A Study on the Efficacy of Combination Therapy with Alpha-blockers and Anticholinergics in the Lower Urinary Tract Symptoms Patients Accompanied with Overactive Bladder Symptoms

ABSTRACT

PURPOSE: Benign prostatic hyperplasia(BPH) patients usually accompanies overactive bladder(OAB) symptoms. Adding anticholinergics in these patients evokes us worrying about deterioration of obstructive symptoms. We evaluated the relative benefit of anticholinergics compared with alpha-blocker only group in terms of emptying efficiency and storing symptoms. MATERIALS AND METHODS: From October 2000 to February 2006, male LUTS(lower urinary tract symptoms) patients with more than 8 IPSS(international prostate symptom score) and more than 2 score in IPSS urgency question(question 4) were selected. 168 patients were eligible without exclusion criteria or drop-out and with follow-up. In 109 patients, alpha-blocker plus anti-cholinergic were used(group I) and in 59 patients alpha-blocker only(group II). Used anti-cholinergics were tolterodine 1 mg, 2 mg and propiverine 10 mg, 20 mg. After mean 15.3 months, follow up evaluation was done. IPSS score was divided as emptying domain(question 1,3,5,6) and storing domain(question 2,4,7). Between the 2 groups the amount of change in each domain of IPSS, urgency question score, total IPSS, QoL, uroflowmetry and RU were compared. According to used anticholinergic and dosage 4 divided groups were also compared as the same methods. RESULTS: The mean age was 64.7+/-9.8 years. Baseline characteristics between the 2 groups were not different in all parameters. After mean 15.3 months later, the changes of storing symptom domain score were -3.3+/-2.7, -2.4+/-2.5 for group I and group II respectively(p=0.041) and urgency question score -1.6+/-1.4, -1.1+/-1.2 (p=0.046) and quality of life score -0.7+/-1.2, -0.4+/-0.8(p=0.028). But the changes of all other parameters were not different between 2 groups. Subdivided 4 cholinergic groups didn't show any differences among groups. CONCLUSIONS: Combination of alpha-blockers with anticholinergics in benign prostatic hyperplasia with overactive bladder patients seems not to lower emptying efficiency significantly but improve storing symptoms significantly.