In men with BPH, is procedural intervention superior to combination medical therapy for reduction of symptoms?

Abstract

eight days or more compared with placebo (93 vs 94 mL, P..05). Limitations included lack of adverse effect reporting, methodological inconsistencies between the pooled trials, and various dosing used.A 2020 systematic review of 41 RCTs (N53,005 mothers, 3,006 infants) assessed the effect of oral galactagogues for increasing milk production in nonhospitalized breastfeeding mother-term infant pairs. 2 After evaluation, only one trial (n550) had data sufficient for analysis on breast milk and domperidone as a galactagogue. Women were randomized to either 10 mg domperidone four times daily (n525) and continued four days postpartum or a placebo containing vitamin B6 (n525) over the same period. Mean milk volume was measured after two expressions via breast pump at least two hours after breastfeeding. A significant increase in milk volume at four days postpartum was found in the domperidone group compared with placebo (MD 100 mL; 95% CI, 37-161 mL).A 2019 per-protocol secondary analysis of a multicenter, double-masked RCT (n583) evaluated breast milk production response in mothers who completed a 14-day course of domperidone. 3 Of note, this trial was included in the abovementioned review and meta-analysis, but this secondary analysis assessed if the timing of domperidone initiation affected milk production response. Mothers of infants 29 weeks' gestation or less who were 8 to 21 days postdelivery with insufficient breast milk volume production were included. Women received 10 mg domperidone three times daily either on days 1 to 14 of the trial (n545) or days 15 to 28 of the trial (n538). The primary outcome was the number of mothers who increased expressed milk volume by at least 50% after the 14-day treatment with domperidone compared with the start of treatment. Secondary outcomes included median expressed milk volume, mean total volume, and percent change at the end of the 14-day period. Results were similar between groups of women in the first to second week mothers and third to fourth week mothers demonstrating a 50% increase in volume (odds ratio [OR] 2.0; 95% CI, 0.72-5.0). Additionally, no difference was noted between the early treatment group and delayed group in median volume (241 vs 302 mL, P5.99), mean volume (294 vs 302 mL, P5.99), and overall percent change (146% vs 103%, P5.09).