ABSTRACT

Lower urinary tract symptoms (LUTS) related with benign prostatic hyperplasia (BPH) and bladder over activity are very common disorders in aging men. The relationship between BPH and LUTS is also complex. Not all men with BPH develop LUTS or there is no BPH in every man with LUTS. Persistent LUTS after medical or surgical treatment for BPH indicate extra-prostatic causes. One of the main reasons is detrusor instability. Moreover, bladder over activity in men demonstrates a similar prevalence with women. Although, alpha blockers are currently the first line medical therapy for men with LUTS/BPH, at least a certain group of patients do not respond well. Therefore, combination therapy has been raised due to the failure of this initial medical treatment. Combination of anticholinergic and alpha-1 receptor blockers proposes a synergistic effect on prostatic obstruction and detrusor contractions. Combination therapy is shown as an effective medical treatment for BPH with persistent storage symptoms. The main disadvantage of this combination regimen is the risk of increasing residual urine and acute urinary retention, although current studies suggest minimal risk for these complications. Therefore, combination therapy should not be applied in patients with infravesical obstruction, and also residual urinary volume should be checked in men receiving anticholinergics. In conclusion, larger randomized trials with long follow-up will shed light on combination therapy.