The Efficacy and Safety of Combined Therapy with α-Blockers and Anticholinergics for Men with Benign Prostatic Hyperplasia: A Meta-Analysis

Abstract

Purpose We performed a meta-analysis to compare treatment with α-blockers and anticholinergics (ie combination therapy) to α-blocker monotherapy to clarify the efficacy and safety of this treatment approach among men with storage urinary symptoms related to benign prostatic hyperplasia. Materials and Methods We searched for trials of men with benign prostatic hyperplasia/lower urinary tract symptoms that were randomized to combination treatment or α-blockers alone. We pooled data from 7 placebo controlled trials meeting inclusion criteria. Primary outcomes of interest included changes in International Prostate Symptom Score (storage subscores) and urinary frequency. We also assessed post-void residual volume, maximal flow rate and the incidence of urinary retention. Data were pooled using random effects models for continuous outcomes and the Peto method to generate odds ratios for acute urinary retention. Results Combination therapy had a significantly greater reduction in International Prostate Symptom Score storage subscores (Δ −0.73, 95% CI −1.09 – −0.37) and voiding frequency (Δ −0.69 voids, 95% CI −0.97 – −0.41). There was also a greater reduction in maximal urinary flow rate (Δ −0.59 ml per second, 95% CI −1.04 – −0.14) and increase in post-void residual urine volume (Δ 11.60 ml, 95% CI 8.50–14.70) with combination therapy. The number needed to treat with combination therapy to cause 1 acute urinary retention episode was 101 (95% CI 60–267). Conclusions Combination treatment with α-blockers and anticholinergics significantly improved storage voiding parameters compared to men treated with α-blocker therapy alone. This treatment approach is safe with a minimal risk of increased post-void residual urine volume, decreased maximal urinary flow rate or acute urinary retention.

Tamsulosin combined with solifenacin versus tamsulosin monotherapy for male lower urinary tract symptoms: a meta-analysis

“…The most prominent finding in our study is that combination therapy is associated with significant additional benefits on our primary outcomes (SIPSS and QoL), and also some secondary outcomes (micturitions per 24 hours and urgency episodes per 24 hours) in male LUTS patients. Our results on these four outcomes are almost consistent with the former meta-analyses conducted by Filson et al 9 , Hao et al 10 and Wang et al 11 but not completely consistent with the result of Li et al 12 . All the characteristics and results of the present study compared with the former meta-analyses are summarized in Table 3.…”

“…However, the research included different kinds of alpha-blockers and antimuscarinics, and their results are not completely consistent. Previous meta-analyses [9][10][11] have shown consistent effects of alpha-blockers combined with antimuscarinics for male LUTS patients compared to alpha-blocker monotherapy on relieving storage symptoms, but not completely consistent results about voiding symptoms. Since tamsulosin and solifenacin are most commonly used in clinical practice, many studies have researched in detail combination therapy with tamsulosin and solifenacin compared to tamsulosin monotherapy.…”

Treatment of benign prostatic hyperplasia

“…19 Although it can increase the risk of acute urinary retention in patients with BPH with baseline postvoid volume > 150 mL, the rate of acute urinary retention is reduced in patients with postvoid volume < 150 mL, around 1%. [16][17][18][19] …”

Landmarks in BPH—from aetiology to medical and surgical management

“…37 Anticholinergics have been effective in com bination with αblockers and seem to be safe, with minimal risk of acute urinary reten tion. 38 Furthermore, new targets and new therapeutic agents continue to be explored, such as the use of botulinum toxin and other injectables-although, strictly speaking, these are interventional treatments. 39 …”