title: Antimuscarinics and α-blockers or α-blockers monotherapy on lower urinary tract symptoms--a meta-analysis.
abstract: OBJECTIVE
  To assess the clinical efficiency and safety of combination pharmacotherapy of antimuscarinics and α-blockers vs α-blockers monotherapy on patients with moderate to severe lower urinary tract symptoms (LUTS).
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, the Cochrane Database of Systematic Review, and Web of Science from their inception until June 2013 to identify all eligible studies that compare the 2 pharmacotherapy strategies on LUTS. The Cochrane Collaboration's RevMan 5.2 software was used for data analysis, and the fixed or the random effect model was selected depending on the proportion of heterogeneity.
  
  
  RESULTS
  Eighteen eligible randomized controlled trials were included in this systematic review, including 2106 (51.57%) in cotherapy group and 1978 (48.43%) in monotherapy group. Synthetic data showed that there were significant improvements on Storage International Prostate Symptom Score (mean difference [MD] = -1.51; 95% confidence interval [CI] -2.10 to -0.91, P <.00001), quality of life score (MD = -0.53; 95% CI -0.89 to -0.17, P = .004), micturitions per 24 hours (MD = -1.14; 95% CI -1.84 to -0.45, P = .001), and urgency episodes per 24 hours (MD = -0.99; 95% CI -1.46 to -0.51, P <.0001) in the cotherapy group. There were no significant difference regarding maximum flow rate (MD = -0.05; 95% CI -0.27 to 0.17, P = .64), Total International Prostate Symptom Score (TIPSS) (MD = -0.88; 95% CI -1.64 to -0.12, P = .02), and Voiding International Prostate Symptom Score (VIPSS) (MD = 0.40; 95% CI -0.34 to 1.15, P = .29). As to postvoid residual volume, however, a worse condition was showed in the cotherapy group (MD = -6.53; 95% CI 3.06-10.00, P <.0002).
  
  
  CONCLUSIONS
  Antimuscarinics could and should be added to the drug regimen for patients with LUTS attributed to benign prostatic hyperplasia/bladder outlet obstruction, particularly are dominated by storage symptoms. For patients with increased acute urinary retention risk, they should be carefully monitored.
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Nan
authors.initials: N
authors.lastname: Hao
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Romel
authors.initials: R
authors.lastname: Wazir
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Liangren
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China. Electronic address: kunjiewang_scu@163.com.
authors.forename: Kunjie
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Li
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy* / Q000503:physiopathology; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D011788:Quality of Life; D012720:Severity of Illness Index; D014554:Urination; D014563:Urodynamics / Q000187:drug effects
chemical_list: D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D018727:Muscarinic Antagonists