title: Tolterodine extended release in the treatment of male OAB/storage LUTS: a systematic review.
abstract: BACKGROUND
  Overactive bladder (OAB)/ storage lower urinary tract symptoms (LUTS) have a high prevalence affecting up to 90% of men over 80 years. The role of sufficient therapies appears crucial. In the present review, we analyzed the mechanism of action of tolterodine extended-release (ER) with the aim to clarify its efficacy and safety profile, as compared to other active treatments of OAB/storage LUTS.
  
  
  METHODS
  A wide Medline search was performed including the combination of following words: "LUTS", "BPH", "OAB", "antimuscarinic", "tolterodine", "tolterodine ER". IPSS, IPSS storage sub-score and IPSS QoL (International Prostate Symptom Score) were the validated efficacy outcomes. In addition, the numbers of urgency episodes/24 h, urgency incontinence episodes/24 h, incontinence episodes/24 h and pad use were considered. We also evaluated the most common adverse events (AEs) reported for tolterodine ER.
  
  
  RESULTS
  Of 128 retrieved articles, 109 were excluded. The efficacy and tolerability of tolterodine ER Vs. tolterodine IR have been evaluated in a multicenter, double-blind, randomized placebo controlled study in 1529 patients with OAB. A 71% mean reduction in urgency incontinence episodes was found in the tolterodine ER group compared to a 60% reduction in the tolterodine IR (p < 0.05). Few studies evaluated the clinical efficacy of α-blocker/tolterodine combination therapy. In patients with large prostates (prostate volume >29 cc) only the combination therapy significantly reduced 24-h voiding frequency (2.8 vs. 1.7 with tamsulosin, 1.4 with tolterodine, or 1.6 with placebo). A recent meta-analysis evaluating tolterodine in comparison with other antimuscarinic drugs demonstrated that tolterodine ER was significantly more effective than placebo in reducing micturition/24 h, urinary leakage episodes/24 h, urgency episodes/24 h, and urgency incontinence episodes/24 h. With regard to adverse events, tolterodine ER was associated with a good adverse event profile resulting in the third most favorable antimuscarinic. Antimuscarinic drugs are the mainstay of pharmacological therapy for OAB / storage LUTS; several studies have demonstrated that tolterodine ER is an effective and well tolerated formulation of this class of treatment.
  
  
  CONCLUSIONS
  Tolterodine ER resulted effective in reducing frequency urgency and nocturia and urinary leakage in male patients with OAB/storage LUTS. Dry mouth and constipation are the most frequently reported adverse events.
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Viale S, Luca - 50134, Florence, Italy. maurogacci@yahoo.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
authors.forename: Arcangelo
authors.initials: A
authors.lastname: Sebastianelli
authors.forename: Matteo
authors.initials: M
authors.lastname: Salvi
authors.forename: Matthias
authors.initials: M
authors.lastname: Oelke
authors.forename: Stavros
authors.initials: S
authors.lastname: Gravas
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced; D003408:Cresols / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy*; D008297:Male; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010665:Phenylpropanolamine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000068737:Tolterodine Tartrate; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*; D064804:Urological Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014987:Xerostomia / Q000139:chemically induced
chemical_list: D000317:Adrenergic alpha-Antagonists; D001559:Benzhydryl Compounds; D003408:Cresols; D003692:Delayed-Action Preparations; D018727:Muscarinic Antagonists; D064804:Urological Agents; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate