Eur Urol. 2005 Mar;47(3):361-5.
Epub 2004 Dec 16. The utility of tamsulosin in the management
of orgasm-associated pain: a pilot analysis.
Barnas J, Parker M, Guhring P, Mulhall JP.
Department of Urology, Weill Medical College of Cornell University,
New York Presbyterian Hospital, 525 E 68th Street, Starr 900, NY
10021, USA.
INTRODUCTION:: Orgasmic pain is an infrequently reported but distressing
problem for the patients who experience it. No consensus exists
as to its etiology however bladder neck/pelvic floor spasm may play
a role. This analysis was conducted to assess the effect of the
alpha-blocking medication, tamsulosin on post-orgasmic pain. METHODS::
In a prospective, non-placebo controlled study, patients with orgasmic
pain were interviewed and administered tamsulosin 0.4mg po qhs for
at least 4 weeks. Outcome measures included libido, pain and continence
and these were evaluated using the International Index of Erectile
Function (IIEF), a visual analog scale (VAS) for pain and an incontinence
scale respectively pre and post treatment. Patients were separated
into groups based on etiology of the problem (radical prostatectomy,
radiation therapy, and other) for statistical analysis. RESULTS::
98 patients were enrolled. Pain was located predominantly in the
penis (72%), with other sites including testis, rectum and abdomen.
Most patients (52%) experienced pain for less than 5minutes post-orgasm.
76/98 (77%) patients reported significant improvement in pain (>/=2
points on pain VAS) and 12/98 (12%) noted complete resolution of
their pain. The VAS for pain reflected a statistically significant
decrease in pain for all groups in response to tamsulosin treatment.
The entire group had a decrease of 2.7 points between pre and post-treatment
phases. The IIEF libido domain increased significantly (mean of
2.4 points) for all treatment groups. CONCLUSION:: Tamsulosin decreases
orgasmic pain intensity in patients with orgasmic pain. These data
support the hypothesis that orgasmic pain is related to bladder
neck and/or pelvic floor muscle spasm.
BJU Int. 2005 Feb;95(3):354-7. Tamsulosin in the management of patients
in acute urinary retention from benign prostatic hyperplasia.
Lucas MG, Stephenson TP, Nargund V.
Morriston Hospital, Swansea, UK.
OBJECTIVE: To evaluate the efficacy of tamsulosin compared to
placebo for treating catheterized patients with acute urinary
retention (AUR) caused by benign prostatic hyperplasia (BPH),
by comparing the numbers of patients who voided successfully after
removing their catheter. PATIENTS AND METHODS: This was a randomized,
double-blind, placebo-controlled, parallel-group, multicentre
study. Men with AUR secondary to BPH were catheterized and then,
if they fulfilled the entry criteria, were randomly assigned to
receive either 0.4 mg tamsulosin hydrochloride in a modified-release
capsule once daily, or a placebo. After up to eight doses the
catheter was removed and the ability to void unaided assessed.
RESULTS: In all, 149 men (mean age 69.4 years) were randomly assigned
to receive tamsulosin (75) or placebo (74); eight were not evaluable,
so the intent-to-treat population was 141 men. Thirty-four men
taking tamsulosin and 18 taking placebo did not require re-catheterization
on the day of the trial without catheter (48% and 26% respectively,
P = 0.011; odds ratio 2.47, 95% confidence interval, CI, 1.23-4.97).
Success using free-flow variables was also higher in the men who
received tamsulosin, at 37 (52%) vs 24 (34%) on placebo (P = 0.019;
odds ratio 2.34, 95% CI 1.15-4.75). Withdrawals were high (120
men, 81%), mostly because of a need for re-catheterization (89
men, 60%). Dizziness and somnolence occurred in seven (10%) and
four (6%) men who received tamsulosin, and two (3%) who received
placebo, but overall the incidence of adverse events was similar
in the two groups. One patient died from carcinomatosis. CONCLUSION:
Men catheterized for AUR can void more successfully after catheter
removal if treated with tamsulosin, and are less likely to need
re-catheterization. The side-effect profile was similar for tamsulosin
and placebo, and consistent with known pharmacology. From these
results tamsulosin can be recommended for treating men after catheterization
for AUR, and can reduce the likelihood of the need for re-catheterization.
