title: Urodynamic effects of the combination of tamsulosin and daily tadalafil in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia: a randomized, placebo-controlled clinical trial Efficacy and safety of extended-release oxybutynin in combination with tamsulosin for treatment of lower urinary tract symptoms in men: randomized, double-blind, placebo-controlled study. Evaluation of the effect of sildenafil and/or doxazosin on Benign prostatic hyperplasia–related lower urinary tract symptoms and erectile dysfunction Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Combination therapy with solifenacin and tamsulosin oral controlled absorption system in a single tablet for lower urinary tract symptoms in men: efficacy and safety results from the randomised controlled NEPTUNE trial. Efficacy and safety of solifenacin plus tamsulosin OCAS in men with voiding and storage lower urinary tract symptoms: results from a phase 2, dose-finding study (SATURN). Randomized Crossover Comparison of the Short-Term Efficacy and Safety of Single Half-Dose Silodosin and Tamsulosin Hydrochoride in Men With Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Safety and tolerability of solifenacin add-on therapy to alpha-blocker treated men with residual urgency and frequency. Combination of alfuzosin and sildenafil is superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. A comparative randomized prospective study to evaluate efficacy and safety of combination of tamsulosin and tadalafil vs. tamsulosin or tadalafil alone in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Randomized Controlled Trial to Assess the Efficacy of the Combination Therapy of Alfuzosin and Tadalafil in Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Effect of Improvement in Lower Urinary Tract Symptoms on Sexual Function in Men: Tamsulosin Monotherapy vs. Combination Therapy of Tamsulosin and Solifenacin Evaluation of silodosin in comparison to tamsulosin in benign prostatic hyperplasia: A randomized controlled trial A Randomized Crossover Study Comparing Patient Preference for Tamsulosin and Silodosin in Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia Efficacy of alfuzosin and sildenafil combination in male patients with lower urinary tract symptoms Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia: Combined Treatment with Fesoterodine Fumarate Extended-Release and Tamsulosin - A Prospective Study Silodosin, a new α1A‐adrenoceptor‐selective antagonist for treating benign prostatic hyperplasia: results of a phase III randomized, placebo‐controlled, double‐blind study in Japanese men Tolterodine treatment improves storage symptoms suggestive of overactive bladder in men treated with alpha-blockers. Short-term effects of crossover treatment with silodosin and tamsulosin hydrochloride for lower urinary tract symptoms associated with benign prostatic hyperplasia. Sildenafil citrate and tamsulosin combination is not superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction Tadalafil for the Treatment of Lower Urinary Tract Symptoms in Japanese Men with Benign Prostatic Hyperplasia: Results from a 12-week Placebo-controlled Dose-finding Study with a 42-week Open-label Extension. Comparison of Two Different α1-Adrenoceptor Antagonists, Tamsulosin and Silodosin, in the Treatment of Male Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: A Prospective Randomized Crossover Study. 'Tamsulosin and Darifenacin' Versus 'Tamsulosin Monotherapy' for 'BPH with Accompanying Overactive Bladder'. Evaluation of Tadalafil effect on lower urinary tract symptoms of benign prostatic hyperplasia in patients treated with standard medication. Solifenacin as add-on therapy for overactive bladder symptoms in men treated for lower urinary tract symptoms--ASSIST, randomized controlled study. Tadalafil once daily for lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a randomized placebo- and tamsulosin-controlled 12-week study in Asian men. Initial combined treatment with anticholinergics and α-blockers for men with lower urinary tract symptoms related to BPH and overactive bladder: a prospective, randomized, multi-center, double-blind, placebo-controlled study A randomized, comparative, open-label study of efficacy and tolerability of alfuzosin, tamsulosin and silodosin in benign prostatic hyperplasia A randomized controlled study of the efficacy of tamsulosin monotherapy and its combination with mirabegron for overactive bladder induced by benign prostatic obstruction. Efficacy and safety of combined oral therapy with tadalafil and alfuzosin: an integrated approach to the management of patients with lower urinary tract symptoms and erectile dysfunction. Preliminary report. Tamsulosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effects. Tadalafil Administered Once Daily for Treatment of Lower Urinary Tract Symptoms in Korean men with Benign Prostatic Hyperplasia: Results from a Placebo-Controlled Pilot Study Using Tamsulosin as an Active Control. Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo- and active-controlled clinical trial performed in Europe. A randomized, placebo-controlled study to assess safety and efficacy of vardenafil 10 mg and tamsulosin 0.4 mg vs. tamsulosin 0.4 mg alone in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Efficacy and safety of the coadministration of tadalafil once daily with finasteride for 6 months in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia. Long-term safety and efficacy of single-tablet combinations of solifenacin and tamsulosin oral controlled absorption system in men with storage and voiding lower urinary tract symptoms: results from the NEPTUNE Study and NEPTUNE II open-label extension.
abstract: Objectives To evaluate the effect of association of tamsulosin/tadalafil taken daily compared with tamsulosin/placebo in the lower urinary tract with urodynamic study ( UDS ) . Methods All patients underwent baseline UDS before r and omization to tamsulosin 0.4 mg/tadalafil 5 mg ( Group 1 ; n = 20 ) or tamsulosin 0.4 mg/placebo ( Group 2 ; n = 20 ) once daily for 30 days . End-of- study UDS were performed on completion of the treatment period . The primary end point was to demonstrate changes in urodynamic variables in the voiding phase , detrusor pressure at maximum flow ( PdetQmax ) , and maximum flow rate ( Qmax ) , from baseline to week four . Results The primary outcome measure of this clinical trial , PdetQmax , showed a significant reduction in tamsulosin/tadalafil group ( 13 ± 17.0 ) compared to tamsulosin/placebo ( −1.2 ± 14.35 ) group ( P = 0.03 ) . Qmax increased in both groups , tamsulosin/tadalafil ( 1.0 ± 2.4 ) and tamsulosin/placebo ( 1.4 ± 2.4 ) , but the difference was not significant between treatment groups ( P = 0.65 ) . Total IPSS , storage , and voiding sub-score improved significantly in tamsulosin/tadalafil compared with tamsulosin/placebo group . Conclusions The association of tamsulosin/tadalafil reduces detrusor pressure at maximum flow without changing the maximum flow rate during micturition and significantly improves lower urinary tract symptoms compared with the isolated use of tamsulosin OBJECTIVE To evaluate the efficacy and tolerability of extended-release oxybutynin in combination with the alpha1-blocker tamsulosin in reducing lower urinary tract symptoms in men . PATIENTS AND METHODS In this multicenter , double-blind trial performed between March 29 , 2004 , and June 22 , 2005 , 420 men aged 45 years or older with a total International