Combination therapy may be more effective for LUTS in men

Men with overactive bladder and lower urinary tract symptoms who receive combination therapy are more likely to report improvement in symptoms than are those who receive only one medication, according to results of a study recently reported in JAMA (2006; 296:2319-28).

Steven A. Kaplan, MD, of Weill Cornell Medical College, New York, and colleagues evaluated the effectiveness of extended-release tolterodine (Detrol LA) and tamsulosin (Flomax), used alone or in combination, in men with overactive bladder and BPH. The randomized, double-blind trial was conducted at 95 urology clinics in the United States involving men 40 years of age or older. Patients were randomly assigned to receive placebo, extended-release tolterodine, 4 mg, tamsulosin, 0.4 mg, or a combination of extended-release tolterodine plus tamsulosin for 12 weeks.

Eighty percent of patients receiving the combination therapy reported benefit by week 12 compared with 62% of those receiving placebo, 65% of those receiving extended-release tolterodine, and 71% of those receiving tamsulosin. Symptoms of urgency urinary incontinence, urgency, and 24-hour and nocturnal urination frequency were also significantly improved by week 12 in the group receiving the combination versus placebo, but not in the tamsulosin group. In the extended-release tolterodine group, only urgency urinary incontinence episodes per 24 hours were significantly reduced at week 12.

“The results of this study demonstrate that some men bothered by lower urinary tract symptoms, including bladder diary-documented overactive bladder symptoms, might not respond to monotherapy with either alpha-receptor antagonists or antimuscarinic agents,” the authors wrote. “Treatment with tolterodine extended release plus tamsulosin resulted in statistically and clinically significant treatment benefit. Similarly, low incidences of acute urinary retention were observed in all treatment groups, and there were no significant differences in maximum urinary flow rate or postvoid residual volume between the two groups.”