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Practitioner 2011; 255 (1738): 13

Improving lower urinary tract symptoms in men with BPH

23 Mar 2011Registered users

Silodosin, a new alpha-blocker, shows promise in the treatment of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). A total of 955 men, aged >50 years, with LUTS caused by BPH were randomised (2:2:1) to receive either silodosin 8 mg, tamsulosin 400 µg or placebo for a 12-week period following a 4-week placebo run in. Importantly, the study was powered to show superiority of silodosin to placebo, but only non-inferiority to tamsulosin. Response was measured in terms of change from baseline in International Prostate Symptom Score (IPSS), storage and voiding subscores, quality of life due to urinary symptoms and maximum urinary flow rate (Qmax). Silodosin is super-selective for the α1A receptor (50 to 100 times more selective) which should in theory mean that it is better tolerated in terms of cardiovascular side effects, and even more efficacious in terms of improving LUTS. 'Although the study demonstrated silodosin's superiority to placebo and non-inferiority to tamsulosin an adequately powered study is needed to determine whether silodosin can be shown to be clinically significantly superior to tamsulosin. Further research is required to see if non-responders to tamsulosin respond to silodosin and whether the long-term effectiveness of silodosin is better than that of tamsulosin. There is a fair way to go before silodosin has an established role in the management of LUTS caused by BPH.'

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