Current role for combination therapy in male LUTS

Area of Science:

• Urology
• Pharmacology

Background:

• Lower Urinary Tract Symptoms (LUTS) in Benign Prostatic Hyperplasia (BPH) management has progressed from surgery to medical therapies.
• Current first-line medical treatments include alpha-adrenergic antagonists and 5alpha-reductase inhibitors for outlet resistance and prostate volume reduction, respectively.

Purpose of the Study:

• To review the evolution and efficacy of medical therapies for LUTS in BPH.
• To evaluate the safety and effectiveness of combination therapies for LUTS in patients with BPH and Overactive Bladder (OAB) symptoms.

Main Methods:

• Review of existing literature on medical monotherapy and combination therapy for LUTS/BPH.
• Analysis of clinical trial data, including MTOPS and ComBAT studies, comparing combination therapy to monotherapy.

Main Results:

• Alpha-adrenergic antagonists, 5alpha-reductase inhibitors, and antimuscarinic agents are safe and effective for LUTS in BPH.
• Combination therapy, particularly 5alpha-reductase inhibitors with alpha-adrenergic antagonists, demonstrates superiority over monotherapy in preventing disease progression.
• Combinations involving antimuscarinic agents are safe and effective for patients with LUTS, BPH, and OAB symptoms.

Conclusions:

• Combination therapy is a valuable strategy for managing LUTS in BPH, offering benefits over monotherapy.
• Clinical practice guidelines currently recommend combination therapy with 5alpha-reductase inhibitors and alpha-adrenergic antagonists.
• Further investigation is necessary to determine optimal patient selection for specific combination therapeutic regimens.