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 .
Do oral antimuscarinic drugs carry an increased risk of acute urinary retention?
PURPOSE We determined whether men treated with oral antimuscarinics  are at increased risk for acute urinary retention . MATERIAL S AND METHODS In this population based , retrospective cohort study using a nested case-control design we analyzed data from a large primary care data base containing patient information entered by general practitioners in the United Kingdom . Our study cohort comprised men 20 to 84 years old . Cases of acute urinary retention were identified by review ing diagnostic codes and were confirmed in a r and om sample through question naires sent to the treating physician . RESULTS The overall incidence of acute urinary retention in the study cohort ( 1,844 ) was 1.0 per 1,000 person-years , with the incidence rate increasing with age . The first 30 days ( early treatment ) of antimuscarinic use was associated with a relative risk of acute urinary retention of 8.3 ( 95 % CI 4.8 - 14.2 ) and with longer term use ( more than 30 days ) the relative risk was 2.0 ( 95 % CI 1.2 - 3.1 ) . The relative risk of acute urinary retention was similar for low/medium and high antimuscarinic doses ( relative risk 2.8 vs 3.0 , 95 % CI 2.1 - 3.8 and 1.3 - 6.8 , respectively ) . The relative risk of acute urinary retention was highest during early treatment for a urogenital indication ( relative risk 14.2 , 95 % CI 6.8 - 29.6 ) . The risk of acute urinary retention was not increased when antimuscarinics were used as antispasmodics or for drug induced parkinsonism . CONCLUSIONS Men prescribed antimuscarinics  , particularly for a urogenital condition , should be closely monitored during the first 30 days of treatment for signs or symptoms of urinary retention
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 .