Safety and Tolerability of Solifenacin Add-on Therapy to α-Blocker Treated Men With Residual Urgency and Frequency

Abstract

Solifenacin plus tamsulosin was well tolerated. There was a low incidence of urinary retention requiring catheterization. At week 12 solifenacin plus tamsulosin decreased daily micturitions and urgency episodes. Only urgency reached statistical significance vs placebo plus tamsulosin.

Can We Decide the Optimal Initial Treatment for Male Lower Urinary Tract Symptoms Patients with Overactive Bladder by the Most Bothersome Symptom? A Randomized, Prospective, Open-Label Study

“…Some have reported that initiating combination therapy to all male LUTS/OAB patients showed significant improvements in their reported QoL compared with α-adrenergic antagonist monotherapy [5,14]. Others have adopted antimuscarinics add-on therapy to an ongoing α-adrenergic antagonist treatment in men with residual OAB symptoms [3,4,13]. …”

“…TIMES, ADAM, VICTOR, and many other similar studies that have evaluated the effect of antimuscarinics in men have incorporated questions about the patient's perception of treatment benefit as the primary endpoint [3,4,5]. This was so because of the assumption that the patient can provide a global response assessment that weighs the risks and benefits of treatment [22].…”

“…This is a major pitfall in the current study because despite the statistically significant QoL improvement shown in various clinical studies, it does not always mean that patients will be satisfied with the treatment and will adhere to the drug regimen in real practice [23]. Even though the findings in both ADAM and VICTOR suggest that their patients experienced significant relief of their OAB symptoms, whether measured by bladder diaries or using the storage subscale of the I-PSS, the percentage of patients showing improvement on their perceived bladder condition failed to reach statistical significance [3,4]. …”

“…Many randomized placebo-controlled trials have revealed that combination therapy with α-adrenergic antagonist and antimuscarinics have given rise to a better response in various clinical parameters including those assessed with subjective and objective scales than α-adrenergic antagonist monotherapy in male lower urinary tract symptoms (LUTS) with OAB patients [3,4,5]. …”

Update on medical therapy for male LUTS

“…In patients with symptoms of OAB, the addition of an antimuscarinic agent such as solifenacin, fesoterodine, tolterodine, or oxybutynin following initial treatment with an alpha1a-selective alpha-blocker has been shown to improve persistent storage symptoms to a greater degree than the alphablocker alone. [14][15][16][17][18] In men with predominant storage LUTS, antimuscarinic monotherapy is well tolerated and improves symptoms such as bedwetting and urgency urinary incontinence. [19][20][21][22] A concern with the use of antimuscarinics in men with BPH is the risk of acute urinary retention (AUR).…”