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 .
The effects of tamsulosin and sildenafil in separate and combined regimens on detailed hemodynamics in patients with benign prostatic enlargement.
PURPOSE We measured the detailed hemodynamic effects of tamsulosin and sildenafil separately and together in patients with benign prostatic enlargement . MATERIAL S AND METHODS The supine effects of and responses to passive orthostasis ( 60 degrees for 8 minutes ) were measured in 16 patients with benign prostatic enlargement with the finger blood pressure method and whole-body impedance cardiography . The medications , 100 mg sildenafil ( single doses ) and 0.4 mg tamsulosin ( once daily for up to 14 days ) , were administered in a r and omized , double-blind , crossover fashion . RESULTS Supine systolic arterial pressure decreased with sildenafil ( mean + /- SEM -11 + /- 2 mm Hg ) and sildenafil plus tamsulosin ( -14 + /- 2 mm Hg ) more than with placebo ( -2 + /- 4 mm Hg , p < 0.05 ) . In comparison to placebo sildenafil plus tamsulosin decreased the systemic vascular resistance index ( 328 + /- 129 vs -241 + /- 134 dyn.sec/cm.m , p = 0.01 ) . Tamsulosin alone did not cause any significant changes in comparison to placebo .  Heart rate , diastolic arterial pressure , stroke index , cardiac index and arterial pulse wave velocity were not affected to a statistically significant degree by any of the treatments compared to placebo . Upon head-up tilt the drugs caused only 1 significant change in that diastolic arterial pressure was significantly higher ( -2.7 vs -8.0 mm Hg , p = 0.04 ) in the placebo group than in the tamsulosin plus sildenafil group . CONCLUSIONS Tamsulosin does not disturb hemodynamics in patients with benign prostatic enlargement . Sildenafil decreases blood pressure with the patient supine but not during head-up tilt . The combination treatment also decreases the systemic vascular resistance index in the supine position
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 .