To evaluate the efficacy and safety of combining antimuscarinics with alpha-blockers to treat storage symptoms in men with benign prostatic hyperplasia.
Searches were carried out on PubMed, MEDLINE, EMBASE, and Cochrane databases to identify randomized, placebo-controlled trials published before February 15, 2022, assessing the efficacy or safety of antimuscarinics in men with benign prostatic hyperplasia treated with alpha-blockers. Further meta-analyses were performed using standardized mean difference (SMD) and risk ratio (RR).
A total of 12 randomized trials were included in the systematic review. The meta-analysis showed no impact of antimuscarinics on the number of urgencies per day (SMD = -0.23 [95%CI: -0.64‒0.17]; P = .21). However, the use of antimuscarinics was associated with a small reduction of micturition episodes per day (SMD = -0.19 [95%CI: -0.37; -0.01]; P = .045). With regards to side-effects, post-void residual increased slightly in patients treated with antimuscarinics (SMD = 0.26 [95%CI: 0.15; 0.37]; P<.01). In addition, there was a higher risk of acute urinary retention (RR = 3.26 [95%CI: 1.35; 7.86]; P = .02), dry mouth (RR = 3.43 [95%CI: 1.86; 6.32]; P<.001), and constipation (RR = 2.92 [95%CI: 1.48; 5.73]; P<.001) with the use of antimuscarinics. Finally, the risk of treatment interruption due to adverse events was higher for the patients treated with antimuscarinics (RR = 1.74 [95%CI: 1.27; 2.38]; P<.01).
The addition of antimuscarinics to alpha-blockers was not associated with a substantial reduction in urgencies and micturition episodes in BPH patients with storage symptoms. In addition, the toxicity profile was not in favor of antimuscarinic use in these patients.
The Journal of urology. 2022 Nov 17 [Epub ahead of print]
Louis Lenfant, Ugo Pinar, Morgan Roupret, Pierre Mozer, Emmanuel Chartier-Kastler, Thomas Seisen
Sorbonne Université, Department of Urology, Academic Hospital Pitié-Salpêtrière, APHP, Paris, France.