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The role of antimuscarinics in the management of men with symptoms of overactive bladder associated with concomitant bladder outlet obstruction: an update.
Eur Urol. 2011 Jul; 60(1):94-105.EU

Abstract

CONTEXT

This review focuses on the contemporary role of antimuscarinics in the management of men with symptoms of bladder outlet obstruction (BOO) and concomitant overactive bladder (OAB). Safety issues of antimuscarinics in this subpopulation of men are also reviewed.

OBJECTIVE

We reviewed the current literature and performed an analysis of the efficacy, suitability, and the safety of antimuscarinics in this subpopulation of men.

EVIDENCE ACQUISITION

We performed a systematic search of Medline/PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews for relevant articles published between 1990 and September 2010, restricted to studies in humans published in English. In addition, published abstracts presented at the annual meetings of the European Association of Urology, the American Urological Association, and the International Continence Society in the last decade (2000-2010) were hand-searched and evaluated. Each article's title and abstract were reviewed for their appropriateness and relevance to the use of antimuscarinics in patients with BOO and concomitant OAB. Relevant articles were fully reviewed and included in the final data acquisition.

EVIDENCE SYNTHESIS

Treatment options include combination treatment with α-blockers and antimuscarinics, sequential use of α-blockers and antimuscarinics, monotherapy with antimuscarinics, and a combination of antimuscarinics and 5α-reductase inhibitors. The sequential use of α-blockers and antimuscarinics seems to be the most appropriate approach, and the use of antimuscarinics and α-blockers appears generally to be safe and efficacious. Data are insufficient for a possible stratification of patients for a specific sequence of the drugs reviewed.

CONCLUSIONS

This review infers that the existing data confirm the safety of antimuscarinics administered for the treatment of these patients. The efficacy of antimuscarinics has been proven in different trials regarding different storage symptom end points, but not all end points regarding OAB reached significance. All the reported trials are of short duration (4-12 wk) and include only men with low postvoid residual urine volumes at baseline (<200ml). Overall, the addition of an antimuscarinic to the treatment of a patient with BOO and concomitant OAB seems to offer an amelioration of the symptoms and a moderate improvement in quality of life.

Authors+Show Affiliations

Urodynamic Urology Unit, Department of Urology, Medical School, University of Patras, Patras, Greece. tassos_athan@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

21497434

Citation

Athanasopoulos, Anastasios, et al. "The Role of Antimuscarinics in the Management of Men With Symptoms of Overactive Bladder Associated With Concomitant Bladder Outlet Obstruction: an Update." European Urology, vol. 60, no. 1, 2011, pp. 94-105.
Athanasopoulos A, Chapple C, Fowler C, et al. The role of antimuscarinics in the management of men with symptoms of overactive bladder associated with concomitant bladder outlet obstruction: an update. Eur Urol. 2011;60(1):94-105.
Athanasopoulos, A., Chapple, C., Fowler, C., Gratzke, C., Kaplan, S., Stief, C., & Tubaro, A. (2011). The role of antimuscarinics in the management of men with symptoms of overactive bladder associated with concomitant bladder outlet obstruction: an update. European Urology, 60(1), 94-105. https://doi.org/10.1016/j.eururo.2011.03.054
Athanasopoulos A, et al. The Role of Antimuscarinics in the Management of Men With Symptoms of Overactive Bladder Associated With Concomitant Bladder Outlet Obstruction: an Update. Eur Urol. 2011;60(1):94-105. PubMed PMID: 21497434.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of antimuscarinics in the management of men with symptoms of overactive bladder associated with concomitant bladder outlet obstruction: an update. AU - Athanasopoulos,Anastasios, AU - Chapple,Christopher, AU - Fowler,Clare, AU - Gratzke,Christian, AU - Kaplan,Steven, AU - Stief,Christian, AU - Tubaro,Andrea, Y1 - 2011/04/09/ PY - 2011/01/12/received PY - 2011/03/29/accepted PY - 2011/4/19/entrez PY - 2011/4/19/pubmed PY - 2011/10/5/medline SP - 94 EP - 105 JF - European urology JO - Eur Urol VL - 60 IS - 1 N2 - CONTEXT: This review focuses on the contemporary role of antimuscarinics in the management of men with symptoms of bladder outlet obstruction (BOO) and concomitant overactive bladder (OAB). Safety issues of antimuscarinics in this subpopulation of men are also reviewed. OBJECTIVE: We reviewed the current literature and performed an analysis of the efficacy, suitability, and the safety of antimuscarinics in this subpopulation of men. EVIDENCE ACQUISITION: We performed a systematic search of Medline/PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews for relevant articles published between 1990 and September 2010, restricted to studies in humans published in English. In addition, published abstracts presented at the annual meetings of the European Association of Urology, the American Urological Association, and the International Continence Society in the last decade (2000-2010) were hand-searched and evaluated. Each article's title and abstract were reviewed for their appropriateness and relevance to the use of antimuscarinics in patients with BOO and concomitant OAB. Relevant articles were fully reviewed and included in the final data acquisition. EVIDENCE SYNTHESIS: Treatment options include combination treatment with α-blockers and antimuscarinics, sequential use of α-blockers and antimuscarinics, monotherapy with antimuscarinics, and a combination of antimuscarinics and 5α-reductase inhibitors. The sequential use of α-blockers and antimuscarinics seems to be the most appropriate approach, and the use of antimuscarinics and α-blockers appears generally to be safe and efficacious. Data are insufficient for a possible stratification of patients for a specific sequence of the drugs reviewed. CONCLUSIONS: This review infers that the existing data confirm the safety of antimuscarinics administered for the treatment of these patients. The efficacy of antimuscarinics has been proven in different trials regarding different storage symptom end points, but not all end points regarding OAB reached significance. All the reported trials are of short duration (4-12 wk) and include only men with low postvoid residual urine volumes at baseline (<200ml). Overall, the addition of an antimuscarinic to the treatment of a patient with BOO and concomitant OAB seems to offer an amelioration of the symptoms and a moderate improvement in quality of life. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/21497434/The_role_of_antimuscarinics_in_the_management_of_men_with_symptoms_of_overactive_bladder_associated_with_concomitant_bladder_outlet_obstruction:_an_update_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(11)00361-7 DB - PRIME DP - Unbound Medicine ER -