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

Abstract

Objectives: To compare the treatment outcome of tamsulosin 0.4 mg (TAM) with or without solifenacin 5 mg (SOL) for the most bothersome symptom in male lower urinary tract symptoms (LUTS) with overactive bladder (OAB). Subjects and Methods: Male LUTS/OAB (≥50 years) patients who had a total International Prostate Symptom Score (I-PSS) of ≥12, I-PSS urgency-related question of ≥2, and quality of life (QoL) of ≥3 points were enrolled. Patients who complained of storage symptoms as the most bothersome were included in the ‘storage' group. Patients who complained of voiding symptoms as the most bothersome were included in the ‘voiding' group. The change in the I-PSS was compared between the two groups 4 weeks after commencing treatment. Results: In the storage group, 172 were able to finish this study (TAM: 88, TAM + SOL: 84). The improvement of I-PSS and QoL with TAM + SOL was significantly greater than with TAM alone (p < 0.001). In the voiding group, 108 were able to finish the study (TAM: 54, TAM + SOL: 54). The improvement of I-PSS and QoL with TAM alone was significantly greater than with TAM + SOL (p < 0.001). Conclusions: The most bothersome symptom in male LUTS/OAB should be considered when choosing the appropriate medical treatment.

Lower Urinary Tract Symptoms and Aging: The Impact of Chronic Bladder Ischemia on Overactive Bladder Syndrome

“…In a model of bladder ischemia induced by arterial injury, mirabegron was able to reduce bladder hyperactivity [57] . Anti-muscarinic drugs may also be used to treat predominantly storage LUTS [60] . At this moment, it is unclear if these drugs act exclusively in bladder contractility or if they also have some effect on blood flow.…”

Solifenacin/tamsulosin fixed-dose combination therapy to treat lower urinary tract symptoms in&nbsp;patients with benign prostatic hyperplasia

“…Yun et al 50 investigated whether men with LUTS can be treated initially with tamsulosin monotherapy or combined with solifenacin, based on patients’ reported most bothersome symptom. Patients were categorized into storage (60% of participants) and voiding (40%) groups, based on the most bothersome symptoms among the IPSS items.…”

“…Therefore, issues of patient adherence to therapy and long-term safety and efficacy of the combination treatment are raised. Studies conducted in Asian populations used tamsulosin 0.2 mg in contrast to the commonly used dose of 0.4 mg, 44 , 45 , 48 – 50 while large discrepancies are also revealed in the dose of solifenacin used, as doses of 3, 5, 6, and 9 mg were used and compared in different studies. 10 , 13 , 14 , 44 – 50 Finally, the noninferiority design selected in some of the major studies dictates the need to evaluate the findings with caution.…”