Can we combine anti-cholinergics and alpha-blockers to treat men with LUTS?
The Paper Kaplan S et al. Tolterodine and Tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder – a randomised controlled trial. JAMA 2006: 296; 2319-2328. Method Randomised double-blind placebo-controlled trial in US of men over 40 with LUTS and symptoms of an overactive bladder. Randomised to placebo, tolterodine, tamsulosin or both with around 220 patients in each arm. Results Combination therapy gave symptomatic improvement in 80%, compared with approximately 70% with single therapy and 62% in the placebo arm. Acute retention occurred in 0.5% of patients receiving tolterodine but in no patients in the other arms. Conclusion Combination therapy is marginally better than single therapy so may be worth a try in patients refractory to treatment with an alpha-blocker alone. Placebo is a surprisingly effective treatment, illustrating the psychological component of LUTS. What I’m going to do now Consider dual therapy especially for those with predominant
