Tolterodine Treatment Improves Storage Symptoms Suggestive of Overactive Bladder in Men Treated With α-Blockers

• Published in: European urology Vol. 56; no. 3; pp. 534 - 543
• Main Authors: Chapple, Christopher, Herschorn, Sender, Abrams, Paul, Sun, Franklin, Brodsky, Marina, Guan, Zhonghong
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.09.2009; Elsevier
• Subjects: Adrenergic alpha-Antagonists - therapeutic use; Adult; Aged; Aged, 80 and over; Benzhydryl Compounds - therapeutic use; Biological and medical sciences; Cresols - therapeutic use; Double-Blind Method; Drug Therapy, Combination; Humans; Male; Medical sciences; Middle Aged; Muscarinic antagonists; Muscarinic Antagonists - therapeutic use; Nephrology. Urinary tract diseases; Overactive bladder; Phenylpropanolamine - therapeutic use; Prospective Studies; Prostatism - complications; Prostatism - drug therapy; Tolterodine; Tolterodine Tartrate; Urinary Bladder, Overactive - diagnosis; Urinary Bladder, Overactive - drug therapy; Urinary Bladder, Overactive - etiology; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology; α-blockers; α-blockers; Muscarinic antagonists; Overactive bladder; Tolterodine; Human; Nephrology; Urinary system disease; Conservation; Male; Urinary tract disease; Urology; Symptomatology; Anticholinergic agent; Cholinergic receptor; Alpha blocking agent; Storage; Treatment; Antimuscarinic agent; Adult; Bladder disease; Muscarinic receptor; Antagonist
• ISSN: 0302-2838; 1873-7560; 1873-7560
• DOI: 10.1016/j.eururo.2008.11.026

Some men receiving α-blocker therapy for lower urinary tract symptoms report persistent storage symptoms suggestive of overactive bladder (OAB). To evaluate the efficacy of tolterodine extended release (ER) in men on α-blocker therapy. This double-blind trial included men aged ≥40 yr with frequency, urgency, and at least moderate problems reported on the Patient Perception of Bladder Condition (PPBC), despite being on a stable dose of α-blocker for ≥1 mo. Subjects were randomized to tolterodine ER 4mg per day or placebo for 12 wk while continuing their prescribed α-blocker therapy. At baseline and week 12, subjects completed the PPBC, International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire (OAB-q), and 5-d bladder diaries using the five-point Urinary Sensation Scale (USS). Frequency–urgency sum was defined as the sum of USS ratings for all micturitions. PPBC improvement from baseline to week 12 was reported by 63.6% and 61.6% of subjects receiving tolterodine ER plus α-blocker and placebo plus α-blocker, respectively; this treatment difference, which was the primary end point, was not statistically significant (p>0.6699). At week 12, subjects receiving tolterodine ER plus α-blocker had significantly greater improvements versus placebo plus α-blocker in 24-h micturitions (−1.8 vs −1.2; p=0.0079) and daytime micturitions (−1.3 vs −0.8; p=0.0123); 24-h urgency episodes (−2.9 vs −1.8; p=0.0010), daytime urgency episodes (−2.2 vs −1.4; p=0.0017), and nocturnal urgency episodes (−0.5 vs −0.3; p=0.0378); frequency–urgency sum (−7.8 vs −5.1; p=0.0065); IPSS storage subscale (−2.6 vs −2.1; p=0.0370); and OAB-q symptom bother scale (−17.9 vs −14.4; p=0.0086) and coping domain (15.4 vs 12.4; p=0.0491). Acute urinary retention requiring catheterization occurred in <1% of either group. There were no clinically meaningful changes in postvoid residual volume or maximum urinary flow rate. Men with bothersome OAB symptoms despite continued α-blocker therapy showed significantly greater improvements in diary variables, IPSS Storage scores, and symptom bother when receiving additional tolterodine ER versus placebo plus α-blocker. Men who experience storage symptoms suggestive of overactive bladder despite α-blocker therapy for their lower urinary tract symptoms may benefit from the addition of tolterodine extended release to their α-blocker therapy.