Skip to main content

Advertisement

Log in

Long-term alpha-blockers and anticholinergic combination treatment for men with lower urinary tract symptoms in real-life practice

  • Urology – Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

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.

Materials and methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Chapple CR, Roehrborn CG (2006) A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 49:651–658

    Article  PubMed  Google Scholar 

  2. Andersson KE (2004) Antimuscarinics for treatment of overactive bladder. Lancet Neurol 3:46–53

    Article  PubMed  CAS  Google Scholar 

  3. Blake-James BT, Rashidian A, Ikeda Y, Emberton M (2007) The role of anticholinergics in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis. BJU Int 99:85–96

    Article  PubMed  CAS  Google Scholar 

  4. Kaplan SA, Walmsley K, Te AE (2005) Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol 174:2273–2276

    Article  PubMed  Google Scholar 

  5. Kaplan SA, Roehrborn CG, Dmochowski R, Rovner ES, Wang JT, Guan Z (2006) Tolterodine extended release improves overactive bladder symptoms in men with overactive bladder and nocturia. Urology 68:328–332

    Article  PubMed  Google Scholar 

  6. Roehrborn CG, Abrams P, Rovner ES, Kaplan SA, Herschorn S, Guan Z (2006) Efficacy and tolerability of tolterodine extended-release in men with overactive bladder and urgency urinary incontinence. BJU Int 97:1003–1006

    Article  PubMed  CAS  Google Scholar 

  7. Irwin DE, Milsom I, Hunskaar S et al (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 50:1306–1314

    Article  PubMed  Google Scholar 

  8. de Nunzio C, Franco G, Rocchegiani A, Iori F, Leonardo C, Laurenti C (2003) The evolution of detrusor overactivity after watchful waiting, medical therapy and surgery in patients with bladder outlet obstruction. J Urol 169:535–539

    Article  PubMed  Google Scholar 

  9. Abrams P, Kaplan SA, De Koning Gans HJ, Millard R (2006) Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 175:999–1004

    Article  PubMed  CAS  Google Scholar 

  10. Lee JY, Kim HW, Lee SJ, Koh JS, Suh HJ, Chancellor MB (2004) Comparison of doxazosin with or without tolterodine in men with symptomatic bladder outlet obstruction and an overactive bladder. BJU Int 94:817–820

    Article  PubMed  CAS  Google Scholar 

  11. Athanasopoulos A, Gyftopoulos K, Giannitsas K, Fisfis J, Perimenis P, Barbalias G (2003) Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol 169:2253–2256

    Article  PubMed  CAS  Google Scholar 

  12. Lee KS, Choo MS, Kim DY et al (2005) Combination treatment with propiverine hydrochloride plus doxazosin controlled release gastrointestinal therapeutic system formulation for overactive bladder and coexisting benign prostatic obstruction: a prospective, randomized, controlled multicenter study. J Urol 174:1334–1338

    Article  PubMed  CAS  Google Scholar 

  13. Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z (2006) Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 296:2319–2328

    Article  PubMed  CAS  Google Scholar 

  14. Lee SH, Chung BH, Kim SJ, Kim JH, Kim JC, Lee JY (2011) Initial combined treatment with anticholinergics and α-blockers for men with lower urinary tract symptoms related to BPH and overactive bladder: a prospective, randomized, multi-center, double-blind, placebo-controlled study. Prostate Cancer Prostatic Dis 14:320–325

    Article  PubMed  CAS  Google Scholar 

  15. Coyne KS, Tubaro A, Brubaker L, Bavendam T (2006) Development and validation of patient-reported outcomes measures for overactive bladder: a review of concepts. Urology 68(Suppl):9–16

    Article  PubMed  Google Scholar 

  16. Blaivas JG, Marks BK, Weiss JP, Panagopoulos G, Somaroo C (2009) Differential diagnosis of overactive bladder in men. J Urol 182:2814–2817

    Article  PubMed  Google Scholar 

  17. Ameda K, Sullivan MP, Bae RJ, Yalla SV (1999) Urodynamic characterization of nonobstructive voiding dysfunction in symptomatic elderly men. J Urol 162:142–146

    Article  PubMed  CAS  Google Scholar 

  18. Fusco F, Groutz A, Blaivas JG, Chaikin DC, Weiss JP (2001) Videourodynamic studies in men with lower urinary tract symptoms: a comparison of community based versus referral urological practices. J Urol 166:910–913

    Article  PubMed  CAS  Google Scholar 

  19. Hyman MJ, Groutz A, Blaivas JG (2001) Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings. J Urol 166:550–552

    Article  PubMed  CAS  Google Scholar 

  20. Kaplan SA, Bowers DL, Te AE, Olsson CA (1996) Differential diagnosis of prostatism: a 12-year retrospective analysis of symptoms, urodynamics and satisfaction with therapy. J Urol 155:1305–1308

    Article  PubMed  CAS  Google Scholar 

  21. Yamaguchi O, Aikawa K, Shishido K, Nomiya M (2009) Place of overactive bladder in male lower urinary tract symptoms. World J Urol 27:723–728

    Article  PubMed  Google Scholar 

  22. Kaplan SA, McCammon K, Fincher R, Fakhoury A, He W (2009) Safety and tolerability of solifenacin add-on therapy to alpha-blocker treated men with residual urgency and frequency. J Urol 182:2825–2830

    Article  PubMed  Google Scholar 

  23. Lee YS, Choo MS, Lee JY, Oh SJ, Lee KS (2011) Symptom change after discontinuation of successful antimuscarinic treatment in patients with overactive bladder symptoms: a randomised, multicentre trial. Int J Clin Pract 65:997–1004

    Article  PubMed  Google Scholar 

  24. Liao CH, Chung SD, Kuo HC (2011) Diagnostic value of International Prostate Symptom Score voiding-to-storage subscore ratio in male lower urinary tract symptoms. Int J Clin Pract 65:552–558

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ji Youl Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bae, W.J., Bae, J.H., Choi, Y.S. et al. Long-term alpha-blockers and anticholinergic combination treatment for men with lower urinary tract symptoms in real-life practice. Int Urol Nephrol 44, 1077–1084 (2012). https://doi.org/10.1007/s11255-012-0173-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-012-0173-5

Keywords

Navigation