Urodynamic Urology Unit, Department of Urology, Medical School, University of Patras, Patras, Greece.
Eur Urol. 2011 Jul;60(1):94-105. doi: 10.1016/j.eururo.2011.03.054. Epub 2011 Apr 9.
This review focuses on the contemporary role of antimuscarinics in the management of men with symptoms of bladder outlet obstruction (BOO) and concomitant overactive bladder (OAB). Safety issues of antimuscarinics in this subpopulation of men are also reviewed.
We reviewed the current literature and performed an analysis of the efficacy, suitability, and the safety of antimuscarinics in this subpopulation of men.
We performed a systematic search of Medline/PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews for relevant articles published between 1990 and September 2010, restricted to studies in humans published in English. In addition, published abstracts presented at the annual meetings of the European Association of Urology, the American Urological Association, and the International Continence Society in the last decade (2000-2010) were hand-searched and evaluated. Each article's title and abstract were reviewed for their appropriateness and relevance to the use of antimuscarinics in patients with BOO and concomitant OAB. Relevant articles were fully reviewed and included in the final data acquisition.
Treatment options include combination treatment with α-blockers and antimuscarinics, sequential use of α-blockers and antimuscarinics, monotherapy with antimuscarinics, and a combination of antimuscarinics and 5α-reductase inhibitors. The sequential use of α-blockers and antimuscarinics seems to be the most appropriate approach, and the use of antimuscarinics and α-blockers appears generally to be safe and efficacious. Data are insufficient for a possible stratification of patients for a specific sequence of the drugs reviewed.
This review infers that the existing data confirm the safety of antimuscarinics administered for the treatment of these patients. The efficacy of antimuscarinics has been proven in different trials regarding different storage symptom end points, but not all end points regarding OAB reached significance. All the reported trials are of short duration (4-12 wk) and include only men with low postvoid residual urine volumes at baseline (<200ml). Overall, the addition of an antimuscarinic to the treatment of a patient with BOO and concomitant OAB seems to offer an amelioration of the symptoms and a moderate improvement in quality of life.
本综述专注于抗毒蕈碱药物在治疗伴有膀胱出口梗阻（BOO）和逼尿肌过度活动（OAB）症状的男性中的当代作用。同时也审查了抗毒蕈碱药物在该男性亚群中的安全性问题。
我们回顾了当前文献，并对该男性亚群中抗毒蕈碱药物的疗效、适用性和安全性进行了分析。
我们对 Medline/PubMed、Embase、Scopus 和 Cochrane 系统评价数据库进行了系统检索，以获取 1990 年至 2010 年 9 月期间发表的相关文章，仅限于以英语发表的人类研究。此外，还对过去十年（2000-2010 年）在欧洲泌尿外科学会、美国泌尿外科学会和国际尿控学会年会上发表的已发表摘要进行了手工检索和评估。审查了每个文章的标题和摘要，以确定其是否适合并与在伴有 BOO 和并发 OAB 的患者中使用抗毒蕈碱药物有关。将相关文章进行全面审查并纳入最终数据采集。
治疗选择包括α-阻滞剂和抗毒蕈碱药物联合治疗、α-阻滞剂和抗毒蕈碱药物序贯治疗、抗毒蕈碱药物单药治疗以及抗毒蕈碱药物和 5α-还原酶抑制剂联合治疗。α-阻滞剂和抗毒蕈碱药物序贯治疗似乎是最恰当的方法，并且使用抗毒蕈碱药物和α-阻滞剂通常是安全有效的。对于所审查药物的特定序列，尚无足够的数据对患者进行分层。
本综述推断，现有数据证实了在治疗这些患者时使用抗毒蕈碱药物的安全性。抗毒蕈碱药物的疗效已在不同的试验中得到证实，这些试验针对不同的储存症状终点，但并非所有关于 OAB 的终点均具有统计学意义。所有报告的试验持续时间均较短（4-12 周），并且仅包括基线时残余尿量<200ml 的男性。总体而言，在 BOO 和并发 OAB 患者的治疗中添加抗毒蕈碱药物似乎可以改善症状，并适度提高生活质量。
