Efficacy of the combination of an alpha1-blocker with an anticholinergic agent in the treatment of lower urinary tract symptoms associated with bladder outlet obstruction.
The combination of an alpha1-blocker with an anticholinergic is a new and promising therapeutic approach for bladder outlet obstruction and detrusor overactivity. Both placebo-controlled and comparative studies have demonstrated that the addition of an anticholinergic in the conventional treatment of patients with bladder outlet obstruction is safe, as the likelihood of acute urinary retention is low. Although the pathophysiology of detrusor overactivity is unknown and most probably multifactorial, it is not expected that the voiding phase is influenced by regular doses of anticholinergics, although high doses may affect detrusor contraction. However, safety issues must be studied further. The combination of tamsulosin with propiverine or tolterodine, and of doxasosin with tolterodine has been shown to cause a significant improvement of lower urinary tract symptoms when compared with alpha1-blocker monotherapy. Indisputably, the existing literature provides clear evidence that the combination of an alpha1-blocker with an anticholinergic extends physicians ability to manage lower urinary tract symptoms caused by bladder outlet obstruction and overactive bladder syndrome.
Athanasopoulos
Anastasios
A
Department of Urology, Medical School University of Patras, 26500 Rio, Patras, Greece.
Perimenis
Petros
P
D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D001561:Benzilates / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D003408:Cresols / Q000627:therapeutic use; D017292:Doxazosin / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D010665:Phenylpropanolamine / Q000627:therapeutic use; D011470:Prostatic Hyperplasia / Q000188:drug therapy / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D013449:Sulfonamides / Q000494:pharmacology / Q000627:therapeutic use; D000077409:Tamsulosin; D000068737:Tolterodine Tartrate; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000150:complications / Q000188:drug therapy; D014563:Urodynamics; D014570:Urologic Diseases / Q000188:drug therapy* / Q000209:etiology
D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists; D001559:Benzhydryl Compounds; D001561:Benzilates; D018680:Cholinergic Antagonists; D003408:Cresols; D013449:Sulfonamides; D010665:Phenylpropanolamine; C015586:propiverine; D000068737:Tolterodine Tartrate; D000077409:Tamsulosin; D017292:Doxazosin