Prostate Symptom Score ( IPSS ) of 13 or more and IPSS for storage of 8 or more were r and omized to receive tamsulosin ( 0.4 mg/d ) with either extended-release oxybutynin ( 10 mg/d ) or placebo for 12 weeks . Eligibility requirements included a maximum flow rate of 8 mL/s or more with voided volume of 125 mL or more and a postvoid residual volume of 150 mL or less on 2 occasions . Postvoid residual volume and peak flow rates at weeks 4 , 8 , and 12 were measured . The primary end point was change from baseline in total IPSS after 12 weeks of treatment . Secondary outcomes included change in IPSSs for storage and quality of life . RESULTS Tamsulosin combined with extended-release oxybutynin result ed in significantly greater improvement in total IPSS compared with tamsulosin and placebo after 8 ( P=.03 ) and 12 ( P=.006 ) weeks of treatment , and improved IPSS for storage and quality of life at all assessment points ( P<.01 ) . The incidence of postvoid residual volume higher than 300 mL was 2.9 % ( 6/209 ) in patients receiving combination therapy compared with 0.5 % ( 1/209 ) in patients receiving tamsulosin alone ( P=.12 ) . Occurrence of peak flow rates below 5 mL/s was 3.8 % ( 8/209 ) for combination therapy and 5.7 % ( 12/209 ) for tamsulosin alone ( P=.49 ) . CONCLUSION In men with substantial storage symptoms , combination therapy with tamsulosin and extended-release oxybutynin demonstrated greater efficacy than and comparable safety and tolerability to tamsulosin monotherapy Purpose : To verify the association between lower urinary tract symptoms ( LUTS ) and erectile dysfunction ( ED ) and evaluate the influence of sildenafil and doxazosin either as single agents or combined on both symptoms . Material and Methods : A prospect i ve r and omized study including 150 patients presented with LUTS caused by BPH in association with clinical ly diagnosed ED , with age equal or more than 45 years from April 2010 to April 20011 . They were categorized into three comparative groups each one containing 50 patients . These groups were comparable regarding pretreatment international prostate symptoms score ( IPSS ) and international index of erectile function ( IIEF ) . The patients of the first group were given sildenafil 50 mg as monotherapy , those of the second group were given doxazosin 2 mg and those of the third group were given combination of both drugs for 4 months for each group . The main post-treatment parameters for assessment and comparison include assessment of patient 's symptoms by repeated IPS S and IIEF , uroflowmetry and assessment of PVR . The statistics was done by use of the Qui -- square test . Results : Pre-treatment parameters were assessed and compared between the three groups . After 4 months of treatment , the comparative parameters were applied to all groups and the differences were measured post-treatment regarding IPSS , erectile function score , uroflowmetry , and post-void residual ( PVR ) urine . Sildenafil alone caused mild improvement in IPSS , more improvement in IIEF score , and little effect on flow rate and PVR urine .  Doxazosin alone caused more improvement in IPSS , flow rate and PVR urine and less improvement in IIEF score . A combination of both sildenafil and doxazosin caused more improvement in all of the comparative parameters than when each drug was given alone . Conclusions : There is a strong relationship between LUTS and ED . Doxazosin or sidenafil as a single drug could be used in treating mild or mild to moderate symptoms but more severe symptoms may usually need a combination of both drugs BACKGROUND Tadalafil improved lower urinary tract symptoms ( LUTS ) suggestive of benign prostatic hyperplasia ( BPH ; LUTS/BPH ) in clinical studies but has not been evaluated together with an active control in an international clinical study . OBJECTIVE Assess tadalafil or tamsulosin versus placebo for LUTS/BPH . DESIGN , SETTING , AND PARTICIPANTS A r and omised , double-blind , international , placebo-controlled , parallel-group study assessed men ≥45 yr of age with LUTS/BPH , International Prostate Symptom Score ( IPSS ) ≥13 , and maximum urinary flow rate ( Q(max ) ) ≥4 to ≤15ml/s . Following screening and washout , if needed , subjects completed a 4-wk placebo run-in before r and omisation to placebo ( n=172 ) , tadalafil 5 mg ( n=171 ) , or tamsulosin 0.4 mg ( n=168 ) once daily for 12 wk . MEASUREMENTS Outcomes were assessed using analysis of covariance ( ANCOVA ) or ranked analysis of variance ( ANOVA ) ( continuous variables ) and Cochran-Mantel-Haenszel test or Fisher exact test ( categorical variables ) . RESULTS AND LIMITATIONS IPSS significantly improved versus placebo through 12 wk with tadalafil ( -2.1 ; p=0.001 ; primary efficacy outcome ) and tamsulosin ( -1.5 ; p=0.023 ) and as early as 1 wk ( tadalafil and tamsulosin both -1.5 ; p<0.01 ) . BPH Impact Index significantly improved versus placebo at first assessment ( week 4 ) with tadalafil ( -0.8 ; p<0.001 ) and tamsulosin ( -0.9 ; p<0.001 ) and through 12 wk ( tadalafil -0.8 , p=0.003 ; tamsulosin -0.6 , p=0.026 ) . The IPSS Quality -of-Life Index and the Treatment Satisfaction Scale-BPH improved significantly versus placebo with tadalafil ( both p<0.05 ) but not with tamsulosin ( both p>0.1 ) . The International Index of Erectile Function-Erectile Function domain improved versus placebo with tadalafil ( 4.0 ; p<0.001 ) but not tamsulosin ( -0.4 ; p=0.699 ) . Q(max ) increased significantly versus placebo with both tadalafil ( 2.4ml/s ; p=0.009 ) and tamsulosin ( 2.2ml/s ; p=0.014 ) . Adverse event profiles were consistent with previous reports . This study was limited in not being powered to directly compare tadalafil versus tamsulosin . CONCLUSIONS Monotherapy with tadalafil or tamsulosin result ed in significant and numerically similar improvements versus placebo in LUTS/BPH and Q(max ) . However , only tadalafil improved erectile dysfunction . TRIAL REGISTRATION Clinical trials.gov ID NCT00970632 BACKGROUND Storage symptoms are particularly bothersome in men with lower urinary tract symptoms ( LUTS ) but may not be adequately treated by α-blocker monotherapy . OBJECTIVE To assess the efficacy and safety of a fixed-dose combination ( FDC ) of solifenacin and an oral controlled absorption system ( OCAS ) formulation of tamsulosin compared with placebo and compared with tamsulosin OCAS ( TOCAS ) monotherapy in men with moderate to severe storage symptoms and voiding symptoms . DESIGN , SETTING , AND PARTICIPANTS A double-blind 12-wk phase 3 study in 1334 men with storage and voiding LUTS : total International Prostate Symptom Score ( IPSS ) ≥ 13 , maximum urinary flow rate ( Qmax ) 4.0 - 12.0 ml/s , two or more urgency episodes per 24 h of Patient Perception of Intensity of Urgency Scale grade 3 or 4 , and eight or more micturitions per 24h . INTERVENTION Patients were r and omised to placebo , TOCAS 0.4 mg , FDC solifenacin 6 mg plus TOCAS 0.4 mg , or FDC solifenacin 9 mg plus TOCAS 0.4 mg . