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Seo, Hong, and Lee: The Efficacy and Safety of Combination Therapy with Alpha-Blocker and Low-Dose Propiverine Hydrochloride for Benign Prostatic Hyperplasia Accompanied by Overactive Bladder Symptoms
Original Article
Lower Urinary Tract Dysfunction
Korean Journal of Urology

Korean Journal of Urology 2009; 50(11): 1078-1082.

Published online: 19 November 2009

DOI: https://doi.org/10.4111/kju.2009.50.11.1078

The Efficacy and Safety of Combination Therapy with Alpha-Blocker and Low-Dose Propiverine Hydrochloride for Benign Prostatic Hyperplasia Accompanied by Overactive Bladder Symptoms

Kang Il Seo, Sung Zoo Hong, Jong Bouk Lee

Department of Urology, National Medical Center, Seoul, Korea.

Correspondence to: Jong Bouk Lee. Department of Urology, National Medical Center, 243, Euljiro, Jung-gu, Seoul 100-799, Korea. TEL: 02-2262-4718, FAX: 02-2274-6601, nmcuro@hanmail.net

Received 25 May 2009       Accepted 5 October 2009

Copyright © The Korean Urological Association, 2009

Abstract

Purpose

We evaluated the efficacy and safety of combined therapy with an alpha-blocker (tamsulosin 0.2 mg) and low-dose anti-cholinergics (propiverine HCl 10 mg) in patients with benign prostatic hyperplasia (BPH) accompanied by overactive bladder (OAB) symptoms.

Materials and Methods

This prospective study enrolled 119 male patients with lower urinary tract symptoms (LUTS) with prostate volume of 20 ml or greater, International Prostate Symptom Score (IPSS) of more than 8, and OAB symptoms from May 2007 to April 2008. Patients with post-void residual volume (PVR) over 100 ml were excluded. Among these patients, 74 patients were treated with tamsulosin 0.2 mg plus propiverine HCl 10 mg (group A) and 45 patients were treated with tamsulosin 0.2 mg only (group B). The clinical parameters, including IPSS, quality of life (QoL) score, uroflowmetry, and PVR were re-evaluated after 3 months.

Results

A total of 115 patients, including 70 in group A and 45 in group B, completed the study. IPSS, QoL score, voided volume, maximum flow rate (Qmax), and PVR showed significant improvement after 3 months of treatment (p<0.05). Baseline characteristics between the 2 groups were not significantly different for any parameter (p>0.05). Changes in the QoL score were -1.9±1.1 and -1.5±0.9 for group A and group B, respectively (p=0.043). Changes in all other parameters were not significantly different between the 2 groups (p>0.05).

Conclusions

For those patients with LUTS due to BPH and concomitant OAB, combination therapy with an alpha-blocker (tamsulosin 0.2 mg) and low-dose anti-cholinergics (propiverine HCl 10 mg) may be a reasonable and effective therapeutic option as an initial therapy.

Keywords: Prostatic hyperplasia, Overactive urinary bladder

Figures and Tables

Table 1
Baseline demographics and characteristics between the groups (Mean±SD)
kju-50-1078-i001

PSA: prostate-specific antigen, IPSS: International Prostate Symptom Score, QoL score: quality of life score, Qmax: maximum flow rate, PVR: post-void residual volume, a: statistical significance was done by independent t-test

Table 2
Changes in each parameters after 3 months (Mean±SD)
kju-50-1078-i002

IPSS: International Prostate Symptom Score, QoL score: quality of life score, Qmax: maximum flow rate, PVR: post-void residual volume, a: statistical significance was done by independent t-test

Table 3
Differences in changes in clinical parameters according to the patient's age, prostate volume, initial PSA value, and PVR
kju-50-1078-i003

PSA: prostate-specific antigen, PVR: post-void residual volume, IPSS: International Prostate Symptom Score, QoL score: quality of life score, Qmax: maximum flow rate, a: statistical significance was done by independent t-test

