Abstract
Lower urinary tract symptoms (LUTS) in men are often associated with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH). The current standard of care for men with LUTS is treatment with α-adrenergic receptor antagonists to reduce outlet tone or 5-α-reductase inhibitors to reduce prostatic volume. Up to 60% of men with BOO secondary to BPH have storage symptoms attributable to detrusor overactivity (DO), which makes treatment with anticholinergics, either alone or in combination, an attractive proposition. We present a review of the literature concerning the use of anticholinergic drugs in men with LUTS and focus on the studies that relate to enlarged prostate volumes. There have been a number of uncontrolled studies and one large, randomized controlled trial (RCT) evaluating anticholinergic drugs in men with LUTS, overactive bladder, and BPH. The results of these studies were not stratified by prostate size. A recent post-hoc analysis of the RCT, however, now provides data stratified by prostate size.
Similar content being viewed by others
References and Recommended Reading
Berry SJ, Coffey DS, Walsh PC, et al.: The development of human benign prostatic hyperplasia with age. J Urol 1984, 132:474–479.
Eckhardt MD, Van Venrooij GE, Boon TA: Interactions between prostate volume, filling cystometric estimated parameters, and data from pressure-flow studies in 565 men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Neurourol Urodyn 2001, 20:579–590.
Girman CJ, Jacobsen SJ, Tsukamoto T, et al.: Health-related quality of life associated with lower urinary tract symptoms in four countries. Urology 1998, 51:428–436.
Abrams P, Cardozo L, Fall M, et al.: The standardization of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003, 61:37–49.
Peters TJ, Donovan JL, Kay HE, et al.: The International Continence Society “Benign Prostatic Hyperplasia” Study: the bothersomeness of urinary symptoms. J Urol 1997, 157:885–889.
Andersson KE: Storage and voiding symptoms: pathophysiologic aspects. Urology 2003, 62:3–10.
Andersson KE, Yoshida M: Antimuscarinics and the overactive detrusor—which is the main mechanism of action? Eur Urol 2003, 43:1–5.
Hyman MJ, Groutz A, Blaivas JG: Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings. J Urol 2001, 166:550–552.
Knutson T, Schafer W, Fall M, et al.: Can urodynamic assessment of outflow obstruction predict outcome from watchful waiting?—a four-year follow-up study. Scand J Urol Nephrol 2001, 35:463–469.
Gosling JA, Kung LS, Dixon JS, et al.: Correlation between the structure and function of the rabbit urinary bladder following partial outlet obstruction. J Urol 2000, 163:1349–1356.
Turner WH, Brading AF: Smooth muscle of the bladder in the normal and the diseased state: pathophysiology, diagnosis and treatment. Pharmacol Ther 1997, 75:77–110.
Rosier PF, de la Rosette JJ, Wijkstra H, et al.: Is detrusor instability in elderly males related to the grade of obstruction? Neurourol Urodyn 1995, 14:625–633.
Kageyama S, Watanabe T, Kurita Y, et al.: Can persisting detrusor hyperreflexia be predicted after transurethral prostatectomy for benign prostatic hypertrophy? Neurourol Urodyn 2000, 19:233–240.
Milsom I, Abrams P, Cardozo L, et al.: How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 2001, 87:760–766.
Chapple CR: Pharmacological therapy of benign prostatic hyperplasia/lower urinary tract symptoms: an overview for the practicing clinician. BJU Int 2004, 94:738–744.
Chapple CR, Roehrborn CG: A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 2006, 49:651–659.
McConnell JD, Roehrborn CG, Bautista OM, et al.: The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003, 349:2387–2398.
Abrams P, Kaplan SA, De Koning Gans HJ, et al.: Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol 2006, 175:999–1004.
Kaplan SA, Walmsley K, Te AE: Tolterodine extended release attenuates lower urinary tract symptoms in men with benign prostatic hyperplasia. J Urol 2005, 174:2273–2276.
Roehrborn CG, Abrams P, Rovner ES, et al.: Efficacy and tolerability of tolterodine extended-release in men with overactive bladder and urgency urinary incontinence. BJU Int 2006, 97:1003–1006.
Kaplan SA, Roehrborn CG, Dmochowski R, et al.: Tolterodine extended release improves overactive bladder symptoms in men with overactive bladder and nocturia. Urology 2006, 68:328–332.
Athanasopoulos A, Gyftopoulos K, Giannitsas K, et al.: Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol 2003, 169:2253–2256.
Lee KS, Choo MS, Kim DY, et al.: 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 2005, 174:1334–1338.
Lee JY, Kim HW, Lee SJ, et al.: Comparison of doxazosin with or without tolterodine in men with symptomatic bladder outlet obstruction and an overactive bladder. BJU Int 2004, 94:817–820.
Kaplan SA, Roehrborn CG, Rovner ES, et al.: Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 2006, 296:2319–2328.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zoltan, E., Lee, R., Staskin, D.R. et al. Combination therapy for benign prostatic hyperplasia: Does size matter?. Curr Bladder Dysfunct Rep 3, 102–108 (2008). https://doi.org/10.1007/s11884-008-0016-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11884-008-0016-5