Combination therapy beneficial for men with BPH with overactive bladder symptoms

This study examined the benefit of combining silodosin (Rapaflo) with propiverine (Mictonorm) in reducing urinary symptoms due to benign prostatic hyperplasia (BPH). Authors reported greater overall improvements when both therapies were combined. 

Men with BPH often experience urinary symptoms that can significantly affect quality of life. An enlarged prostate can put pressure on the bladder. This can cause urinary urgency, frequency and incontinence (overactive bladder symptoms). It can also cause an obstruction in the base of the bladder. This can lead to voiding symptoms such as weak urine stream and incomplete bladder emptying.  

Drugs that are commonly prescribed for treating urinary symptoms in BPH include alpha-blockers, such as silodosin, and anticholinergic drugs, such as propiverine. Alpha-blockers work by relaxing the muscles in the prostate and bladder, allowing urine to flow more easily. These are often the first choice for treating men with BPH. Anticholinergic drugs are commonly used to treat overactive bladder symptoms. Combining both therapies could be beneficial for men with BPH experiencing both overactive bladder and voiding symptoms. 

The aim of this study was to examine the benefit of combining silodosin with propiverine in reducing overactive bladder and voiding symptoms.

120 men with with BPH experiencing both overactive bladder and voiding symptoms were included. Men were randomly assigned to receive either silodosin alone (monotherapy) or silodosin plus propiverine (combination therapy). Physical examinations and questionnaires measured treatment outcomes. Patients were followed for 1 year.

Overall, both groups showed significant improvements in urinary symptoms and quality of life after treatment. Combination therapy was associated with greater improvements compared to monotherapy. Urinary symptoms continued to improve for up to 1 year after the end of combination therapy. They slightly worsened after the end of monotherapy.

Bladder muscle overactivity disappeared in 51.1% of men after 12 weeks of combination therapy. This was significantly greater compared to 28.6% of men receiving monotherapy. Combination therapy was also associated with greater improvements in bladder capacity (how much urine the bladder can hold). Bladder capacity was increased by 61 ml with combination therapy and by 33 ml with monotherapy. Bladder obstruction and incomplete bladder emptying was similarly improved in both groups.

No significant differences in the rate of side effects were observed between the two groups. 6.7% of men undergoing monotherapy discontinued treatment due to side effects. These included dry mouth, low blood pressure when standing up, and dizziness. 11.7% of men undergoing combination therapy discontinued treatment due to side effects. These included dry mouth, constipation, and dizziness. 8.3% (combination therapy) and 10% (monotherapy) of men experienced ejaculatory dysfunction, but continued treatment.

Authors concluded that combining alpha-blocker and anticholinergic therapy was more effective overall at reducing urinary symptoms than alpha-blockers alone. Voiding symptoms were similarly improved in both treatment groups.