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Combination Therapy More Effective for Treating Lower Urinary Tract Symptoms

Men with overactive bladder and lower urinary tract symptoms who received a combination therapy were more likely to report improvement in symptoms than men who// received only one medication, according to a study in the November 15 issue of JAMA, a theme issue on men's health.

Steven A. Kaplan, M.D., of Weill Cornell Medical College, New York, presented the findings of the study today at a JAMA media briefing on men's health in New York.

Overactive bladder is a syndrome characterized by urinary urgency, usually with increased urination frequency during the day and night. An estimated 10 million men 40 years or older have symptoms consistent with overactive bladder, according to background information in the article. Lower urinary tract symptoms include urinary hesitancy and intermittency and weak urinary stream. Some men with these symptoms do not respond to treatment with common medications.

Dr. Kaplan and colleagues evaluated the effectiveness of two widely used medications, tolterodine extended release (ER), an antimuscarinic, and tamsulosin, an ?1-receptor antagonist, used alone or in combination in men with overactive bladder and benign prostatic hyperplasia (enlarged prostate). The randomized, double-blind trial was conducted at 95 urology clinics in the United States involving men 40 years or older who had a self-rated bladder condition of at least moderate bother, and a bladder diary documenting urination frequency (8 or more urinations per 24 hours) and urgency (3 or more episodes per 24 hours), with or without urgency urinary incontinence. Patients were randomly assigned to receive placebo (n = 222), 4 mg of tolterodine ER (n = 217), 0.4 mg of tamsulosin (n = 215), or both tolterodine ER plus tamsulosin (n = 225) for 12 weeks. Patients were recruited between November 2004 and February 2006, and the study was completed May 2006.

The researchers found that 80 percent of patients receiving tolterodine ER plus
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