Evaluation of the treatment pattern, clinical outcomes, and quality of life in patients with bladder outlet obstruction in a South Indian hospital

Radhakrishnan, Rajesh and Mohan, Nitha and Chawla, Arun (2009) Evaluation of the treatment pattern, clinical outcomes, and quality of life in patients with bladder outlet obstruction in a South Indian hospital. The Journal of Medicine Use in Developing Countries, 1 (3). pp. 14-23.

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Abstract

This study provides an insight into the assessment of the treatment pattern, clinical outcome with bladder outlet obstruction and to assess the safety and efficacy of 0.2 mg and(0.4 mg tamsulosin and quality of life in female patients with bladder outlet obstruction in a tertiary care teaching hospital in South India. This was a randomised controlled study conducted for eight months at Dept. of Urology, Kasturba Hospital, Manipal. The treatment patterns were analyzed with respect to medical treatment or surgical procedures adapted to the patient. The American Urological Association Symptom Score (AUASS) was adopted to assess the severity of urinary symptoms and to check the effectiveness of the treatment. The percentage of improvement of treatment was also assessed in terms of both objective and subjective parameters like Maximum Flow Rate (MFR), Post Voidal Residual Volume (PVR) and bladder thickness. Female patients were randomised into two groups, first group of patients receiving (0.2 mg of tamsulosin) while second group of patients receiving (0.4 mg of tamsulosin) daily for a period of two months with periodic follow up at 2nd , 4 th and 8 th week, assessed with IPSS (International Prostate Symptom Score) and uroflowmetry and ultrasonography at 8 th week. The quality of life in female patients with bladder outlet obstruction was evaluated by using the quality of life questionnaire. A total number of 177 patients diagnosed with bladder outlet obstruction were aged between 55 to 65 years and males (n=152) predominated over females (n=25). Weak stream urinary symptoms were found to be the highest complained symptom. The co morbidities associated with bladder outlet obstruction was hypertension. Surgery was the main line of treatment in patients with bladder outlet obstruction. Tamsulosin was the most implicated drug in the medical group. The most common surgical procedure performed was transurethral resection of the prostate. The results of both objective and subjective parameters for all types of treatment in the bladder outlet obstruction showed that highest percentage of improvement in the surgical group. The safety and efficacy of tamsulosin in female patients showed that patients were having AUASS score between 8-19 (moderate) before treatment and most of them showed an improvement in the score from moderate to mild (1-7) after treatment. The subjective parameters showed that the female patients had an MFR value of < 15ml/s before treatment and have improved after treatment from < 15ml/s to >15ml/s. The PVR values were >50ml in all patients before treatment and < 50ml after treatment. The bladder thickness showed a reduction from > 5mm to < 2.5mm. Our results show tamsulosin to be very effective in the management of bladder outlet obstruction in female patient if detected early. The results of the quality of life questionnaire showed that most of the female patients were unhappy by their disease state before treatment and mostly satisfied after treatment. Bladder outlet obstruction is a significant problem in ageing men and women.

Item Type: Article
Uncontrolled Keywords: Bladder outlet obstruction, Medical management, Tamsulosin, Urodynamics
Subjects: Pharmacy > MCOPS Manipal > Pharmacy Practice
Medicine > KMC Manipal > Urology
Depositing User: KMC Manipal
Date Deposited: 05 Jul 2011 11:04
Last Modified: 01 Oct 2013 05:23
URI: http://eprints.manipal.edu/id/eprint/543

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