Antimuscarinics “could and should” be used in the pharmacological treatment of men with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia or bladder outlet obstruction, say the authors of a meta-analysis published in Urology.
These agents are particularly beneficial in patients with predominant storage symptoms, they say, but should be carefully monitored in patients at increased risk of acute urinary retention (AUR).
Kunjie Wang (Sichuan University, Chengdu, People’s Republic of China) and co-authors searched the literature for studies that compared combination therapy with antimuscarinics and α-blockers with α-blocker monotherapy in men with LUTS.
A total of 18 studies were eligible for inclusion, with 2106 patients given combination therapy and 1978 given monotherapy.
Pooled analysis indicated that combination therapy was superior to monotherapy with regard to symptomatic improvement, measured using the Storage International Prostate Symptom Score (mean treatment difference [MD] –1.51) and the Total International Prostate Symptom Score (MD –0.88).
Combination therapy was also significantly better than monotherapy with regard to quality of life score (MD –0.53), micturitions per 24 hours (MD –1.14) and urgency episodes per 24 hours (MD –0.99).
However, the treatments did not differ on other endpoints, such as maximum flow, and Voiding International Prostate Symptom Score, and combination therapy was worse than monotherapy with regard to postvoid residual volume, with a MD of –6.53.
Wang et al say their study “provides proof of concept that antimuscarinics and α-blockers combination should be recommended for male LUTS.”
They write in Urology: “As storage symptoms are likely because of bladder rather than prostate problems, it could be reasonably expected that a combination therapy comprising an antimuscarinic agent would significantly alleviate storage LUTS.”
However, they caution that “men initiating antimuscarinics treatment, particularly those with characteristics associated with increased AUR risk, should be carefully monitored.”
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