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary efficacy end points were ( 1 ) total IPSS and ( 2 ) Total Urgency and Frequency Score ( TUFS ) . An FDC met the success criteria if it demonstrated superiority compared with placebo and noninferiority compared with TOCAS for total IPSS , as well as superiority compared with TOCAS for TUFS . RESULTS AND LIMITATIONS Reductions in total IPSS and TUFS were observed with both solifenacin 6 mg plus TOCAS ( -7.0 and -8.1 , respectively ) and solifenacin 9 mg plus TOCAS ( -6.5 and -7.6 , respectively ) compared with TOCAS ( -6.2 and -6.7 , respectively ) and placebo ( -5.4 and -4.4 , respectively ) . Solifenacin 6 mg plus TOCAS met all prespecified success criteria for both primary end points , while solifenacin 9 mg plus TOCAS met success criteria compared with placebo but not compared with TOCAS . Both FDCs improved quality of life ( QoL ) measures and were well tolerated , with low incidences of acute urinary retention . CONCLUSIONS The FDC of solifenacin 6 mg plus TOCAS significantly improved storage and voiding symptoms , as well as QoL parameters , compared with placebo . This FDC also improved storage symptoms and QoL compared with TOCAS alone in men with moderate to severe storage symptoms and voiding symptoms  , and it was well tolerated BACKGROUND Storage symptoms are often undertreated in men with lower urinary tract symptoms ( LUTS ) . OBJECTIVE To evaluate the combination of an antimuscarinic ( solifenacin ) with an α-blocker ( tamsulosin ) versus tamsulosin alone in the treatment of men with LUTS . DESIGN , SETTING , AND PARTICIPANTS A double-blind , 12-wk , phase 2 study in 937 men with LUTS ( ≥ 3 mo , total International Prostate Symptom Score [ IPSS ] ≥ 13 , and maximum urinary flow rate 4.0 - 15.0 ml/s ) . INTERVENTION Eight treatment groups : tamsulosin oral controlled absorption system ( OCAS ) 0.4 mg ; solifenacin 3 , 6 , or 9 mg ; solifenacin 3 , 6 or 9 mg plus tamsulosin OCAS 0.4 mg ; or placebo . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary efficacy end point was change from baseline in total IPSS . Secondary end points included micturition diary and quality -of-life ( QoL ) parameters . Post hoc subgroup analyses were performed by severity of baseline storage symptoms , with statistical comparisons presented only for tamsulosin OCAS alone versus combination therapy , due to the small sample size of the solifenacin monotherapy and placebo subgroups . RESULTS AND LIMITATIONS Combination therapy was associated with significant improvements in micturition frequency and voided volume  versus tamsulosin OCAS alone in the total study population ; improvements in total IPSS were not significant . Statistically significant improvements in urgency episodes , micturition frequency , total urgency score , voided volume , IPSS storage subscore , IPSS-QoL index , and Patient Perception of Bladder Condition were observed in a sub population of men with two or more urgency episodes per 24h ( Patient Perception of Intensity of Urgency Scale grade 3 or 4 ) and eight or more micturitions per 24h at baseline ( storage symptoms subgroup ) with combination therapy versus tamsulosin OCAS alone ( p ≤ 0.05 for the dose-response slope , all variables ) . Combination therapy was well tolerated , and adverse events were consistent with the safety profiles of both compounds . CONCLUSIONS Solifenacin plus tamsulosin OCAS did not significantly improve IPSS in the total study population but offered significant efficacy and QoL benefits over tamsulosin OCAS monotherapy in men with both voiding and storage symptoms at baseline . Combination therapy was well tolerated . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00510406 OBJECTIVE To compare the efficacy and safety of single half-dose silodosin and single full-dose tamsulosin in Japanese men with lower urinary tract symptoms secondary to benign prostatic hyperplasia ( LUTS/BPH ) . METHODS Japanese men aged ≥50 years with LUTS/BPH and an International Prostate Symptom Score ( IPSS ) of ≥8 were enrolled in the r and omized crossover study and divided into silodosin-preceding ( S-T ) and tamsulosin-preceding ( T-S ) groups . The S-T group received 4 mg silodosin once daily for 4 weeks followed by 0.2 mg tamsulosin once daily for 4 weeks . The T-S group received the reverse treatment sequence . A washout period prior to drug crossover was not included . Subjective and objective efficacy parameters including IPSS , quality of life ( QOL ) index , uroflowmetry , and safety were compared between the two groups . RESULTS Thirty of 34 men ( S-T group n = 16 ; T-S group n = 14 ) completed the study . Both drugs significantly improved all IPSS items and QOL index in the first treatment period . Subjective improvement in nocturia by silodosin was observed in both the first and crossover treatment periods . Objective improvement in maximum flow rate by silodosin was only observed in the first treatment period . Adverse events occurred more frequently with silodosin than with tamsulosin ; however , none of the adverse events required treatment discontinuation . Ejaculation disorders occurred in three participants ( 10 % ) and were associated with silodosin use . CONCLUSION Single half-dose silodosin has a similar efficacy to full-dose tamsulosin in Japanese men with LUTS/BPH and thus , may represent an effective , safe , and affordable treatment option PURPOSE VICTOR was a 12-week , double-blind , placebo controlled trial assessing the safety and tolerability of solifenacin plus tamsulosin in men with residual overactive bladder symptoms after tamsulosin monotherapy .  Efficacy of solifenacin plus tamsulosin vs placebo plus tamsulosin was also evaluated . MATERIAL S AND METHODS A total of 398 men 45 years old or older were r and omized to 12 weeks of solifenacin plus tamsulosin or placebo plus tamsulosin once daily . The study population had 8 or more micturitions per 24 hours and 1 or more urgency episode per 24 hours after taking tamsulosin for 4 or more weeks , a total International Prostate Symptom Score of 13 or greater , a Patient Perception of Bladder Condition score of 3 or greater , a post-void residual of 200 ml or less and a peak flow rate of 5 ml per second or greater . Adverse events were monitored throughout the study . The primary efficacy end point was mean change from baseline to week 12 in micturitions per 24 hours . Secondary measures included mean change in urgency episodes per 24 hours , and changes in Patient Perception of Bladder Condition , Urgency Perception Scale and total International Prostate Symptom Scores . RESULTS The most frequent adverse events in the solifenacin plus tamsulosin and placebo plus tamsulosin groups were dry mouth ( 7 % and 3 % , respectively ) and dizziness ( 3 % and 2 % , respectively ) . Of the patients on solifenacin plus tamsulosin 7 ( 3 % ) reported retention and 3 required catheterization . No patients on placebo plus tamsulosin reported retention . Patients on solifenacin plus tamsulosin vs placebo plus tamsulosin showed larger reductions in frequency but not of statistical significance ( -1.05 vs -0.67 , p = 0.135 ) . However , patients on solifenacin plus tamsulosin vs placebo plus tamsulosin did show statistically significant reductions in urgency ( -2.18 vs -1.10 , p < 0.001 ) . Patient reported outcome measures showed no significant between group differences . CONCLUSIONS Solifenacin plus tamsulosin was well tolerated . There was a low incidence of urinary retention requiring catheterization . At week 12 solifenacin plus tamsulosin decreased daily micturitions and urgency episodes . Only urgency reached statistical significance vs placebo plus tamsulosin OBJECTIVES This pilot study was undertaken to assess the efficacy and safety of the alpha(1)-blocker alfuzosin 10 mg once daily ( OD ) , the PDE-5 inhibitor sildenafil 25 mg OD , and the combination of both on lower urinary tract symptoms ( LUTS ) suggestive of benign prostatic hyperplasia ( BPH ) and erectile dysfunction ( ED ) . MATERIAL AND METHODS Men aged 50 - 76 yr with previously untreated LUTS and ED were r and omized to receive alfuzosin ( n=20 ) , sildenafil ( n=21 ) , or the combination of both ( n=21 ) for 12 wk . Changes from baseline in International Prostate Symptom Score ( IPSS ) , voiding diary , maximum urinary flow rate ( Qmax ) , postvoid residual urine ( PVRU ) volume , and erectile function domain of the International Index of Erectile Function ( IIEF ) were assessed at week 12 . RESULTS Improvement of IPSS was significant with the three treatments but greatest with the combination ( -24.1 % ) compared with alfuzosin ( -15.6 % ) and sildenafil ( -11.8 % ) [ corrected ] alone ( p<0.03 ) . Frequency , nocturia , PVR , and Qmax were significantly improved with alfuzosin only and the combination . Improvement in IIEF was slight with alfuzosin ( 16.7 % ) , marked with sildenafil ( 49.7 % ) , and greatest with the combination ( 58.6 % ) . Likewise , increases in the frequency of penetration ( Q3 ) and of maintained erection ( Q4 ) were greater with the combination therapy ( 65.2 % and 68.2 % , respectively ) than with sildenafil ( 41.7 % and 59.1 % , respectively ) and alfuzosin ( 27.3 % and 33.3 % , respectively ) alone . All three treatments were well tolerated . CONCLUSIONS In this pilot study , the combination of alfuzosin 10 mg OD and sildenafil 25 mg OD is safe and more effective than monotherapy with either agent to improve both voiding and sexual dysfunction in men with LUTS suggestive of BPH INTRODUCTION Lower urinary tract symptoms ( LUTS ) associated with benign prostatic hyperplasia ( BPH ) and erectile dysfunction are common disorders of advancing age . AIM To evaluate the efficacy and safety of tamsulosin and tadalafil in patients with LUTS due to BPH . METHODS In this prospect i ve r and omized study , 133 men complaining of LUTS due to BPH were included . Forty-five patients received tamsulosin 0.4 mg/day alone ( Group A ) , 44 patients received tadalafil 10 mg/day ( Group B ) , and combination therapy ( tamsulosin and tadalafil both ) was instituted in 44 patients ( Group C ) . After a 2-week medication free run-in period , they were evaluated for International Prostatic Symptom Score ( IPSS ) , International Index of Erectile Function score ( IIEF5 ) , quality of life ( IPSS QoL ) , maximum urinary flow rate ( Qmax ) , post-void residual urine ( PVR ) volume , and safety parameters before and at 3 months of treatment . MAIN OUTCOME MEASURES There were primary ( IPSS , IPSS QoL index , Qmax , and PVR ) and secondary ( erectile function [ EF ] domain scores from IIEF5 ) efficacy end points . Safety assessment included laboratory tests and patient 's reporting of adverse event . RESULTS A significant improvement in IPSS score was observed in all the 3 groups A , B , and C ( -50.90 % , P < 0.05 ; -33.50 % , P < 0.05 ; and -53.90 % , P < 0.05 , respectively ) . IIEF5 score increased significantly in these three groups ( + 39.28 % , P < 0.05 ; + 45.96 % , P < 0.05 ; and + 60.23 % , P < 0.05 , respectively ) . A significant increase in Qmax and decrease in PVR were also observed ( 33.99 % , P < 0.05 ; 29.78 % , P < 0.05 ; and 37.04 % , P < 0.05 ) and ( -60.90 % , P < 0.05 ; -49.45 % , P < 0.05 ; and -62.97 % , P < 0.05 , respectively ) . The QoL scores improved significantly ( -73.35 % , P < 0.05 ; -70.26 % , P < 0.05 ; and -79.65 % , P < 0.05 , respectively ) . Side effects were dyspepsia , heartburn , headache , flushing , myalgia , and backache . Adverse effect dropout was 3.7 % . No participant experienced any severe or serious adverse events . CONCLUSIONS In patients with LUTS due to BPH , tamsulosin and tadalafil alone or in combination cause a significant improvement in patients with LUTS . Their EF also improves with these medications . The improvement is better with combination therapy compared with single agent alone OBJECTIVE The purpose of our study was to evaluate the effect of alfuzosin and tadalafil as combination therapy compared with each monotherapy , in patients with lower urinary tract symptoms ( LUTS ) due to benign prostatic hyperplasia ( BPH ) . METHODS Men over the age of 50 years with LUTS secondary to BPH and an International Prostate Symptom Score ( IPSS ) 8 or higher , were r and omized to receive 10 mg alfuzosin ( n = 25 ) , 10 mg tadalafil ( n = 25 ) or the combination of both the drugs ( n = 25 ) once daily for 3 months . Symptoms were assessed at baseline , 6 weeks and 3 months . The primary endpoint was the change in IPSS from the baseline . Secondary endpoints were changes in IPSS storage and voiding subscores , peak urinary flow rate , residual urine volume , IPSS quality of life score and erectile domain score . RESULTS There were significant improvements in all IPSS scores , peak urinary flow rate and IPSS quality of life score from baseline at both 6 weeks and 3 months in all the three groups ( P < 0.003 ) . Combination therapy was better than monotherapy in improving IPSS scores and reducing post-void residual urine volume ( P < 0.005 ) . Combination therapy was similar to alfuzosin regarding improvement in maximum urine flow rate ( P = 0.22 ) , similar to tadalafil in improvement on erectile function ( P = 0.22 ) and better than each monotherapy in improving the IPSS quality of life ( P ≤ 0.015 ) . CONCLUSION Alfuzosin and tadalafil combination therapy provides greater symptomatic improvement as compared to either monotherapy in men with LUTS due to BPH Purpose To evaluate how much the improvement of lower urinary tract symptoms ( LUTS ) affects sexual function and which storage symptoms or voiding symptoms have the greatest effect on sexual function . Material s and Methods A total of 187 patients were enrolled in this study . Patients were r and omly assigned to receive either tamsulosin 0.2 mg ( group A ) or tamsulosin 0.2 mg and solifenacin 5 mg ( group B ) . At 4 weeks and 12 weeks , the LUTS and sexual function of the patients were evaluated by use of the International Index of Erectile Function-5 ( IIEF5 ) , International Prostate Symptom Score ( IPSS ) , Overactive Bladder Symptom Score ( OABSS ) question naire , uroflowmetry , and bladder scan . Results Both groups A and B showed statistically significant improvements in IPSS , OABSS , and quality of life ( QoL ) . Group A showed improved maximum flow rate , mean flow rate , and residual urine volume by time . Group B did not show an improvement in flow rate or residual urine volume but total voiding volume increased with time . The IIEF5 score was not improved in either group . In group A , the IIEF5 score dropped from 13.66±4.97 to 11.93±6.14 after 12 weeks ( p=0.072 ) . Group B showed a decline in the IIEF5 score from 13.19±5.91 to 12.45±6.38 ( p=0.299 ) . Although group B showed a relatively smaller decrease in the IIEF5 score , the difference between the two groups was not significant ( p=0.696 ) . Conclusions Tamsulosin monotherapy and combination therapy with solifenacin did not improve erectile function despite improvements in voiding symptoms and QoL. The improvement in storage symptoms did not affect erectile function Objectives : Benign prostatic hyperplasia ( BPH ) is the most common cause of lower urinary tract symptoms in elderly men .  