EVIDENCE SYNTHESIS The most studied combination therapy for the treatment of male LUTS is the α1-adrenoceptor antagonist/5α-reductase inhibitor combination .
This combination seems to be more efficacious in terms of several outcome variables , in particular in men who have moderate-to-severe LUTS and are at risk of disease progression .
Also in terms of nocturia improvements , this combination is significantly more effective than the monotherapy .
The other often studied combination treatment , in both male and female patients with LUTS , was the combination of antimuscarinics ( in particular solifenacin ) and mirabegron .
This combination seems to be more effective in comparison with the monotherapies with respect to urinary incontinence and urgency urinary incontinence episodes and several other objective and subjective parameters , without relevant increase of adverse events .
The combination of hormone therapy and antimuscarinics in women with LUTS does not seem to be useful .
For the treatment of LUTS in men and women , combination therapy appears to be a promising option to optimize the efficacy of the available drugs for those who do not experience sufficient benefit with monotherapy .
This add-on scenario offers the possibility to have a more tailored approach to the management of LUTS , always seeking the optimal balance between efficacy and tolerability for a given patient .
PATIENT SUMMARY Some combination of drugs may offer advantages over monotherapies for the treatment of voiding and storage complaints in men and women
CONTEXT Several drugs are approved and available for the treatment of lower urinary tract symptoms ( LUTS ) in men and women .
However , the vast majority of available data , upon which the approval and recommendation in guidelines are based , considered only the role of the monotherapies and did not evaluate possible combination therapies .
OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male and female LUTS .
Solifenacin plus tamsulosin combination treatment in men with lower urinary tract symptoms and bladder outlet obstruction: a randomized controlled trial.
BACKGROUND Alpha blockers are prescribed to manage lower urinary tract symptoms ( LUTS ) associated with benign prostatic hyperplasia ( BPH ) .  Antimuscarinics are prescribed to treat overactive bladder ( OAB ) . OBJECTIVE To investigate the safety of a combination of solifenacin ( SOLI ) and tamsulosin oral controlled absorption system ( TOCAS ) in men with LUTS and bladder outlet obstruction ( BOO ) . DESIGN , SETTING , AND PARTICIPANTS R and omized , double-blind , parallel-group , placebo-controlled study in men aged > 45 yr with LUTS and BOO for ≥3 mo , total International Prostate Symptom Score ( IPSS ) ≥8 , BOO index ≥20 , maximum urinary flow rate ( Q(max ) ) ≤12 ml/s , and voided volume ≥120 ml . INTERVENTIONS Once-daily coadministration of TOCAS 0.4 mg plus SOLI 6 mg , TOCAS 0.4 mg plus SOLI 9 mg , or placebo for 12 wk . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary ( safety ) measurements : Q(max ) and detrusor pressure at Q(max ) ( P(det)Q(max ) ) . Other safety assessment s included postvoid residual ( PVR ) volume . Secondary end points included bladder contractile index ( BCI ) score and percent bladder voiding efficiency ( BVE ) . An analysis of covariance model compared each TOCAS plus SOLI combination with placebo . RESULTS AND LIMITATIONS Both active treatment groups were noninferior to placebo at end of treatment ( EOT ) for P(det)Q(max ) and Q(max ) . Mean change from baseline PVR was significantly higher at all time points for TOCAS 0.4 mg plus SOLI 6 mg , and at weeks 2 , 12 , and EOT for TOCAS 0.4 mg plus SOLI 9 mg versus placebo . Both treatment groups were similar to  placebo for BCI and BVE . Urinary retention was seen in only one patient receiving TOCAS 0.4 mg plus SOLI 6 mg . Limitations of the study were that prostate size and prostate-specific antigen level were not measured . CONCLUSIONS TOCAS 0.4 mg plus SOLI 6 mg or 9 mg was noninferior to placebo at EOT for P(det)Q(max ) and Q(max ) in men with LUTS and BOO , and there was no clinical or statistical evidence of increased risk of urinary retention
EVIDENCE SYNTHESIS The most studied combination therapy for the treatment of male LUTS is the α1-adrenoceptor antagonist/5α-reductase inhibitor combination .
This combination seems to be more efficacious in terms of several outcome variables , in particular in men who have moderate-to-severe LUTS and are at risk of disease progression .
Also in terms of nocturia improvements , this combination is significantly more effective than the monotherapy .
The other often studied combination treatment , in both male and female patients with LUTS , was the combination of antimuscarinics ( in particular solifenacin ) and mirabegron .
This combination seems to be more effective in comparison with the monotherapies with respect to urinary incontinence and urgency urinary incontinence episodes and several other objective and subjective parameters , without relevant increase of adverse events .
The combination of hormone therapy and antimuscarinics in women with LUTS does not seem to be useful .
For the treatment of LUTS in men and women , combination therapy appears to be a promising option to optimize the efficacy of the available drugs for those who do not experience sufficient benefit with monotherapy .
This add-on scenario offers the possibility to have a more tailored approach to the management of LUTS , always seeking the optimal balance between efficacy and tolerability for a given patient .
PATIENT SUMMARY Some combination of drugs may offer advantages over monotherapies for the treatment of voiding and storage complaints in men and women
CONTEXT Several drugs are approved and available for the treatment of lower urinary tract symptoms ( LUTS ) in men and women .
However , the vast majority of available data , upon which the approval and recommendation in guidelines are based , considered only the role of the monotherapies and did not evaluate possible combination therapies .
OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male and female LUTS .