Details

Autor(en) / Beteiligte

• Liao, C.-H.
• Kuo, H.-C.

Titel

How to choose first-line treatment for men with predominant storage lower urinary tract symptoms: a prospective randomised comparative study

Ist Teil von

• International journal of clinical practice (Esher), 2015-01, Vol.69 (1), p.124-130

Ort / Verlag

England: Blackwell Publishing Ltd

Erscheinungsjahr

2015

Quelle

Wiley Blackwell Single Titles

Beschreibungen/Notizen

• Summary Aims To compare the therapeutic effects and identify predictors of successful treatment of first‐line antimuscarinic and α‐blocker monotherapy for men with predominant storage lower urinary tract symptoms (LUTS). Methods This prospective randomised comparative study included men aged ≥ 40 years with a total IPSS ≥ 8, IPSS storage subscore (IPSS‐S) ≥ voiding subscore (IPSS‐V) and PVR ≤ 250 ml. Subjects were randomised to receive tolterodine 4 mg or doxazosin 4 mg daily for 12 weeks. The primary end‐point included changes of total IPSS, IPSS subscore and global response assessment (GRA) after treatment. The secondary end‐points included comparisons of baseline parameters between patients with a GRA ≥ 1 and GRA < 1. All adverse events were also recorded. Results This study was completed by 163 patients. The IPSS‐T, IPSS‐S and quality of life index decreased significantly in both groups. An improved outcome (GRA ≥ 1) at 4 weeks was reported in 51/74 patients (68.9%) receiving doxazosin and 69/89 patients (77.5%) receiving tolterodine. The rate of improved outcome in patients with a TPV < 40 ml was significantly higher in tolterodine group (73.3% vs. 57.6%, p = 0.040). Patients with tolterodine treatment failure (GRA < 1) had higher baseline IPSS‐V and IPSS intermittency domain, whereas patients with doxazosin treatment failure had a higher baseline IPSS urgency domain. Conclusions The rate of improved outcome was comparable between first‐line tolterodine and doxazosin monotherapy for male storage LUTS. Antimuscarinic monotherapy was suggested for men with smaller prostate volume and higher urgency symptom scores, whereas α‐blocker monotherapy was suggested for those with higher voiding symptom scores.