Selective alfa1-adrenergic antagonists are now first-line drugs in the medical management of BPH . We conducted a single-blind , parallel group , r and omized , controlled trial to compare the effectiveness and safety of the new alfa1-blocker silodosin versus the established drug tamsulosin in symptomatic BPH . Material s and Methods : Ambulatory male BPH patients , aged above 50 years , were recruited on the basis of International Prostate Symptom Score ( IPSS ) . Subjects were r and omized in 1:1 ratio to receive either tamsulosin 0.4 mg controlled release or silodosin 8 mg once daily after dinner for 12 weeks . Primary outcome measure was reduction in IPSS . Proportion of subjects who achieved IPSS < 8 , change in prostate size as assessed by ultrasonography and changes in peak urine flow rate and allied uroflowmetry parameters , were secondary effectiveness variables . Treatment emergent adverse events were recorded . Results : Data of 53 subjects – 26 on silodosin and 27 on tamsulosin were analyzed . Final IPSS at 12-week was significantly less than baseline for both groups . However , groups remained comparable in terms of IPSS at all visits . There was a significant impact on sexual function ( assessed by IPSS sexual function score ) in silodosin arm compared with tamsulosin . Prostate size and uroflowmetry parameters did not change . Both treatments were well-tolerated . Retro grade ejaculation was encountered only with silodosin and postural hypotension only with tamsulosin . Conclusions : Silodosin is comparable to tamsulosin in the treatment of BPH in Indian men . However , retro grade ejaculation may be troublesome for sexually active patients Patient preference for benign prostatic hyperplasia ( BPH ) treatment with the α1-blockers , tamsulosin or silodosin , was compared using patient-reported outcomes . Japanese patients with lower urinary tract symptoms associated with BPH were r and omly allocated to either the T – S group ( tamsulosin 0.2 mg orally once daily for 4 weeks then silodosin 4 mg orally twice daily for 4 weeks ) or the S – T group ( silodosin 4 mg orally twice daily for 4 weeks then tamsulosin 0.2 mg orally once daily for 4 weeks ) . The primary endpoint was the preferred drug for treatment continuation at 8 weeks , determined by a patient-reported question naire . In total , 102 patients ( mean age 70.3 years ) were enrolled and 84 ( n = 42 per group ) completed the study . A significant difference was observed between the proportion of patients who preferred tamsulosin ( 59/84 patients ; 70.2 % ) and those who preferred silodosin ( 18/84 patients ; 21.4 % ) . A major reason for preference of either drug was ‘ good efficacy ’ . Incidence of adverse effects was significantly lower with tamsulosin ( 3/91 patients ; 3.3 % ) than with silodosin ( 25/88 patients ; 28.4 % ) . These findings indicate that tamsulosin is very effective for BPH , has few adverse effects and that patients want to continue to use it Lower urinary tract symptoms ( LUTS ) and erectile dysfunction ( ED ) are frequently encountered in ageing males . We compared the efficacy of alfuzosin 10 mg alone or in combination with sildenafil 50 mg in the treatment of LUTS due to benign prostatic hyperplasia . One hundred male patients older than 45 years were r and omized to two groups containing 50 patients each ; one group receiving alfuzosin 10 mg and the other group alfuzosin 10 mg combined with sildenafil 50 mg  . International Prostate Symptom Score ( IPSS ) , quality of life ( QoL ) , maximum flow rate ( Qmax ) , prostate volume and post‐void residual urine were evaluated . The mean age was 60.2 ± 17.8 . Mean data of evaluated parameters in both groups at the end of 3rd month compared with baseline values are given respective order as ; 5.1 ( 26.8 % ) and 5.8 ( 28.2 % ) points decreases in IPSS ; 1.6 ( 41.1 % ) and 1.8 ( 45 % ) points decreases in QoL ; and 3.4 ( 29.6 % ) and 3.4 ( 33 % ) points increases in Qmax . The outcomes of our study can not be interpreted in such a way to report that alpha blocker‐PDE5 inhibitor combination  has a better efficacy than alpha blocker treatment alone in patients with LUTS Objective : To evaluate the efficacy and safety of fesoterodine extended-release ( ER ) plus tamsulosin in men with lower urinary tract symptoms ( LUTS ) associated with benign prostatic hyperplasia ( BPH ) . Patients and Methods : Men aged ≥50 years , with LUTS , prostate volume ≤60 ml and International Prostate Symptom Score ( IPSS ) ≥13 were enrolled in this study . 173 consecutive patients were treated initially with tamsulosin ( 0.4 mg ) for 1 week . At the second visit , 47 patients out of the sample of 173 who were still experiencing inconvenient LUTS were r and omized into two groups . The first group received a therapy with tamsulosin and fesoterodine combination ( group 1 , n = 24 ) while the second continued the therapy with the single administration of tamsulosin ( group 2 , n = 23 ) for an additional 4-week period . Results : There was no statistically significant difference in age , prostate volume , Qmax , and postvoid residual urine between the two groups . A statistical significance appeared in the combination group regarding the storage and the total IPSS values among the second and third visits ( 10.5 ± 1.4 to 8.5 ± 1.3 and 16.1 ± 1.8 to 13.7 ± 1.5 respectively ) . Conclusion : Regarding bothersome LUTS and storage symptoms  , fesoterodine ER and tamsulosin combination was significantly more effective than the single administration of tamsulosin This section contains papers from Japan , Austria , the UK , and joint papers from France , Denmark , Switzerl and , Australia and the USA . A wide variety of lower urinary tract topics is covered , from BPH to overactive bladder and urodynamic stress incontinence BACKGROUND Some men receiving alpha-blocker therapy for lower urinary tract symptoms report persistent storage symptoms suggestive of overactive bladder ( OAB ) . OBJECTIVE To evaluate the efficacy of tolterodine extended release ( ER ) in men on alpha-blocker therapy . DESIGN , SETTING , AND PARTICIPANTS This double-blind trial included men aged > or = 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 alpha-blocker for > or = 1 mo . INTERVENTIONS Subjects were r and omized to tolterodine ER 4 mg per day or placebo for 12 wk while continuing their prescribed alpha-blocker therapy . MEASUREMENTS At baseline and week 12 , subjects completed the PPBC , International Prostate Symptom Score ( IPSS ) , Overactive Bladder Question naire ( 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 . RESULTS AND LIMITATIONS PPBC improvement from baseline to week 12 was reported by 63.6 % and 61.6 % of subjects receiving tolterodine ER plus alpha-blocker and placebo plus alpha-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 alpha-blocker had significantly greater improvements versus placebo plus alpha-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 clinical ly meaningful changes in postvoid residual volume or maximum urinary flow rate .  