dutasteride + tamsulosin (Jalyn / Combodart / Duodart)

Emergency Management of Obstructing Ureteric Stones: A Closed-Loop Audit of Hot Ureteroscopy Uptake Against Getting It Right First Time (GIRFT) Standards.

Girgis Ayman E AE

National guidance recommends hot (same-admission) ureteroscopy and laser lithotripsy as the default definitive treatment for suitable obstructing ureteric stones, rather than defaulting to temporizing measures such as ureteric stent insertion. The primary aim was (1) to determine the proportion of emergency ureteric stone cases managed by hot ureteroscopy against the GIRFT standard. Secondary aims were (2) to describe the pattern of emergency management and identify deviations from evidence-based practice, and (3) to assess the impact of a targeted action plan on the hot ureteroscopy rate. In addition, this article reports emergent findings identified during data review, including inter-surgeon variation in hot ureteroscopy uptake and individual case-level governance considerations, which were not prespecified analyses but are presented descriptively for their quality-improvement value. Cycle 1 (baseline) captured all emergency ureteric stone admissions over a three-month period (March to May 2024). Following presentation of results and an agreed action plan, cycle 2 (re-audit) captured all surgically-managed cases over the subsequent three-month period (August to October 2024). The primary outcome was the proportion of surgically-managed cases treated by hot ureteroscopy. Cycle 1 identified 48 admissions, of which 22 were managed surgically; hot ureteroscopy was performed in only five (22.7%), with 17 (77%) judged retrospectively suitable. Tamsulosin was prescribed for all conservatively-managed stones regardless of size or location, contrary to trial and guideline evidence discussed below. Following the action plan, cycle 2 identified 20 surgically-managed cases; hot ureteroscopy rose to 10 (50%), more than doubling cycle 1's rate. Seven of the 10 stented-only cases were retrospectively judged suitable for hot ureteroscopy; individual surgeon rates ranged up to 100%, against a department average of 50%. A structured closed-loop audit with an explicit action plan more than doubled the hot ureteroscopy rate for obstructing ureteric stones, moving practice closer to national standards. Residual missed opportunities and surgeon-level variation support a dedicated hot ureteroscopy list and further audit cycles.

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