The role of anticholinergics in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta‐analysis

Blake-James, Benedict; Rashidian, Arash; Ikeda, Youko; Emberton, Mark

doi:10.1111/j.1464-410x.2006.06574.x

Cited by 102 publications

(41 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A key safety consideration in the use of antimuscarinics in elderly men is the possible risk of inducing increased PVR/urinary retention. A meta-analysis showed an incidence of urinary retention while antimuscarinic treatment in men of 0.8% [29]. In line with previous controlled studies with propiverine [12, 13, 18], the observed changes in PVR were small and acute urinary retention occurred only rarely in the present study.…”

Section: Discussionsupporting

confidence: 89%

Efficacy of propiverine ER with or without α-blockers related to maximum urinary flow rate in adult men with OAB: results of a 12-week, multicenter, non-interventional study

Oelke

Murgas

Baumann³

et al. 2011

World J Urol

View full text Add to dashboard Cite

PurposeComparison of efficacy of propiverine extended release (ER) 30 mg o.d. in the treatment of male OAB administered as monotherapy (MT) or add-on to α-blockers (combination treatment, CT) in relation to maximum urinary flow (Qmax) in a non-interventional study.MethodsMen ≥40 years with OAB symptoms, Qmax ≥10 ml/s, prostate volume <40 ml, post-void residuals (PVR) <100 ml, and IPSS <20 were included. OAB symptoms, IPSS, and PVR were recorded before and after 12 weeks of treatment. Participants were stratified by Qmax (group A ≥15 ml/s, group B <15 ml/s) and CT vs. MT. Safety parameters were monitored.ResultsA total of 2,219 men participated and were involved in safety analysis; 1,849 men (mean age 66 years) fulfilled the inclusion criteria and were involved in efficacy analysis. In group A, 291 men received MT and 479 CT; in group B, 184 men received MT and 895 CT. OAB symptoms improved significantly in all groups throughout the study without differences between MT and CT. IPSS improvement in group B was less with MT than with CT (−3.9 vs. −5.2; P < 0.001), whereas IPSS improvement was similar in group A (−4.6 vs. −5.1). Mean PVR change was not clinically relevant, but two men (0.1%) experienced urinary retention.ConclusionsUnder real-life conditions, treatment of OAB symptoms with propiverine ER is equally effective in men with MT or CT regardless of baseline Qmax. In men with reduced Qmax, IPSS improvement is significantly smaller with MT. The incidence of urinary retention during propiverine ER treatment is low.

show abstract

Section: Discussionsupporting

confidence: 89%

Efficacy of propiverine ER with or without α-blockers related to maximum urinary flow rate in adult men with OAB: results of a 12-week, multicenter, non-interventional study

Oelke

Murgas

Baumann³

et al. 2011

World J Urol

View full text Add to dashboard Cite

show abstract

“…studies provide compelling evidence that antimuscarinic + α‐blocker treatment provides significant benefit to men with LUTS including OAB symptoms (19–21,25,37,42), and several prospective studies have also demonstrated that an antimuscarinic + α‐blocker is more effective for OAB symptoms than an α‐blocker alone in men (26–28,39). These findings are consistent with a meta‐analysis of data from five randomised trials and 15 observational studies that included men with LUTS suggestive of BPO (51), which found that antimuscarinics improved IPSS scores, particularly storage scores, and generally had a positive effect on HRQL. These findings are important because the storage symptoms that define OAB are common and bothersome in men and adversely affect HRQL, perhaps to a greater extent than voiding symptoms (12,52,53).…”

Section: Discussionsupporting

confidence: 86%

Antimuscarinics for treatment of storage lower urinary tract symptoms in men: a systematic review

Kaplan

Roehrborn

Abrams

et al. 2011

International Journal of Clinical Practice

View full text Add to dashboard Cite

Despite potential benefits, primary care clinicians may avoid using antimuscarinics in men with overactive bladder (OAB) symptoms because of safety concerns. To review the efficacy and safety of antimuscarinics, alone or in combination with an α-blocker, for the treatment of men with OAB symptoms, we conducted a systematic review of articles published before 22 July 2010, using PubMed. Data from 12-week, randomised, double-blind, placebo-controlled trials of tolterodine extended release (ER), oxybutynin and solifenacin show that combined antimuscarinic+α-blocker treatment is generally more effective than monotherapy or placebo in men with OAB symptoms. The efficacy and safety of tolterodine ER+α-blocker treatment was not affected by prostate size or prostate-specific antigen (PSA) level. In men meeting entry criteria for OAB and benign prostatic obstruction trials, tolterodine ER alone was effective selectively in men with prostate size or PSA level below study medians. Incidence of acute urinary retention (AUR) in men receiving antimuscarinics with or without an α-blocker was ≤3% in all of these trials; changes in postvoid residual volume and maximum flow rate did not appear clinically meaningful. Post hoc analyses from double-blind, placebo-controlled trials and prospective studies of fesoterodine, oxybutynin, propiverine, solifenacin and tolterodine also suggest that antimuscarinics are generally safe and efficacious in men. A retrospective database study found that risk of AUR in men was the highest in the first month of treatment and decreased considerably thereafter. Antimuscarinics, alone or with an α-blocker, appear to be efficacious and safe in many men with predominant OAB symptoms or persistent OAB symptoms despite α-blocker or 5-α-reductase inhibitor treatment. However, antimuscarinics are not approved for the treatment of benign prostatic hyperplasia. Monitoring men for AUR is recommended, especially those at increased risk, and particularly within 30 days after starting antimuscarinic treatment.

show abstract

“…Although our findings parallel what has previously been described in other systematic reviews, 22 the only meta-analysis to date only quantified changes in PVR, Qmax and urodynamic parameters. 23 Furthermore, it predates the majority of the RCTs that we have incorporated into our meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

View full text Add to dashboard Cite

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.

show abstract

The role of anticholinergics in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta‐analysis

Cited by 102 publications

References 32 publications

Efficacy of propiverine ER with or without α-blockers related to maximum urinary flow rate in adult men with OAB: results of a 12-week, multicenter, non-interventional study

Efficacy of propiverine ER with or without α-blockers related to maximum urinary flow rate in adult men with OAB: results of a 12-week, multicenter, non-interventional study

Antimuscarinics for treatment of storage lower urinary tract symptoms in men: a systematic review

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

Contact Info

Product

Resources

About