Urologie pro praxi 5-6/2007
COMBINATION DRUG THERAPY IN MEN WITH LOWER URINARY TRACT SYMPTOMS: CONTEMPORARY STATUS
Paper makes a brief summary of relevant information concerning combination pharmacotherapy in men with lower urinary tract symptoms (LUTS) and informs about indications, effectiveness, adverse effects of various types of combination pharmacological treatment. Diagnosis and therapy of LUTS must be comprehensive and individualized. Combination therapy of an alpha-blocker with a 5alpha-reductaseinhibitor seems to be more beneficial and durable than the monotherapy of either substance in symptomatic men with high risk of progression of benign prostate hyperplasia. Indications for using of combination alpha-blocker + 5alpha-reductase-inhibitor are: symptomatic men with prostate volume > 30 (40) ml, prostate specific antigen (PSA) > 1,4–1,6 ng/ml, post void residual urine > 40 ml and in a cases of ineffectiveness of medicamentous monotherapy. The combination of an alpha-adrenergic receptor antagonist and 5-alpha reductase inhibitor is appropriate and effective treatment for patients with LUTS associated with demonstrable prostatic enlargement. All combinations of an alpha-blocker and 5-alpha reductase inhibitor would be equally effective. The combination of doxazosin and finasteride is the best tested regarding safety and afficacy. The clinical utility of this combination therapy take account of the balance between cost efficacy and additional side effects. The management of OAB occuring in the presence of BOO is the subject of ongoing research. Antimuscarinic therapy as solo therapy can not be recommended for routinne use. Combination therapy of antimuscarinic and alpha blocker may be efficacious. There is insufficient evidence to recommend that the combination of phosphodiesterase inhibitors and an alpha adrenoreceptor antagonists has any advantage over monotherapy with alpha-blocker alone. Combination treatment (alpha-blocker/or 5-alpha reductase inhibitor + antidiuretic hormone/desmopressin/seems to be effective and appropriate for patients with BPH and nocturnal polyuria. Paper makes a review of new medical developments and targets in the management of LUTS in adult men.
Keywords: lower urinary tract symptoms, men, combination drug therapy
