Seok-Soo Byun

Effects of initial combined tamsulosin and solifenacin therapy for overactive bladder and bladder outlet obstruction secondary to benign prostatic hyperplasia: a prospective, randomized, multicenter study

PurposeThe purpose of the study is to evaluate the clinical efficacy of initial combined therapy of an alpha-blocker and anticholinergic agent compared with the alpha-blocker alone in patients with benign prostatic hyperplasia (BPH) with overactive bladder (OAB).MethodsHundred and fifty-six BPH patients with International Prostate Symptom Score (IPSS) of over 14 (voiding sub-score ≥8 and storage sub-score ≥6) were prospectively included in Korea. Group 1 (nxa0=xa069) was the patients who were treated with Tamsulosin 0.2xa0mg daily alone for 4xa0weeks and after 8xa0weeks they were treated with tamsulosin 0.2xa0mg and solifenacin 5.0xa0mg daily combination. Group 2 (nxa0=xa070) was the patients who were treated initially with tamsulosin 0.2xa0mg and solifenacin 5.0xa0mg combination for 12xa0weeks. Detailed questionnaires were used to assess treatment satisfaction at 4th week and at 12th week of treatment in 2 groups.ResultsBaseline characteristics were not different between the 2 groups. In the 4th week, there was no difference between the 2 groups with regard to IPSS total score and voiding symptom score, although the IPSS storage symptom score was significantly lower in the Group 2 [−2.0 (0.2) △23.8 vs. −3.0 (0.2) △35.7] (Pxa0<xa00.001). In the 12th week, there was improvement in storage indices such as IPSS storage symptom score, OABSS, and urgency symptoms compared with baseline in each group (Pxa0<xa00.001). No statistical differences in storage indices observed between the two groups at 12 week.ConclusionsEarlier treatment with alpha-blocker and anticholinergic agent helped to improve storage symptoms and quality-of-life scores earlier for patients with lower urinary tract symptoms related to BPH and OAB symptoms.

Diabetes Mellitus as an Independent Predictor of Survival of Patients Surgically Treated for Renal Cell Carcinoma: A Propensity Score Matching Study

PURPOSEnControversy continues about the prognostic significance of diabetes mellitus in patients with renal cell carcinoma. We investigated the relationship between diabetes mellitus and prognosis in patients with renal cell carcinoma who underwent surgical treatment.nnnMATERIALS AND METHODSnWe reviewed data on 3,075 consecutive patients treated with radical or partial nephrectomy for nonmetastatic renal cell carcinoma from 1988 to 2013. The propensity score of a diabetes mellitus history was calculated and 417 patients with diabetes were matched to 814 without diabetes in a 1:2 ratio. The potential association of preexisting diabetes and preoperative HbA1c with outcomes was tested. Univariate and multivariate analyses were performed to identify independent predictors of progression-free, cancer specific and overall survival.nnnRESULTSnBefore matching, patients with diabetes showed worse prognosis in terms of progression-free, overall and cancer specific survival (each p<0.001). In matched cohorts 1,231 patients with diabetes showed progression-free (p=0.001), cancer specific (p<0.001) and overall survival (p<0.001) inferior to that in patients without diabetes. On multivariate analyses diabetes was an independent predictor of disease progression (HR 1.766 p=0.002), all cause mortality (OR 1.825, p=0.001) and cancer specific mortality (HR 2.266, p=0.001). Among patients with diabetes who had available preoperative HbA1c data high HbA1c independently predicted postoperative disease progression (HR 2.221, p=0.023).nnnCONCLUSIONSnDiabetes mellitus is an independent predictor of cancer specific and overall survival in patients who undergo surgery for renal cell carcinoma. Also, in patients with diabetes mellitus poor glycemic control is associated with a higher risk of progression.