Combining ?-blockers with anticholinergics helps relieve urinary symptoms

This study reviewed the effects of combined α-blocker and anticholinergic therapy on urinary symptoms in men with benign prostatic hyperplasia (BPH).

Men with enlarged prostates often experience bothersome urinary symptoms. These may include increased frequency or urgency of urination, frequently waking up at night to urinate (nocturia), or urinary incontinence. These symptoms are often collectively referred to as urinary storage symptoms, or overactive bladder symptoms.

Alpha-blockers (α-blockers) are a group of drugs that work by blocking the effects of the hormone noradrenaline. These drugs are often the first choice for treating men with BPH. Commonly prescribed α-blocker include doxazosin (Cardura) and Tamsulosin (Flomax).

Anticholinergic drugs, such as tolterodine (Detrol), help relieve urinary storage symptoms by relaxing the bladder muscle.

This study reviewed seven randomized trials, including a total of 3629 men with BPH. Patient reported symptom scores were compared between men receiving combination α-blocker and anticholinergic therapy, and men treated by α-blockers alone. Urine flow rate, incomplete bladder emptying, and the risk of urinary retention (an inability to pass urine), were also compared.

Men receiving combination therapy reported greater improvements in urinary storage symptoms. Men on combination therapy also reported needing to urinate less frequently. However, compared to α-blocker therapy alone, urine flow rates were reduced in men receiving combination therapy. Combination therapy also increased incomplete bladder emptying. The risk for urinary retention was increased with combination therapy, but occurred in less than 1% of men.

Researchers concluded that combination treatment with α-blockers and anticholinergics improves urinary storage symptoms compared to α-blocker therapy alone. Combination treatment is safe, with a small risk of urinary retention.