[Paradigm shift in combination therapy during the COVID-19 pandemic]

Insufficient efficiency of combination therapy with -adrenergic blockers and 5-reductase inhibitors with subsequent proceeding to surgical treatment in the absence of absolute indications is a prerequisite for poor postoperative results.

to evaluate the efficiency of changing standard combination therapy to -adrenergic blockers + m-cholinoblockers instead of proceeding to surgical treatment.

From January 2019 to December 2019, a total of 137 patients with lower urinary treatment were referred to the Pletnev City Clinical Hospital due to limited efficiency of combination therapy with -adrenergic blockers and 5-reductase inhibitors in order to undergone laser enucleation/vaporization of the prostate. After evaluation, 41 patients with absolute indications for surgical treatment or with suspected prostate cancer were excluded. After a comprehensive examination, 96 patients were prescribed tamsulosin 0.4 mg daily in combination with solifenacin 10 mg daily. All patients were followed up for 12 months.

As a result of using solifenacin, better control over storage symptoms was achieved according to the I-PSS scale (-4 points), which also led to a significant decrease in the total I-PSS score after 12 months of therapy. There was an increase in the mean voided volume (by 53%) after 6 months. Neither Qmax, nor residual urine volume did not change significantly. According to the MIEF-5 scale, an improvement in erectile function was revealed. There was a slight decrease in the average prostate volume and an increase in the PSA level from 3.1 to 4.1 ng/ml. There was no acute urinary retention. However, 6 patients discontinued taking of m-cholinoblockers due to dry mouth.

If there are no absolute indications for surgical treatment, changing the combination of -adrenergic blockers + 5-Reductase inhibitors to a combination of -adrenergic blockers + m-cholinoblockers results in a pronounced symptomatic improvement due to alleviation of storage symptoms.