surgery. These findings indicate that the apparent crude reduction in POUR with tamsulosin was largely influenced by unequal sex distribution rather than an independent pharmacological effect. Nevertheless, tamsulosin was associated with lower pre-void and post-void bladder volumes, suggesting improved bladder emptying. Future adequately powered trials should incorporate sex-stratified or block randomization and prespecified sex-specific analyses to better define the role of sex and tamsulosin in POUR prevention after hip-fracture surgery.

Letter to the Editor: Sex Imbalance and the Interpretation of Tamsulosin Efficacy in Hip Fracture Surgery.

Sağlıcak Harun H

Acute Urinary Retention Leading to Post-renal Acute Kidney Injury Post-radiotherapy: A Case Report.

Bitterman Brayden B, Vaishampayan Nitin N, Hart Kimberly B KB, Boggula Ramesh R et al.

A man in his 70s with high-risk localized prostate adenocarcinoma underwent definitive external beam radiotherapy (EBRT) to the prostate and pelvis with concurrent androgen deprivation therapy using leuprolide. Eight days after completion of radiotherapy, he developed acute urinary retention (AUR) with overflow incontinence, constipation, and post-renal acute kidney injury (AKI), requiring hospitalization and bladder decompression with Foley catheter placement. Initial urine output was approximately 1 liter, and creatinine improved from 4.89 mg/dL to 1.46 mg/dL after decompression. Imaging demonstrated mild left hydronephrosis and chronic renal disease without an obstructing calculus. He was discharged home on tamsulosin and a bowel regimen with a Foley catheter in place. Persistent catheter dependence subsequently required transurethral resection of the prostate (TURP) with improvement in symptoms. This case report describes a case of severe acute urinary retention with post-renal acute kidney injury occurring shortly after prostate and pelvic radiotherapy. The obstruction was likely multifactorial, with radiation-associated inflammation or edema potentially aggravating the underlying outlet issues and constipation. Prompt recognition and bladder decompression may permit rapid renal recovery and are important in patients with reduced renal reserves.