title: The role of antimuscarinics in the management of men with symptoms of overactive bladder associated with concomitant bladder outlet obstruction: an update.
abstract: BACKGROUND
  This review focuses on the contemporary role of antimuscarinics in the management of men with symptoms of bladder outlet obstruction (BOO) and concomitant overactive bladder (OAB). Safety issues of antimuscarinics in this subpopulation of men are also reviewed.
  
  
  OBJECTIVE
  We reviewed the current literature and performed an analysis of the efficacy, suitability, and the safety of antimuscarinics in this subpopulation of men.
  
  
  METHODS
  We performed a systematic search of Medline/PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews for relevant articles published between 1990 and September 2010, restricted to studies in humans published in English. In addition, published abstracts presented at the annual meetings of the European Association of Urology, the American Urological Association, and the International Continence Society in the last decade (2000-2010) were hand-searched and evaluated. Each article's title and abstract were reviewed for their appropriateness and relevance to the use of antimuscarinics in patients with BOO and concomitant OAB. Relevant articles were fully reviewed and included in the final data acquisition.
  
  
  RESULTS
  Treatment options include combination treatment with α-blockers and antimuscarinics, sequential use of α-blockers and antimuscarinics, monotherapy with antimuscarinics, and a combination of antimuscarinics and 5α-reductase inhibitors. The sequential use of α-blockers and antimuscarinics seems to be the most appropriate approach, and the use of antimuscarinics and α-blockers appears generally to be safe and efficacious. Data are insufficient for a possible stratification of patients for a specific sequence of the drugs reviewed.
  
  
  CONCLUSIONS
  This review infers that the existing data confirm the safety of antimuscarinics administered for the treatment of these patients. The efficacy of antimuscarinics has been proven in different trials regarding different storage symptom end points, but not all end points regarding OAB reached significance. All the reported trials are of short duration (4-12 wk) and include only men with low postvoid residual urine volumes at baseline (<200ml). Overall, the addition of an antimuscarinic to the treatment of a patient with BOO and concomitant OAB seems to offer an amelioration of the symptoms and a moderate improvement in quality of life.
authors.affiliation: Urodynamic Urology Unit, Department of Urology, Medical School, University of Patras, Patras, Greece. tassos_athan@hotmail.com
authors.forename: Anastasios
authors.initials: A
authors.lastname: Athanasopoulos
authors.forename: Christopher
authors.initials: C
authors.lastname: Chapple
authors.forename: Clare
authors.initials: C
authors.lastname: Fowler
authors.forename: Christian
authors.initials: C
authors.lastname: Gratzke
authors.forename: Steven
authors.initials: S
authors.lastname: Kaplan
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000188:drug therapy*; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000188:drug therapy*
chemical_list: D000317:Adrenergic alpha-Antagonists; D018727:Muscarinic Antagonists