Does combining anti-muscarinic and alpha-blocker medications improve lower urinary tract symptoms (LUTS) in men with BPH?

This study investigated the effectiveness of combining anti-muscarinics with alpha-blocker treatment to treat men with LUTS/BPH. The authors concluded that the addition of anti-muscarinic drugs improved some LUTS and are well tolerated by patients. 
 

Lower urinary tract symptoms (LUTS) include nocturia (increased urge to urinate at night) and urinary incontinence (inability to control urination). LUTS are common in men with benign prostatic hyperplasia (BPH, enlarged prostate).

Treating LUTS can be complicated, as there can be a number of causes. Alpha-(adrenoreceptor) blockers are often the first treatments used. These cause the bladder and prostate muscles to relax. In some patients, alpha-blockers will not provide an improvement in storage symptoms such as nocturia. Storage symptoms are those related to the storage capacity of the bladder. Anti-muscarinic treatments may improve LUTS in patients who do not benefit from alpha-blocker treatment alone.

It is unclear if combining anti-muscarinic drugs with alpha-blockers can improve LUTS in patients with BPH.
 

This study investigated the effectiveness of combining anti-muscarinic drugs and alpha-blockers for the treatment of LUTS in patients with BPH. This study analyzed 15 clinical reports on combining anti-muscarinic drug and alpha-blocker therapy in LUTS/BPH patients. 

Patients who received a combination of an anti-muscarinic drug and an alpha-blocker had significant reductions in the number of urgency episodes compared to alpha-blockers alone. Overall, symptoms and quality of life were improved in patients receiving combination treatment. Urinary function was not improved by additional treatment with anti-muscarinic drugs. 

Patients in the combination groups reported more adverse (negative) events (50.1%) compared to monotherapy patients (34.4%). Adverse effects in the combination group included dry mouth and constipation. 
 

The authors concluded that the addition of anti-muscarinic drugs improved some LUTS and are well tolerated by patients.

This study compared data from a number of clinical trials. Comparing data from different clinical trial designs is difficult. A larger, randomized-controlled trial is needed to confirm the observations in this study.

If you have any concerns regarding treatment of LUTS, please consult with your doctor.