This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for > 1 yr ; when given for < 1 yr , α1-blockers alone are just as effective .
The combination of α1-blocker/5-ARI shows a slightly increased rate of adverse events .
It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after > 6 yr .
The α1-blocker/muscarinic receptor antagonist ( antimuscarinic ) combination was most frequently assessed as an add-on therapy to already existing α1-blocker therapy .
Inconsistent data derive from heterogeneous study population s and different study design s. Currently , the α1-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy .
The combination seems to be safe in men with postvoid residual < 200 ml .
The α1-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports .
CONCLUSIONS An α1-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for > 1 yr .
Based on short-term follow-up studies , add-on of antimuscarinics to α1-blockers is an option when postvoid residual is < 200 ml
BACKGROUND Several drugs are approved for the treatment of lower urinary tract symptoms ( LUTS ) in men , but these are mostly used by clinicians as monotherapies .
The combination of different compounds , each of which targets a different aspect of LUTS , seems appealing .
However , only few clinical trials have evaluated the effects of combination therapies .
OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS .
Efficacy of propiverine ER with or without α-blockers related to maximum urinary flow rate in adult men with OAB: results of a 12-week, multicenter, non-interventional study
Purpose Comparison of efficacy of propiverine extended release ( ER ) 30 mg o.d . in the treatment of male OAB administered as monotherapy ( MT ) or add-on to α-blockers ( combination treatment , CT ) in relation to maximum urinary flow ( Qmax ) in a non-interventional study . Methods Men ≥40 years with OAB symptoms , Qmax ≥10 ml/s , prostate volume < 40 ml , post-void residuals ( PVR ) < 100 ml , and IPSS < 20 were included . OAB symptoms , IPSS , and PVR were recorded before and after 12 weeks of treatment . Participants were stratified by Qmax ( group A ≥15 ml/s , group B < 15 ml/s ) and CT vs. MT . Safety parameters were monitored . Results A total of 2,219 men participated and were involved in safety analysis ; 1,849 men ( mean age 66 years ) fulfilled the inclusion criteria and were involved in efficacy analysis . In group A , 291 men  received MT and 479 CT ; in group B , 184 men  received MT and 895 CT . OAB symptoms improved significantly in all groups throughout the study without differences between MT and CT . IPSS improvement in group B was less with MT than with CT ( −3.9 vs. −5.2 ; P < 0.001 ) , whereas IPSS improvement was similar in group A ( −4.6 vs. −5.1 ) . Mean PVR change was not clinical ly relevant , but two men ( 0.1 % ) experienced urinary retention . Conclusions Under real-life conditions , treatment of OAB symptoms with propiverine ER is equally effective in men with MT or CT regardless of baseline Qmax . In men with reduced Qmax , IPSS improvement is significantly smaller with MT . The incidence of urinary retention during propiverine ER treatment is low
This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for > 1 yr ; when given for < 1 yr , α1-blockers alone are just as effective .
The combination of α1-blocker/5-ARI shows a slightly increased rate of adverse events .
It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after > 6 yr .
The α1-blocker/muscarinic receptor antagonist ( antimuscarinic ) combination was most frequently assessed as an add-on therapy to already existing α1-blocker therapy .
Inconsistent data derive from heterogeneous study population s and different study design s. Currently , the α1-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy .
The combination seems to be safe in men with postvoid residual < 200 ml .
The α1-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports .
CONCLUSIONS An α1-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for > 1 yr .
Based on short-term follow-up studies , add-on of antimuscarinics to α1-blockers is an option when postvoid residual is < 200 ml
BACKGROUND Several drugs are approved for the treatment of lower urinary tract symptoms ( LUTS ) in men , but these are mostly used by clinicians as monotherapies .
The combination of different compounds , each of which targets a different aspect of LUTS , seems appealing .
However , only few clinical trials have evaluated the effects of combination therapies .
OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS .