title: Efficacy and Safety of Initial Combination Treatment of an Alpha Blocker with an Anticholinergic Medication in Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptoms: Updated Meta-Analysis.
abstract: BACKGROUND
  There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS).
  
  
  OBJECTIVE
  The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis.
  
  
  METHODS
  We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL).
  
  
  RESULTS
  In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14-0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 - -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 - -0.07), 0.00 (95% CI: -0.08-0.08), and 0.56 (95% CI: 0.23-0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR.
  
  
  CONCLUSIONS
  Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/ LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function.
authors.affiliation: Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Hwa Yeon
authors.initials: HY
authors.lastname: Sun
authors.affiliation: Department of Urology, Korea University Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Hoon
authors.initials: H
authors.lastname: Choi
authors.affiliation: Department of Urology, Korea University Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Urology, Korea University Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Bae
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Seung Whan
authors.initials: SW
authors.lastname: Doo
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Won Jae
authors.initials: WJ
authors.lastname: Yang
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Yun Seob
authors.initials: YS
authors.lastname: Song
authors.affiliation: Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Korea.
authors.forename: Young Myoung
authors.initials: YM
authors.lastname: Ko
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Sonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Jae Heon
authors.identifier: http://orcid.org/0000-0002-4490-3610
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D059411:Lower Urinary Tract Symptoms; D008297:Male; D011470:Prostatic Hyperplasia / Q000175:diagnosis* / Q000188:drug therapy*; D017594:Publication Bias; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D000317:Adrenergic alpha-Antagonists; D018680:Cholinergic Antagonists