Data from 12-week , r and omised , double-blind , placebo-controlled trials of tolterodine extended release ( ER ) , oxybutynin and solifenacin show that combined antimuscarinic+α-blocker treatment is generally more effective than monotherapy or placebo in men with OAB symptoms .
The efficacy and safety  of tolterodine ER+α-blocker treatment was not affected by prostate size or prostate-specific antigen ( PSA ) level .
In men meeting entry criteria for OAB and benign prostatic obstruction trials  , tolterodine ER alone was effective selectively in men with prostate size or PSA level below study medians .
Post hoc analyses from double-blind , placebo-controlled trials and prospect i ve studies of fesoterodine , oxybutynin , propiverine , solifenacin and tolterodine also suggest that antimuscarinics are generally safe and efficacious in men .
A retrospective data base study found that risk of AUR in men was the highest in the first month of treatment and decreased considerably thereafter .
Antimuscarinics , alone or with an α-blocker , appear to be efficacious and safe in many men with predominant OAB symptoms or persistent OAB symptoms despite α-blocker or 5-α-reductase inhibitor treatment .
Despite potential benefits , primary care clinicians may avoid using antimuscarinics in men with overactive bladder ( OAB ) symptoms because of safety concerns .
Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings.
PURPOSE We evaluated the correlation of lower urinary tract symptoms suggestive of detrusor instability with urodynamic findings in men . MATERIAL S AND METHODS Enrolled in our prospect i ve study were 160 consecutive neurologically intact men referred for urodynamic evaluation of persistent lower urinary tract symptoms . All patients had storage symptoms suggestive of detrusor instability . Patients were further clinical ly categorized according to the chief complaint of urge incontinence , frequency and urgency , nocturia or difficult voiding . The clinical and urodynamic diagnosis in all patients as well as specific urodynamic characteristics of those with detrusor instability were analyzed according to the these 4 clinical categories . RESULTS Mean patient age was 61 + /- 15 years . The chief complaint was urge incontinence in 28 cases ( 17 % ) , frequency and urgency in 57 ( 36 % ) , nocturia in 30 ( 19 % ) and difficult voiding in 45 ( 28 % ) . Detrusor instability was diagnosed in 68 cases ( 43 % ) . A higher incidence of detrusor instability was associated with urge incontinence than with the other clinical categories ( 75 % versus 36 % , p < 0.01 ) . Of the patients 109 ( 68 % ) had bladder outlet obstruction , including 50 ( 46 % ) with concomitant detrusor instability . The prevalence of bladder outlet obstruction was similar in all patients regardless of the chief complaint . All other urodynamic diagnoses were also similar in the 4 clinical categories . The mean bladder volume at which involuntary detrusor contractions occurred were lower in patients with urge incontinence and frequency and urgency than in those with nocturia and difficult voiding ( 277.1 + /- 149.4 and 267.7 + /- 221.7 versus 346.7 + /- 204.6 and 306.2 + /- 192.1 ml . , respectively , not statistically significant , p = 0.07 ) . CONCLUSIONS Detrusor instability and bladder outlet obstruction are common in men with lower urinary tract symptoms . The symptom of urge incontinence strongly correlated with detrusor instability . Other lower urinary tract symptoms did not correlate well with any urodynamic findings . Therefore , we believe that an accurate urodynamic diagnosis may enable focused and more efficient management of lower urinary tract symptoms in men
Data from 12-week , r and omised , double-blind , placebo-controlled trials of tolterodine extended release ( ER ) , oxybutynin and solifenacin show that combined antimuscarinic+α-blocker treatment is generally more effective than monotherapy or placebo in men with OAB symptoms .
The efficacy and safety  of tolterodine ER+α-blocker treatment was not affected by prostate size or prostate-specific antigen ( PSA ) level .
In men meeting entry criteria for OAB and benign prostatic obstruction trials  , tolterodine ER alone was effective selectively in men with prostate size or PSA level below study medians .
Post hoc analyses from double-blind , placebo-controlled trials and prospect i ve studies of fesoterodine , oxybutynin , propiverine , solifenacin and tolterodine also suggest that antimuscarinics are generally safe and efficacious in men .
A retrospective data base study found that risk of AUR in men was the highest in the first month of treatment and decreased considerably thereafter .
Antimuscarinics , alone or with an α-blocker , appear to be efficacious and safe in many men with predominant OAB symptoms or persistent OAB symptoms despite α-blocker or 5-α-reductase inhibitor treatment .
Despite potential benefits , primary care clinicians may avoid using antimuscarinics in men with overactive bladder ( OAB ) symptoms because of safety concerns .