ALFUZOSIN VS. PLACEBO

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boulder
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Re: ALFUZOSIN VS. PLACEBO

Post by boulder »

A 2006 study by Dr. Nickel found alfuzosin 10mg/day beneficial for LUTS, ED, and painful ejaculation:

http://pubmed.ncbi.nlm.nih.gov/16686719
BJU Int. 2006 Jun;97(6):1242-6.

The beneficial effect of alfuzosin 10 mg once daily in 'real-life' practice on lower urinary tract symptoms (LUTS), quality of life and sexual dysfunction in men with LUTS and painful ejaculation.

Nickel JC, Elhilali M, Emberton M, Vallancien G; The Alf-One Study Group.

Department of Urology, Queen's University, Kingston, ON, Canada. [email protected]

OBJECTIVE: To determine the efficacy and safety of the selective alpha(1)-blocker alfuzosin in men with lower urinary tract symptoms (LUTS) and painful ejaculation, compared with those with LUTS only, as painful ejaculation is one of the most prevalent, differentiating and bothersome symptoms in men with chronic prostatitis/chronic pelvic pain syndrome.

PATIENTS AND METHODS: In all, 4857 sexually active men with LUTS had an evaluable answer to the Danish Prostate Symptom Score for Sexual Symptoms question related to pain/discomfort on ejaculation at enrolment in a 6-month open-label study with alfuzosin 10 mg once daily. Efficacy was analysed at the endpoint in the intent-to-treat population.

RESULTS: Of the 4857 men, 997 (20.5%) had pain/discomfort on ejaculation and 889/997 (89.2%) considered it was a problem. At inclusion, men with painful ejaculation had more severe LUTS and bother than men with LUTS only. Erectile dysfunction (ED) and reduced ejaculation were more prevalent (74.5% and 71.9%, respectively) and bothersome in men with painful ejaculation than in those with no pain (59.6% and 57.4%, respectively). Under alfuzosin treatment, all variables in both groups significantly improved from baseline; men with painful ejaculation compared to LUTS-only had similar improvements in weighted scores for LUTS (-7.8 vs -7.7), bother (-1.7 vs -1.7), and reduced ejaculate (-0.5 vs -0.4) but greater improvements in ED (-0.6 vs -0.4; P < 0.001). The weighted score for painful ejaculation decreased from 2.2 to 0.8 (P < 0.001). Alfuzosin was well tolerated in both groups.

CONCLUSIONS: This 6-month open-label study suggests that alfuzosin 10 mg once daily significantly improves LUTS, quality of life and sexual function in men with prostatitis-like symptoms, and is well tolerated.

PMID: 16686719 [PubMed - indexed for MEDLINE]
Should we consider this overturned by the results of Dr. Nickel's new multi-center study? Or might there be some significance to that fact that the study abstracted here lasted six months, twice as long the new one? Sorry if I'm speculating too eagerly on this thread, I'll admit I'm way out of my league and this stuff perplexes me... Now might be a good time to state again that I am definitely (obviously!) not a doctor of any kind! :)
Age: 36 | Onset Age: 29 (Summer 2005) Main Symptoms (all intermittent): penile/anal/rectal/perineum pain/numbness/tingling/coldness, LUTS, ED | Helped By: duloxetine (Cymbalta), topical benzocaine, occasional benzodiazepines, hot weather, hot baths, understanding friends & family, pushing myself to be more sociable and active, psychotherapy (mostly CBT), diaphragmatic breathing, relaxation, meditation (concentration and mindfulness), adequate sleep | Worsened By: cold weather, stress, inadequate sleep, prolonged sitting or standing in place, walking uphill, heavy exercise, erection/ejaculation (sometimes)
Last But Not Least: I am not a medical/health professional of any kind. This is not medical advice.
latte
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Re: ALFUZOSIN VS. PLACEBO

Post by latte »

I took Flomax for a couple years and it did help with the voiding symptoms but not with the pain. I could pee better which helped. I was surprised to find that after I discontinued the Flomax it was hard to pee for a short while but then I seemed to be back to normal. It had a minimally positive effect. The main side effect was retrograde ejaculation which bothered me. I was glad to stop taking it. Also, hello to JD from San Diego. Hope you are doing well.
Age: | Onset Age: | Symptoms: | Helped By: | Worsened By: | Other comments:
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J Dimitrakov
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Re: ALFUZOSIN VS. PLACEBO

Post by J Dimitrakov »

latte wrote:Also, hello to JD from San Diego. Hope you are doing well.
Thanks, latte
This communication provides general information, and is not a substitute for face-to-face medical care. A doctor-patient relationship should not be assumed by the reader.
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Re: ALFUZOSIN VS. PLACEBO

Post by J Dimitrakov »

boulder wrote:A 2006 study by Dr. Nickel found alfuzosin 10mg/day beneficial for LUTS, ED, and painful ejaculation:

http://pubmed.ncbi.nlm.nih.gov/16686719
BJU Int. 2006 Jun;97(6):1242-6.

The beneficial effect of alfuzosin 10 mg once daily in 'real-life' practice on lower urinary tract symptoms (LUTS), quality of life and sexual dysfunction in men with LUTS and painful ejaculation.

