Comparison of doxazosin with or without tolterodine in men with symptomatic bladder outlet obstruction and an overactive bladder.
OBJECTIVE
To assess the efficacy of combined treatment with doxazosin and tolterodine, as although alpha-blockers are commonly used and generally effective in men with symptomatic bladder outlet obstruction (BOO), a subset of men with BOO and overactive bladder (OAB) symptoms often complain of persistent symptoms.


METHODS
In a prospective study of 144 consecutive men with BOO at one tertiary urology centre, all had a baseline pressure-flow urodynamic study and were then subdivided into those with BOO or BOO + OAB, based on absence or presence of involuntary detrusor contractions. The Abrams-Griffiths nomogram was used to determine obstructive BOO. After the initial evaluation, all patients were treated with doxazosin 4 mg/day for 3 months. In patients with no symptomatic improvement, tolterodine 2 mg twice daily was added for an additional 3 months.


RESULTS
Of the 144 patients, 76 (53%) were diagnosed as having BOO and 68 (47%) BOO + OAB. The patients with BOO + OAB were older (P < 0.05) and had a higher International Prostate Symptom Score. After 3 months of treatment with doxazosin, 60 (79%) with BOO and 24 (35%) BOO + OAB reported a symptomatic improvement. In those patients with no improvement, six of 16 with BOO and 32 of 44 (73%) with BOO + OAB improved after adding tolterodine. Acute urinary retention developed in only two of 60 men (3.3%) treated with the combined therapy.


CONCLUSIONS
About half of men with symptomatic BOO had an OAB; while about three-quarters of men with symptomatic BOO and no OAB improved with doxazosin, only a third with BOO + OAB were helped with doxazosin alone. Combining tolterodine with doxazosin was effective in three-quarters of men with BOO + OAB. Overall, most men with BOO with or with no OAB were helped with doxazosin alone or with the addition of tolterodine.
Department of Urology, The Catholic University of Korea, School of Medicine, Seoul, Korea.
Ji Youl
JY
Lee
Hyun Woo
HW
Kim
Seung Ju
SJ
Lee
Jun Sung
JS
Koh
Hong Jin
HJ
Suh
Michael B
MB
Chancellor
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage*; D001559:Benzhydryl Compounds / Q000008:administration & dosage*; D003408:Cresols / Q000008:administration & dosage*; D017292:Doxazosin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010665:Phenylpropanolamine; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications / Q000188:drug therapy*; D013644:Tartrates / Q000008:administration & dosage*; D000068737:Tolterodine Tartrate; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000188:drug therapy* / Q000209:etiology; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000209:etiology; D014563:Urodynamics
D000317:Adrenergic alpha-Antagonists; D001559:Benzhydryl Compounds; D003408:Cresols; D013644:Tartrates; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; D017292:Doxazosin