title: Combination of a cholinergic drug and an alpha-blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor.
abstract: OBJECTIVE
  The aim of the present study was to compare the effectiveness of a cholinergic drug, an alpha-blocker and combinations of the two for the treatment of underactive detrusor.
  
  
  METHODS
  One hundred and nineteen patients with underactive bladder were assigned to three groups: the cholinergic group, consisting of 40 patients taking bethanechol chloride (60 mg/day) or distigmine bromide (15 mg/day); the alpha-blocker group, consisting of 38 patients taking urapidil (60 mg/day); and the combination group, consisting of 41 patients taking both a cholinergic drug and an alpha-blocker. The effectiveness of each therapy was assessed 4 weeks after initialization of the therapy.
  
  
  RESULTS
  Total urinary symptom scores (International Prostate Symptom Score, IPSS) remained unchanged after the cholinergic therapy, but were significantly lower after the alpha-blocker treatment (P = 0.0001) and the combination therapy (P = 0.0001). With regard to the total IPSS, there were significant differences between the cholinergic and the alpha-blocker groups (P = 0.0008), and also between the cholinergic and combination groups (P = 0.0033), in favor of the latter. The average and maximum flow rates did not increase significantly after monotherapy with either the cholinergic drug or the alpha-blocker, but they significantly increased after combination therapy compared to baseline values (P = 0.0033 and P= 0.0004, respectively). Postvoid residual volume did not decrease significantly after the cholinergic drug therapy, but decreased significantly after the alpha-blocker (P = 0.0043) and the combination therapies (P = 0.0008). The percentage of residual urine decreased significantly after therapy in all groups (P = 0.0005, P= 0.0176 and P= 0.0001, respectively).
  
  
  CONCLUSIONS
  Combination therapy with a cholinergic drug and an alpha-blocker appears to be more useful than monotherapy for the treatment of underactive detrusor.
authors.affiliation: Department of Urology, Dokkyo University, Mibu, Chiba, Japan. yamanish@dokkyomed.ac.jp
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamanishi
authors.forename: Kosaku
authors.initials: K
authors.lastname: Yasuda
authors.forename: Takao
authors.initials: T
authors.lastname: Kamai
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Tsujii
authors.forename: Ryuji
authors.initials: R
authors.lastname: Sakakibara
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Ken-ichiro
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000284:Administration, Oral; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D018723:Bethanechol / Q000008:administration & dosage*; D018678:Cholinergic Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage*; D011336:Probability; D011446:Prospective Studies; D011726:Pyridinium Compounds / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome; D016055:Urinary Retention / Q000175:diagnosis / Q000188:drug therapy; D014555:Urination Disorders / Q000175:diagnosis / Q000188:drug therapy*; D014563:Urodynamics
chemical_list: D000317:Adrenergic alpha-Antagonists; D018678:Cholinergic Agents; D010879:Piperazines; D011726:Pyridinium Compounds; D018723:Bethanechol; C015568:urapidil; C084645:distigmine