CONCLUSIONS Men with bothersome OAB symptoms despite continued alpha-blocker therapy showed significantly greater improvements in diary variables , IPSS Storage scores , and symptom bother when receiving additional tolterodine ER versus placebo plus alpha-blocker OBJECTIVES To compare the efficacy and safety of silodosin and tamsulosin in patients with lower urinary tract symptoms ( LUTS ) associated with benign prostatic hyperplasia ( BPH ) by a r and omized crossover method . METHODS BPH patients with the complaint of LUTS were included in this study , and were r and omly divided into two groups : a silodosin-preceding group ( 4 weeks of twice-daily administration of silodosin at 4 mg , followed by 4 weeks of once-daily administration of tamsulosin at 0.2 mg ) or a tamsulosin-preceding group ( 4 weeks ' administration of tamsulosin , followed by 4 weeks ' administration of silodosin ) . No drug withdrawal period was provided when switching the drug . RESULTS In the first treatment period , both drugs significantly improved the International Prostate Symptom Score total score , but the improvement by silodosin was significantly superior to that by tamsulosin . After crossover treatment , significant improvement was observed only with silodosin treatment . Moreover , intergroup comparison of changes revealed that silodosin showed significant improvement of straining and nocturia with first and crossover treatments , respectively , compared with tamsulosin . Silodosin also significantly improved quality of life ( QOL ) score in both treatment periods , while tamsulosin significantly improved QOL score only in the first treatment period . The most frequent adverse drug reaction was ejaculatory disorder with silodosin ; however , the incidence of dizziness with silodosin was similar to that with tamsulosin . CONCLUSIONS In BPH/LUTS patients , silodosin exhibits excellent efficacy in improving subjective symptoms in both initial and crossover treatment , and it appears to improve the QOL of patients Purpose To evaluate the efficacy of sildenafil citrate only , 25 mg . Four times/week , tamsulosin only , 0.4 mg once daily , and the combination of both on lower urinary tract symptoms ( LUTS ) suggestive of benign prostate hyperplasia ( BPH ) and erectile dysfunction . Methods A total of 60 men with BPH-related LUTS were r and omized to receive sildenafil citrate only ( n = 20 ) , tamsulosin only ( n = 20 ) , and the combination of both ( n = 20 ) for 8 weeks . Changes from baseline in International Prostate Symptom Score ( IPSS ) , maximum urinary flow rate ( Qmax ) , post voiding residual urine volume ( PRV ) , Sexual Health Inventory for Male ( SHIM ) score , 3rd and 4th questions of International Index of Erectile Function ( IIEF ) were assessed at the end of the treatment . Results The mean age was 58 years .  IPSS , Qmax , PRV , SHIM scores , and 3rd and 4th questions in IIEF significantly improved in each group . Improvement of IPSS was more remarkable in combination ( 40.1 % ) and tamsulosin only ( 36.2 % ) groups in comparison with sildenafil citrate only group ( 28.2 % ; p < 0.001 ) . Improvement of Qmax and PRV were greater in tamsulosin only and combination than sildenafil citrate only group . SHIM scores significantly improved in sildenafil citrate only ( 65 % ) and combination ( 67.4 % ) than tamsulosin only ( 12.4 % ; p < 0.001 ) . Increases in the 3rd and 4th questions of IIEF were greater in sildenafil only and combination than tamsulosin only ( p < 0.001 ) . Conclusions Treatment with the combination of tamsulosin only and sildenafil citrate only was not superior to tamsulosin only to enhance voiding symptoms . Also , sexual function improvement was similar for both the combination and sildenafil citrate only treatments OBJECTIVES To examine the efficacy , safety , and dose response of tadalafil once daily in Japanese men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia ( BPH-LUTS ) . METHODS Men ≥45 years with moderate-to-severe BPH-LUTS were r and omized to once-daily placebo ( N = 140 ) , tadalafil 2.5 mg ( N = 142 ) , or tadalafil 5.0 mg ( N = 140 ) , in a 12-week double-blind phase , followed by a 42-week , tadalafil 5.0 mg open-label extension ( OLE ) phase ( N = 394 ) . The primary outcome was total International Prostate Symptom Score ( IPSS ) change from baseline to last available observation in the double-blind phase . RESULTS The least squares ( LS ) mean difference between placebo and tadalafil  in total IPSS change from baseline was -0.7 ( P = 0.201 ) and -1.1 ( P = 0.062 ) for tadalafil 2.5 and 5 mg , respectively ( ANCOVA ; a dose-dependent improvement in placebo-adjusted total IPSS for tadalafil 5 mg versus 2.5 mg of 57 % ) . Repeated- measures analyses identified a significant total IPSS change  for tadalafil 5 mg ( LS mean difference between placebo and tadalafil 5 mg : -1.2 ; P = 0.035 ) , but not tadalafil 2.5 mg , at week 12 . Significant improvements for tadalafil 5 mg were demonstrated ( ANCOVA ) for IPSS obstructive subscore ( P = 0.033 ) and IPSS quality of life index ( P = 0.022 ) . Numerical improvements in IPSS scores were maintained over the OLE phase . Tadalafil was well tolerated with no unexpected adverse events . CONCLUSION Tadalafil ( 5.0 mg ) had a favorable benefit-to-risk profile , supporting further investigation of tadalafil ( 5.0 mg ) in Japanese men with BPH-LUTS OBJECTIVES We assessed the efficacy and safety of two α1-adrenoceptor antagonists , tamsulosin and silodosin , in the treatment of male lower urinary tract symptoms . METHODS Men aged 50 years or older who had a total International Prostate Symptom Score ( IPSS ) of 8 or higher were enrolled in this study . Forty-six patients were r and omized into two groups . Twenty-three patients were initially prescribed tamsulosin 0.2 mg once daily for 3 months , followed by silodosin 4 mg twice daily for 3 months ( group T ) ; the other group of 23 patients were initially prescribed silodosin , followed by tamsulosin ( group S ) . Patients then switched to the alternative treatment after a 1-month clearance period . Evaluations included clinical determination of IPSS , quality -of-life index , maximum flow rate and postvoid residual urine volume before and after treatment . RESULTS A total of 46 men , 23 in group T and 23 in group S , were treated and 41 ( 89.1 % ) completed the treatment . IPSS , quality -of-life index , maximum flow rate and postvoid residual urine volume were significantly improved in both groups after treatment . The changes in the total IPSS from baseline in groups S and T at 3 months were -6.6 and -7.5 , respectively . There were no significant differences between the two groups . After taking both medications , 18 patients preferred silodosin , 11 preferred tamsulosin and others felt they had the same effects . Six and none patients experienced adverse events  during silodosin and tamsulosin treatment , respectively . CONCLUSION Two types of α1-adrenoceptor antagonists in the same individuals provide similar efficacy . Profiles and difference of each drug should be considered in making treatment choice PURPOSE To evaluate the efficacy/safety of ' tamsulosin and darifenacin ' ( TD ) vs. ' tamsulosin and placebo ' ( TP ) for patients with symptomatic benign prostrate hyperplasia ( BPH ) with accompanying overactive bladder ( OAB ) symptoms . MATERIAL S AND METHODS This study included symptomatic patients of BPH with one or more of the following OAB symptoms ; micturition frequency > 8 , nocturnal frequency > 2 , urgency > 1 per 24 hour between November 2012 and February 2014 . After protocol approval by ethics committee and obtaining informed consent , patients were r and omly assigned to receive tamsulosin 0.4 mg plus placebo ( TP ) ( n=30 ) or tamsulosin 0.4 mg plus darifenacin 7.5 mg ( TD ) ( n=30 ) for 8 weeks . The mean change from baseline in urinary frequency and incontinence episodes/24 hour ( primary end points ) , and nocturnal frequency ; mean change in PVR and changes in IPSS ( secondary end points ) were compared between groups at 0/eight week using voiding diary and ultrasonography . RESULTS