References

1. Douchamps J, Derenne F, Stockis A, Gangji D, Juvent M, Herchuelz A. The pharmacokinetics of oxybutynin in man. Eur J Clin Pharmacol. 1988. 35:515–520.
2. Lepor H, Rigaud G. The efficacy of transurethral resection of the prostate in men with moderate symptoms of prostatism. J Urol. 1990. 143:533–537.
3. Knutson T, Edlund C, Fall M, Dahlstrand C. BPH with coexisting overactive bladder dysfunction--an everyday urological dilemma. Neurourol Urodyn. 2001. 20:237–247.
4. Oelke M, Baard J, Wijkstra H, de la Rosette JJ, Jonas U, Höfner K. Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur Urol. 2008. 54:419–426.
5. Wadie BS, Ebrahim el-HE, Gomha MA. The relationship of detrusor instability and symptoms with objective parameters used for diagnosing bladder outlet obstruction: a prospective study. J Urol. 2002. 168:132–134.
6. Abrams P, Kelleher CJ, Kerr LA, Rogers RG. Overactive bladder significantly affects quality of life. Am J Manag Care. 2000. 6:11 Suppl. S580–S590.
7. Abrams P, Kaplan S, De Koning Gans HJ, Millard R. Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. J Urol. 2006. 175:999–1004.
8. Athanasopoulos A, Gyftopoulos K, Giannitsas K, Fisfis J, Perimenis P, Barbalias G. Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol. 2003. 169:2253–2256.
9. Lee KS, Choo MS, Kim DY, Kim JC, Kim HJ, Min KS, et al. Combination treatment with propiverine hydrochloride plus doxazosin controlled release gastrointestinal therapeutic system formulation for overactive bladder and coexisting benign prostatic obstruction: a prospective, randomized, controlled multicenter study. J Urol. 2005. 174:1334–1338.
10. Saito H, Yamada T, Oshima H, Morita T, Takeuchi S, Ando M, et al. A comparative study of the efficacy and safety of tamsulosin hydrochloride and combination of propiverine hydrochloride and tamsulosin hydrochloride in benign prostatic hyperplasia with pollakisuria and/or urinary incontinence. Jpn J Urol Surg. 1999. 12:525–536.
11. Han DS, Kim H, Sul CK. The effects of combined therapy with propiverine (BUP-4®) after α-blocker on the improvements of quality of life scores in patients with benign prostatic hyperplasia accompanied with overactive bladder. Korean J Urol. 2003. 44:409–413.
12. Kim HW, Seo SI, Ko JS, Jung JH, Lee JY. Incidence of overactive bladder in benign prostatic hyperplasia and the efficacy of combination therapy of alpha blocker with tolterodine. Korean J Urol. 2003. 44:1006–1010.
13. Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA. 2006. 296:2319–2328.
14. Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol. 1997. 158:481–487.
15. Crawford ED, Wilson SS, McConnell JD, Slawin KM, Lieber MC, Smith JA, et al. Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol. 2006. 175:1422–1426.
16. Roehrborn CG, McConnell J, Bonilla J, Rosenblatt S, Hudson PB, Malek GH, et al. Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study. J Urol. 2000. 163:13–20.
17. Mochtar CA, Kiemeney LA, van Riemsdijk MM, Barnett GS, Laguna MP, Debruyne FM, et al. Prostate-specific antigen as an estimator of prostate volume in the management of patients with symptomatic benign prostatic hyperplasia. Eur Urol. 2003. 44:695–700.
18. Caulfield MP, Birdsall NJ. International union of pharmacology. XVII. Classification of muscarinic acetylcholine receptors. Pharmacol Rev. 1998. 50:279–290.
19. Yamanishi T, Chapple CR, Chess-Williams R. Which muscarinic receptor is important in the bladder? World J Urol. 2001. 19:299–306.
20. Abrams P, Andersson KE. Muscarinic receptor antagonists for overactive bladder. BJU Int. 2007. 100:987–1006.
21. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol. 2004. 46:547–554.
22. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003. 170:530–547.
23. Hyman MJ, Groutz A, Blaivas JG. Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings. J Urol. 2001. 166:550–552.
24. Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up. BJU Int. 2004. 93:745–750.
25. Jung YS, Hwang TK, Kim JC. The outcome and satisfaction of patients with lower urinary tract symptoms/benign prostatic hyperplasia following transurethral resection of the prostate according to urodynamic obstruction and the bladder function. Korean J Urol. 2007. 48:965–970.
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