Nickel JC, Elhilali M, Emberton M, Vallancien G; The Alf-One Study Group.

Department of Urology, Queen's University, Kingston, ON, Canada. [email protected]

OBJECTIVE: To determine the efficacy and safety of the selective alpha(1)-blocker alfuzosin in men with lower urinary tract symptoms (LUTS) and painful ejaculation, compared with those with LUTS only, as painful ejaculation is one of the most prevalent, differentiating and bothersome symptoms in men with chronic prostatitis/chronic pelvic pain syndrome.

PATIENTS AND METHODS: In all, 4857 sexually active men with LUTS had an evaluable answer to the Danish Prostate Symptom Score for Sexual Symptoms question related to pain/discomfort on ejaculation at enrolment in a 6-month open-label study with alfuzosin 10 mg once daily. Efficacy was analysed at the endpoint in the intent-to-treat population.

RESULTS: Of the 4857 men, 997 (20.5%) had pain/discomfort on ejaculation and 889/997 (89.2%) considered it was a problem. At inclusion, men with painful ejaculation had more severe LUTS and bother than men with LUTS only. Erectile dysfunction (ED) and reduced ejaculation were more prevalent (74.5% and 71.9%, respectively) and bothersome in men with painful ejaculation than in those with no pain (59.6% and 57.4%, respectively). Under alfuzosin treatment, all variables in both groups significantly improved from baseline; men with painful ejaculation compared to LUTS-only had similar improvements in weighted scores for LUTS (-7.8 vs -7.7), bother (-1.7 vs -1.7), and reduced ejaculate (-0.5 vs -0.4) but greater improvements in ED (-0.6 vs -0.4; P < 0.001). The weighted score for painful ejaculation decreased from 2.2 to 0.8 (P < 0.001). Alfuzosin was well tolerated in both groups.

CONCLUSIONS: This 6-month open-label study suggests that alfuzosin 10 mg once daily significantly improves LUTS, quality of life and sexual function in men with prostatitis-like symptoms, and is well tolerated.

PMID: 16686719 [PubMed - indexed for MEDLINE]
Should we consider this overturned by the results of Dr. Nickel's new multi-center study? Or might there be some significance to that fact that the study abstracted here lasted six months, twice as long the new one? Sorry if I'm speculating too eagerly on this thread, I'll admit I'm way out of my league and this stuff perplexes me... Now might be a good time to state again that I am definitely (obviously!) not a doctor of any kind! :)
These are great questions and some of the answers can be found in my meta-analysis of treatment of CPPS. The full text is available for free in PubMed Central and can be accessed by following the link below (look at the results and discussion sections on alpha blockers)

http://www.pubmedcentral.nih.gov/articl ... id=1463048

Best,
JD
This communication provides general information, and is not a substitute for face-to-face medical care. A doctor-patient relationship should not be assumed by the reader.
Jordan Dimitrakov, M.D., Ph.D.
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Jay
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Re: ALFUZOSIN VS. PLACEBO

Post by Jay »

Dr. Dimitrakov,

I just wanted to thank you for posting so much interesting information, and more currently, for keeping us updated on interesting reports at the AUA meeting.

For what it's worth, my experience with Flomax has been similar to latte's. I've been on it for about four months now, since the onset of my worsened pain. It may be offering some benefit, but if so, it's minor enough that I actually haven't noticed its absence after forgetting to take the pill.
I am not a physician. This is not medical advice. Consult your doctor!

Age: 26 Onset Age: 17 Symptoms: Shooting, nerve-like pains throughout the penis, which abruptly hit and leave. Testicular pain, perineum pain, burning/irritative urination, extended pain after ejaculation. Occasionally, some allodynia or ache in the coccyx/sacrum/thigh/buttocks/legs. Diagnosis: Pelvic floor dysfunction, degenerated lumbar disk, and mildly herniated lumbar disk. Helped By: Physical therapy, pain management doctor, hot baths, therapy pool, stretching regimen, breathing exercises, relaxation, distraction. Worsened By: Arousal/ejaculation (worst), constipation, panicking/obsessing, other triggers depend upon current symptoms. Tests/Prior Treatments: Too many antibiotics to count, multiple urine tests (all normal), testicular ultrasound (normal), bladder and renal ultrasound (normal), lumbar and pelvic MRI with and w/o contrast (revealed disk problems), Elavil 25mg (caused retention), Flomax 0.4mg.
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J Dimitrakov
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Re: ALFUZOSIN VS. PLACEBO

Post by J Dimitrakov »

Jay wrote:Dr. Dimitrakov,

I just wanted to thank you for posting so much interesting information, and more currently, for keeping us updated on interesting reports at the AUA meeting.

For what it's worth, my experience with Flomax has been similar to latte's. I've been on it for about four months now, since the onset of my worsened pain. It may be offering some benefit, but if so, it's minor enough that I actually haven't noticed its absence after forgetting to take the pill.
Hi, Jay,

Glad the info is helpful. I cannot comment on the study results but I believe that the condition is certainly multifactorial and also patients go through different stages where different strategies might help

Best,
JD
This communication provides general information, and is not a substitute for face-to-face medical care. A doctor-patient relationship should not be assumed by the reader.
Jordan Dimitrakov, M.D., Ph.D.
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