The mean change in frequency , incontinence , nocturnal frequency/24 hour and IPSS ( International prostrate symptom score ) were ( -4.83 vs. -3.93 , p=0.023 ) , ( -1.50 vs. 1.08 , p=0.001 ) , ( -2.20 vs. -1.87 , p<0.001 ) and ( -7.90 vs. -6.27 , p<0.001 ) in the TD/TP group respectively ( significant ) . Apart from some minor side effects ( 12 vs. 9 ) all interventions appeared to be safe and well tolerated . The mean change in the PVR ( Postvoid residual ) was marginal ( + 10.84ml and -16.93 ) and the incidence of urinary retention was 13 % and 3 % in the TD and TP groups respectively ( p=0.35 ) . CONCLUSION Treatment with tamsulosin and darifenacin for 8 weeks is an effective and safe treatment modality in select patients of BPH with accompanying OAB symptoms OBJECTIVES To evaluate safety and efficacy of tadalafil on  lower urinary tract symptoms ( LUTS ) suggestive of benign prostatic hyperplasia ( BPH ) in patients treated with st and ard medication . MATERIAL S AND METHODS In this case-controlled r and omized clinical trial , from November 2008 to August 2009 , 132 patients with obstructive and irritative urinary tract symptoms due to BPH , IPSS ≥ 8 , no indication for surgical intervention and that reached plateau levels of response to treatment were selected . These patients were r and omly allocated in two groups ( each containing 66 patients ) . The treatment group received st and ard treatment of BPH and tadalafil ( 10 mg nightly ) ; the placebo group received only st and ard treatment of BPH . IPSS , maximum urinary flow rate ( Qmax ) and quality of life were assessed before and after a 3-month period of study . RESULTS Before treatment , mean IPSS , Qmax and quality of life values in the treatment and placebo groups were 13.06 ± 4.37 and 13.66 ± 4.25 , 8.92 ± 2.96 mL/s and 9.09 ± 2.91 mL/s , 2.93 ± 0.86 and 2.66 ± 0.78 , respectively . After treatment , mean IPSS , Qmax , and quality of life values in treatment group were 7.66 ± 3.99 , 9.99 ± 4.76 mL/s and 1.80 ± 0.98 , respectively . These findings were compared to corresponding values of the placebo group ( 11.37 ± 3.64 , 8.73 ± 2.22 mL/s and 2.19 ± 0.53 , respectively ) : IPSS and quality of life were significantly different but Qmax did n't show a significant change . CONCLUSIONS Tadalafil  improves quality of life and urinary symptoms in patients with LUTS suggestive of BPH , but does n't have any significant effect on Qmax . Therefore , this drug may be effectively used in combination with st and ard medical therapies for BPH OBJECTIVES To assess the efficacy and safety of solifenacin add-on therapy to tamsulosin in lower urinary tract symptoms ( LUTS ) men with residual overactive bladder ( OAB ) symptoms despite tamsulosin monotherapy . METHODS In this r and omized , multicenter , double-blind study , male LUTS patients aged≥50 years with urgency episodes/24 hours≥2 and micturitions/24 hours≥8 were r and omized to 3 groups : 12-weeks tamsulosin plus placebo ( TAM+PBO ) , tamsulosin plus solifenacin 2.5 mg ( TAM+SOL ) , and tamsulosin plus solifenacin 5 mg ( TAM+SOL ) . Changes from baseline to end of treatment in the number of urgency episodes/24 hours ( primary endpoint ) , micturitions , nocturia , urgency incontinence episodes , International Prostate Symptom Scores ( IPSS ) , and Overactive Bladder Symptom Score ( OABSS ) were compared between the TAM+SOL groups and TAM+PBO . Safety was assessed on adverse events , postvoid residual volume , and maximal urinary flow rate ( Qmax . ) . RESULTS Six-hundred thirty-eight men were r and omized . Urgency was reduced by 2.2 and 2.4 episodes in the TAM+SOL 2.5 and 5 mg groups , respectively . The TAM+SOL 5 mg group showed significant improvement compared with TAM+PBO ( -2.4 vs -1.9 , P=.049 ) . The number of micturitions in both TAM+SOL groups were significantly reduced compared with TAM+PBO ( both P<.001 ) . IPSS storage symptom score and OABSS significantly improved in both TAM+SOL groups compared with TAM+PBO . Changes in IPSS voiding symptom score and Qmax . were similar in all groups . Four patients ( 1.9 % ) in the TAM+SOL 5 mg group had urinary retention , but all recovered after catheterization . CONCLUSIONS In male LUTS patients with residual OAB symptoms  despite tamsulosin monotherapy , TAM+SOL showed efficacy on urgency , which represents OAB symptoms and was well tolerated OBJECTIVES To examine the efficacy and safety of tadalafil in Asian men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia . METHODS Asian men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia were r and omized to once-daily placebo ( n=154 ) , tadalafil 2.5 mg ( n=151 ) , tadalafil 5.0 mg ( n=155 ) or tamsulosin 0.2 mg ( active control , n=152 ) for 12 weeks . RESULTS Total International Prostate Symptom Score least-squares mean changes from baseline to end-point significantly improved with tadalafil 2.5 mg ( -4.8 , P=0.003 ) and 5 mg ( -4.7 , P=0.004 ) versus placebo ( -3.0 ) . Significant improvement in the International Prostate Symptom Score versus placebo was observed earlier ( week 2 ) for tadalafil 5.0 mg than for tadalafil 2.5 mg ( week 8) . Significant improvements ( P<0.05 ) in both tadalafil groups versus placebo were observed for the International Prostate Symptom Score voiding subscore , International Prostate Symptom Score Quality of Life , and for Patient and Clinician Global Impressions of Improvement . Significant improvements versus placebo were observed in the International Prostate Symptom Score storage subscore for tadalafil 5.0 mg ( -1.7 , P=0.021 ) , but not tadalafil 2.5 mg ( -1.5 , P=0.072 ) . No significant improvements in benign prostatic hyperplasia Impact Index or improvements in peak urinary flow rates were observed with tadalafil 2.5 mg or 5.0 mg versus placebo . Tamsulosin treatment result ed in significant improvements versus placebo across all efficacy parameters , except for peak urinary flow rates . Safety results were consistent with the known tadalafil and tamsulosin safety profiles . CONCLUSIONS Tadalafil once daily represents an effective and well tolerated medical treatment for Asian men presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia We aim ed to evaluate the efficacy and safety of combination treatment using anticholinergics with α-blocker for initial treatment of both overactive bladder ( OAB ) and other lower urinary tract symptoms ( LUTS ) , secondary to BPH . A 12-week , r and omized , double-blind , placebo-controlled trial was conducted at four urology clinics in Korea , involving men , aged 50 years or older , with LUTS related to BPH and OAB . A total of 176 patients were r and omly assigned to receive doxazosin ( 4 mg ) plus placebo or doxazosin ( 4 mg ) plus tolterodine SR ( 4 mg ) , once a day for 12 weeks . Changes from baseline in total International Prostate Symptom Score ( IPSS ) , bladder diary variables , patient perception of bladder condition ( PPBC ) , uroflowmetry , postvoid residual volume and IPSS subscores ( voiding and storage ) were analyzed . Of the 176 enrolled patients , 91 had doxazosin gastrointestinal therapeutic system ( GITS ) and placebo , and 85 had combined medication with doxazosin GITS and tolterodine SR . Compared with the doxazosin plus placebo group , the doxazosin plus tolterodine group showed significant reductions in IPSS storage subscore and improvement in the quality of life item , urgency episodes , as well as in micturition frequency at weeks 4 and 12 . However , it failed to improve PPBC