When to use antimuscarinics in men who have lower urinary tract symptoms

Although alpha-blockers are commonly used and generally effective in men who have symptomatic bladder outlet obstruction (BOO), a subset of these patients who have detrusor overactivity (DOA) often complain of persistent symptoms even after alpha-blocker therapy. What are the barriers to using antimuscarinics induce additional benefit? Should these men be treated primarily with antimuscarinics? The authors review several recent publications that look at this important issue and discuss when antimuscarinics should be used. It appears that BOO with concomitant DOA can be safely and accurately treated with a combination of alpha-blockers and antimuscarinics.