EFFECTIVENESS OF SILODOSIN IN PATIENTS WITH MEDIAN LOBE PROJECTION OF ENLARGED PROSTATE IN TERMS OF MAXIMUM URINARY FLOW RATE (Qmax)

Median lobe projection of the prostate is a distinct anatomical variation that exacerbates lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Effective management of LUTS in these patients is critical, particularly in resource-limited settings like Pakistan. Silodosin, a highly selective α-1A adrenergic receptor antagonist, has shown promise in alleviating LUTS and improving urinary flow rates, but its efficacy in patients with median lobe projection remains underexplored. Objective: To evaluate the efficacy and safety of silodosin in improving maximum urinary flow rate (Qmax) and alleviating LUTS in patients with median lobe projection of the prostate. Methods: This prospective observational study was conducted at the Institute of Kidney Diseases, Peshawar. A total of 191 male patients aged 40–60 years with baseline Qmax ≤10 mL/sec and International Prostate Symptom Score (IPSS) ≥15 were enrolled. Patients received silodosin 8 mg once daily for four weeks. Outcomes assessed included improvements in Qmax, IPSS, and treatment-related adverse events. Data were analyzed using paired t-tests for continuous variables and Chi-square tests for categorical variables, with a p-value ≤0.05 considered statistically significant. Results: The mean baseline Qmax increased from 7.8 ± 1.2 mL/sec to 16.3 ± 2.4 mL/sec after treatment (p<0.001), with 79.6% of patients achieving a Qmax ≥15 mL/sec. The mean IPSS improved significantly from 19.6 ± 4.3 to 12.2 ± 3.1 (p<0.001), with a 50% reduction in symptoms observed in 77.5% of patients. Adverse events were minimal, with dizziness (5.2%) and nasal congestion (3.7%) being the most commonly reported. Silodosin was effective across different age groups and prostate sizes, with consistent results in patients with smaller (30–40 grams) and larger (>40 grams) prostates. Conclusion: Silodosin significantly improves urinary flow rates and alleviates LUTS in patients with median lobe projection of an enlarged prostate, with minimal adverse events. These findings support its use as an effective and safe first-line therapy in managing BPH-related LUTS in resource-limited settings like Pakistan.