Clinical efficacy of tolterodine for patients with overactive bladder after insufficient efficacy by monotherapy with α1-adrenoceptor antagonist

Abstract

(Purpose) The efficacy of aradrenoceptor (α-AR) antagonist and anticholinergic agent combined therapy for patients with benign prostatic hyperplasia (BPH) together with overactive bladder (OAB) has been controversial. The purpose of this study was to evaluate the effect of tolterodine combined with α-AR antagonist for patients with BPH and OAB after insufficient efficacy by monotherapy with α-AR antagonist The adverse event of this combined therapy was also assessed. (Materials and methods) The study included 47 patients with BPH, whose OAB symptom persisted (OAB symptom score; OABSS≥3) after monotherapy with α1-AR antagonist for more than 4 weeks. The mean age was 72.9 years and the mean prostate volume was 29.8 ml. Four mg/day of tolterodine with α1-AR antagonist was administered for 8 weeks to patients. International prostate symptom score (IPSS), quality of life (QOL) index, 0 ABSS, King's Health Questionnaire (KHQ) and residual urine volume (RUV) were assessed before and after combined therapy. (Results) Six patients were dropped out from this study because of dry mouth, constipation, onset of other disease and insufficient efficacy by self-judgment IPSS (from 15.1 ± 6.8 to 11.0 ± 7.9; P< 0.01), QOL index (from 4.3 ± 1.1 to 3.6 ± 1.3; P<0.01) and OABSS (from 7.0± 3.0 to 5.4 ± 2.9; P<0.01) of 41 patients improved significantly by combined therapy. The storage symptom of IPSS subscore improved significantly (from 8.0 ± 2.9 to 6.5 ± 2.8; P< 0.01), whereas the voiding symptom did not improve. Regarding KHQ, the score of 3 domains (impact on life, role limitation, and physical limitation) improved significantly (P<0.05). RUV did not change and no serious adverse event including urinary retention was found in this study. (Conclusions) This study reveals that the combined therapy of α1AR antagonist and tolterodine represents an effective and safe treatment modality for patients with BPH and OAB, whose OAB symptom was not improved by antecedent monotherapy with α1-AR antagonist.