Antimuscarinics in men with lower urinary tract symptoms suggestive of bladder outlet obstruction due to benign prostatic hyperplasia

Purpose of review This review will provide an update on the use of antimuscarinics, in combination with an alpha-blocker, in men with an overactive bladder and summarize the efficacy and safety of these drugs in this patient population. Recent findings Studies have included a number of antimuscarinic agents (tolterodine, oxybutynin, propiverine, and solifenacin), with or without an alpha-blocker. These studies suggest that in men with persistent storage symptoms (overactive bladder symptoms), clinically meaningful improvements can be achieved by addition of an antimuscarinic therapy to an alpha-blocker. Monotherapy with an antimuscarinic therapy alone in this patient group has proven to be disappointing. Voiding difficulty and acute urinary retention are infrequently reported across all studies, but several trials demonstrated an increase in postvoid residual volume with anticholinergic therapy. It must, however, be borne in mind that reported trials are of short duration (6-12 weeks) and include only men with low postvoid residual volumes at baseline, and the results are, therefore, difficult to unreservedly extrapolate to real-life clinical practice. Summary In a situation in which there are persistent urinary storage symptoms (overactive bladder) following therapy with an alpha-blocker, the addition of an antimuscarinic therapy is worth considering. A postvoid residual volume should be measured prior to commencing antimuscarinic therapy to rule out baseline retention suggestive of poor detrusor function, and patients should be kept under careful review, particularly, in the early stages of having commenced therapy.