Long-term alpha-blockers and anticholinergic combination treatment for men with lower urinary tract symptoms in real-life practice.
ABSTRACT To analyze the treatment outcomes and clinical courses for men with lower urinary tract symptoms, after long-term treatment of alpha-blocker and anticholinergic combination in real-life practice.
A total of 210 men, with lower urinary tract symptoms, had combination therapy for 3 months. Patients were reevaluated and were decided on an alpha-blocker single treatment or a combination therapy, according to the patient-reported outcome for 2 years. The patient responses in 2-year treatment were divided into 3 groups, which depended on clinical courses: 56 patients had an alpha-blocker single therapy after 3-month combination therapy (group I); 106 patients had a continuous alpha-blocker therapy with intermittent 3-month anticholinergic therapy (group II); 48 patients with continuous storage symptoms maintained a combination therapy (group III). Endpoints included 2-year changes in International Prostate Symptom Score (IPSS), Qmax, and residual volume.
Group III had significantly increased IPSS total and subscores compared to that of the other groups in the baseline characteristics. IPSS total and subscores significantly decreased at 3 months and were maintained for 2 years in all groups. Increase in Qmax was significant in all the groups at 3 months, and its increase was still significant after 2 years. Residual urine volume increased in all the groups at 3 months, but changes at 2 years were not statistically significant.
After 3 months of alpha-blocker and anticholinergic combination treatment, 73.4 % of the patients still needed a combination therapy. Although only one patient developed acute urinary retention, voiding difficulty was common (13.3 %), after a combination treatment in the real-life practice.
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ABSTRACT: To summarize data concerning the medical treatment of men with overactive bladder symptoms published in peer-reviewed journals between January 2012 and March 2013. Results of large, randomized trials of solifenacin in combination with tamsulosin in men with lower urinary tract symptoms, including voiding and storage ones, have dominated the medical literature on the subject for the past 12-16 months. Solifenacin in upfront combination with alpha-blockers or as add-on therapy in men with residual storage symptoms despite alpha-blockade offers additional benefits in symptom control. In accordance with data from previous studies on other antimuscarinics, improvements are significant only for some of the efficacy outcomes. Solifenacin in combination with alpha-blockers is associated with an increase in postvoid residual urine volume but not a significantly increased risk of retention. Recent data also indicate that the combination of antimuscarinics with alpha-blockers is cost-effective with long-term efficacy and safety. Recent evidence further supports the efficacy and safety of antimuscarinics in combination with alpha-blockers in treating storage symptoms in men with lower urinary tract symptoms. More studies are needed to evaluate criteria for selecting men likely to benefit more from antimuscarinics and investigate other overactive bladder treatments in male populations.Current opinion in urology 07/2013; · 2.50 Impact Factor
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ABSTRACT: Benign prostatic hyperplasia (BPH) is a major health concern for aging men. BPH is associated with urinary voiding dysfunction and lower urinary tract symptoms (LUTS), which negatively affects quality of life. Surgical resection and medical approaches have proven effective for improving urinary flow and relieving LUTS but are not effective for all men and can produce adverse effects that require termination of the therapeutic regimen. Thus, there is a need to explore other therapeutic targets to treat BPH/LUTS. Complicating the treatment of BPH/LUTS is the lack of biomarkers to effectively identify pathobiologies contributing to BPH/LUTS or to gauge successful response to therapy. This review will briefly discuss current knowledge and will highlight new studies that illuminate the pathobiologies contributing to BPH/LUTS, potential new therapeutic strategies for successfully treating BPH/LUTS, and new approaches for better defining these pathobiologies and response to therapeutics through the development of biomarkers and phenotyping strategies.Current Urology Reports 08/2013;