PURPOSE: We performed a meta-analysis to compare treatment with alpha-blockers and anticholinergics (i.e., combination therapy) to alpha-blocker monotherapy, in order to clarify the efficacy and safety of this treatment approach among men with storage urinary symptoms (LUTS) related to benign prostatic hyperplasia (BPH).
MATERIAL AND METHODS: We searched for trials of men with BPH/LUTS that were randomized to either combination treatment or alpha-blockers alone. We pooled data from seven placebo-controlled trials meeting inclusion criteria. Primary outcomes of interest included changes in International Prostate Symptom Scores (IPSS) (storage subscores) and urinary frequency. We also assessed post-void residual volume (PVR), maximal flow rate (Qmax), and incidence of urinary retention (AUR). Data were pooled using random-effects models for continuous outcomes and the Peto method to generate odds ratios for AUR.
RESULTS: Combination therapy had a significantly greater reduction in IPSS 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 Qmax (Δ= -0.59 mL/s, 95% CI -1.04 - -0.14) and increase in PVR (Δ= 11.60 mL, 95% CI 8.50 - 14.70) with combination therapy. The number needed to treat with combination therapy to cause one AUR episode was 101 (95% CI 60 - 267).
CONCLUSIONS: Combination treatment with alpha-blockers and anticholinergics significantly improved storage voiding parameters compared to men treated with alpha-blocker therapy alone. This treatment approach is safe with a minimal risk of increased PVR, decreased Qmax, or AUR.
Written by:
Filson CP, Hollingsworth JM, Clemens JQ, Wei JT. Are you the author?
Division of Health Services Research, Department of Urology, University of Michigan Medical School.
Reference: J Urol. 2013 May 30. pii: S0022-5347(13)04423-6.
doi: 10.1016/j.juro.2013.05.058
PubMed Abstract
PMID: 23727412
