The Factors Affecting the Compliance of Additional Anticholinergic Medication in the Patients with Benign Prostatic Hyperplasia

ABSTRACT

PURPOSE: Anticholinergic agents are effective in relieving overactive bladder symptoms and historically has been contraindicated in benign prostatic hyperplaisa (BPH) patients because of concerns for developing acute urinary retention. Recently, however, treatment for men with predominant storage symptoms is combined with an antichoilnergic agents. We evaluated the efficacy, discontinuation rate, adverse events and clinical parameters of alpha-blockers and/or 5alpha-reductase inhibitors treatment combined with anticholinergic agents in patients with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: 137 patients with BPH, who had treated with alpha-blockers and/or 5alpha-reductase inhibitors combined with anticholinergic agents at our department from January 2003 to November 2008, were retrospectively studied. In 92 patients, anticholinergic agents continued to be administered (group I) and in 45 patients, ceased to be given (group II). The efficacy and adverse events of anticholinergics treatment were estimated. The International Prostate Symptom Score (IPSS), serum prostate specific antigen (PSA) level, prostate volume, maximum urinary flow rate and residual urine volume before administration of anticholinergics were evaluated. The change in maximum urinary flow rate and residual urine volume and the presence of acute urinary retention after giving anticholinergics were compared. RESULTS: There was no significant difference comparing age, IPSS, serum PSA levels, prostate volum, maximum urinary flow rate and residual urine volume except IPSS storage subscore between the two groups. In group I, there was no significant change in maximum urinary flow rate and residual urine volume after administering anticholinergics. IPSS storage subscore were more significant in group I (9.0+/-3.4 vs 7.4+/-3.4, p<0.05). The duration of anticholinergics administration was longer in group I than II (325.0+/-316.7 vs 95.5+/-96.1). The discontinuation rate was 32.8%. Nocturia (n=48), frequency (n=28) and urgency (n=16) were significantly improved in group I after additional anticholinergic medication. Adverse events causing discontinuation in group II were the increase of residual sensation (n=13), difficult voiding (n=12), dry mouth (n=6), hesitancy (n=6) and constipation (n=2). Acute urinary retention was not reported in both groups. CONCLUSIONS: In men with LUTS suggestive of BPH, anticholinergic treatment appears to be safe and when the storage symptoms were severer, the better compliance was. The overall discontinuation rate was 32.8%, and acute urinary retention was not reported.