Based on improvement of mean International Prostate Symptom Score and quality of life scores , the effectiveness of the newer ABs was not different from the older ABs ( moderate strength of evidence [ SOE ] ) , but had more AEs ( low SOE ) .
Antimuscarinics/AB combination therapy had similar outcomes  as AB monotherapy ( all moderate SOE ) , but often had more AEs .
Phosphodiesterase type-5 inhibitors alone or in combination with ABs had similar or inferior outcomes than ABs alone .
Evidence was insufficient for the beta-3 adrenoceptor agonist .
For all newer agents , the evidence was generally insufficient to assess long-term efficacy , prevention of symptom progression , or AEs .
None of the drugs or drug combinations newly used to treat LUTS attributed to BPH showed outcomes superior to traditional AB treatment .
Given the lack of superior outcomes , the studies ' short time-horizon , and less assurance of their safety , their current value in treating LUTS attributable to BPH appears low .
We found none of the new drugs to be better but there was more concern about side effects
CONTEXT Alpha-blockers ( ABs ) and 5-alpha reductase inhibitors have an established role in treating male lower urinary tract symptoms ( LUTS ) attributed to benign prostatic hyperplasia ( BPH ) .
Recently , newer drugs have shown promise for this indication .
OBJECTIVE To assess the comparative effectiveness and adverse effects ( AEs ) of newer drugs to treat LUTS attributed to BPH through a systematic review and meta- analysis .
PATIENT SUMMARY In this paper , we review ed the evidence of newer drugs to treat men with urinary problems attributable to an enlarged prostate .
A randomized, comparative, open-label study of efficacy and tolerability of alfuzosin, tamsulosin and silodosin in benign prostatic hyperplasia
Objectives : Benign prostatic hyperplasia ( BPH ) is a common and progressive disease affecting elderly males , often associated with lower urinary tract symptoms ( LUTS ) . α1-blockers are the mainstay in symptomatic therapy of BPH . Because of their greater uroselectivity and minimal hemodynamic effects , alfuzosin , tamsulosin , and silodosin are generally preferred . The aim of this study was to compare the efficacy and tolerability of alfuzosin , tamsulosin , and silodosin in patients with BPH and LUTS . Methods : Ninety subjects with BPH and LUTS were r and omized into three groups of thirty in each , to receive alfuzosin sustained release ( SR ) 10 mg , tamsulosin 0.4 mg , or silodosin 8 mg for 12 weeks . The primary outcome measure was a change in the International Prostate Symptom Score ( IPSS ) , and the secondary outcome measures were changes in individual subjective symptom scores , quality of life score ( QLS ) , and peak flow rate ( Qmax ) from baseline . The treatment response was monitored at 2 , 4 , 8 , and 12 weeks . Results : IPSS improved by 88.18 % , 72.12 % , and 82.23 % in alfuzosin SR , tamsulosin and silodosin groups ( P < 0.001 ) at 12 weeks . Improvement in QLS was > 75 % in all the three groups ( P < 0.001 ) . A significant improvement in Qmax was seen with alfuzosin and tamsulosin ( P = 0.025 and P < 0.001 ) but not with silodosin ( P = 0.153 ) . However , the intergroup differences in IPSS , QLS , and Qmax were not significant . Ejaculatory dysfunction was more common with silodosin and corrected QT ( QTc ) prolongation occurred only with alfuzosin ( two subjects ) and tamsulosin ( three subjects ) . Conclusion : Alfuzosin , tamsulosin , and silodosin showed similar efficacy in improvement of LUTS secondary to BPH , with good tolerability , acceptability , and minimum hemodynamic adverse effects . Alfuzosin , tamsulosin , and silodosin are comparable in efficacy in symptomatic management of BPH . The occurrence of QTc prolongation in three subjects with tamsulosin in the present study is an unexpected adverse event as there are no reports of QTc prolongation with tamsulosin in any of the previous studies
Based on improvement of mean International Prostate Symptom Score and quality of life scores , the effectiveness of the newer ABs was not different from the older ABs ( moderate strength of evidence [ SOE ] ) , but had more AEs ( low SOE ) .
Antimuscarinics/AB combination therapy had similar outcomes  as AB monotherapy ( all moderate SOE ) , but often had more AEs .
Phosphodiesterase type-5 inhibitors alone or in combination with ABs had similar or inferior outcomes than ABs alone .
Evidence was insufficient for the beta-3 adrenoceptor agonist .
For all newer agents , the evidence was generally insufficient to assess long-term efficacy , prevention of symptom progression , or AEs .
None of the drugs or drug combinations newly used to treat LUTS attributed to BPH showed outcomes superior to traditional AB treatment .
Given the lack of superior outcomes , the studies ' short time-horizon , and less assurance of their safety , their current value in treating LUTS attributable to BPH appears low .
We found none of the new drugs to be better but there was more concern about side effects
CONTEXT Alpha-blockers ( ABs ) and 5-alpha reductase inhibitors have an established role in treating male lower urinary tract symptoms ( LUTS ) attributed to benign prostatic hyperplasia ( BPH ) .
Recently , newer drugs have shown promise for this indication .
OBJECTIVE To assess the comparative effectiveness and adverse effects ( AEs ) of newer drugs to treat LUTS attributed to BPH through a systematic review and meta- analysis .
PATIENT SUMMARY In this paper , we review ed the evidence of newer drugs to treat men with urinary problems attributable to an enlarged prostate .