at week 4 as well as at week 12 . Earlier intervention with anticholinergics plus α-blocker was tolerated well , including the questions about urinary retention ( n=1 ) and dry mouth ( n=2 ) . Initial combination treatment of anticholinergics plus α-blocker showed positive results for men with LUTS related to BPH and OAB symptoms and did not increase the risk of urinary retention Objectives : Benign prostatic hyperplasia ( BPH ) is a common and progressive disease affecting elderly males , often associated with lower urinary tract symptoms ( LUTS ) . α1-blockers are the mainstay in symptomatic therapy of BPH . Because of their greater uroselectivity and minimal hemodynamic effects , alfuzosin , tamsulosin , and silodosin are generally preferred . The aim of this study was to compare the efficacy and tolerability of alfuzosin , tamsulosin , and silodosin in patients with BPH and LUTS . Methods : Ninety subjects with BPH and LUTS were r and omized into three groups of thirty in each , to receive alfuzosin sustained release ( SR ) 10 mg , tamsulosin 0.4 mg , or silodosin 8 mg for 12 weeks . The primary outcome measure was a change in the International Prostate Symptom Score ( IPSS ) , and the secondary outcome measures were changes in individual subjective symptom scores , quality of life score ( QLS ) , and peak flow rate ( Qmax ) from baseline . The treatment response was monitored at 2 , 4 , 8 , and 12 weeks . Results : IPSS improved by 88.18 % , 72.12 % , and 82.23 % in alfuzosin SR , tamsulosin and silodosin groups ( P < 0.001 ) at 12 weeks . Improvement in QLS was > 75 % in all the three groups ( P < 0.001 ) . A significant improvement in Qmax was seen with alfuzosin and tamsulosin ( P = 0.025 and P < 0.001 ) but not with silodosin ( P = 0.153 ) . However , the intergroup differences in IPSS , QLS , and Qmax were not significant . Ejaculatory dysfunction was more common with silodosin and corrected QT ( QTc ) prolongation occurred only with alfuzosin ( two subjects ) and tamsulosin ( three subjects ) . Conclusion : Alfuzosin , tamsulosin , and silodosin showed similar efficacy in improvement of LUTS secondary to BPH , with good tolerability , acceptability , and minimum hemodynamic adverse effects . Alfuzosin , tamsulosin , and silodosin are comparable in efficacy in symptomatic management of BPH . The occurrence of QTc prolongation in three subjects with tamsulosin in the present study is an unexpected adverse event as there are no reports of QTc prolongation with tamsulosin in any of the previous studies PURPOSE We evaluated the efficacy and safety of add-on treatment with a β3-adrenoceptor agonist ( mirabegron ) for overactive bladder symptoms remaining after α1-blocker ( tamsulosin ) treatment in men with benign prostatic obstruction . MATERIAL S AND METHODS Patients with benign prostatic obstruction with urinary urgency at least once per week and a total OABSS of 3 or more points after 8 or more weeks of treatment with tamsulosin were enrolled in the study . They were r and omly allocated to receive 0.2 mg tamsulosin daily or 0.2 mg tamsulosin and 50 mg mirabegron daily for 8 weeks . The primary end point was change in total OABSS . Safety assessment s included change in post-void residual urine volume and adverse events . RESULTS From January 2012 through September 2013 a total of 94 patients were r and omized . Of these patients 76 completed the protocol treatment . In the full analysis set the change in total OABSS during the treatment period was significantly greater in the combination group than in the monotherapy group ( -2.21 vs -0.87 , p=0.012 ) . The changes in scores for urinary urgency , daytime frequency , International Prostate Symptom Score storage symptom subscore and quality of life index at 8 weeks were significantly greater in the combination group . The change in post-void residual urine volume was significantly greater in the combination group . Although 6 patients experienced adverse events in the combination group , urinary retention was observed in only 1 patient . CONCLUSIONS Combined tamsulosin and mirabegron treatment is effective and safe for patients with benign prostatic obstruction who have overactive bladder symptoms  after tamsulosin monotherapy INTRODUCTION Alpha1-blockers ( AB ) are the first-line monotherapy for lower urinary tract symptoms ( LUTS ) .  Phosphodiesterase type 5 ( PDE5 ) inhibitors are the first-line treatment for erectile dysfunction ( ED ) . Numerous studies have supposed a significant association between ED and LUTS , but a causal relationship can not be established . AIM The aim was to evaluate the efficacy of a combined therapy with an AB ( alfuzosin ) and PDE5 inhibitors ( tadalafil ) in patients with LUTS and ED . METHODS This was a r and omized , open-label , three-arm study . A total of 66 men complaining of ED and LUTS were included in the study . Patients were assessed at baseline and after 12 weeks of study treatment , and then underwent r and omized allocation to either alfuzosin 10 mg once a day ( 22 patients ) or tadalafil 20 mg on alternative days ( 21 patients ) , or a combination of both ( 23 patients ) . MAIN OUTCOME MEASURES All participants completed the erectile function domain of the International Index of Erectile Function ( IIEF-EF ) and the International Prostatic Symptom Score ( IPSS ) . Other efficacy variables included maximum urinary flow rate ( Qmax ) and medium urinary flow rate ( Qave ) . RESULTS IIEF-EF tended to improve with alfuzosin alone ( + 15 % ) , while it was clearly improved with tadalafil alone ( + 36.3 % ) . The greatest improvement was experienced with the combination therapy ( + 37.6 % ) . Improvement in Qmax was observed in all groups , but patients receiving combination therapy had greater improvement ( 29.6 % ) than patients receiving either only alfuzosin ( 21.7 % ) or only tadalafil ( 9.5 % ) . IPSS was significantly improved in alfuzosin group ( 27.2 % ) , was more marked with the combination therapy ( 41.6 % ) , and a small increase , although not significant , was also observed with tadalafil ( 8.4 % ) . CONCLUSIONS Combined therapy improved ED and LUTS as demonstrated by the significant improvement in uroflowmetry measures and in IPSS and IIEF-EF scores . A significant improvement was also observed in quality of life assessment s. The beneficial effects of tadalafil on LUTS similar to the benefits of alfuzosin on ED , although present , were smaller PURPOSE We systematic ally review ed the effectiveness and adverse effects of tamsulosin for lower urinary tract symptoms compatible with benign prostatic obstruction . MATERIAL S AND METHODS Studies were included in analysis when they involved a r and omized trial of at least 1 month in duration , men with lower urinary tract symptoms and a comparison of tamsulosin with placebo or an active control . Study , patient and outcome data were extracted onto st and ard forms using a prospect i ve protocol . RESULTS Of the series 13 involving 3,418 men with a mean age of 64 years met our inclusion criteria . Study duration was 4 to 26 weeks . Baseline symptom scores and flow rates showed moderate lower urinary tract symptoms . Tamsulosin improved symptoms and peak urine flow compared with placebo . The weighted mean difference in the mean change from baseline for the Boyarsky symptom score for 0.4 and 0.8 mg . tamsulosin versus placebo was -1.1 ( 95 % confidence interval [ CI ] -1.49 to -0.72 or 12 % improvement ) and -1.6 points ( 95 % CI -2.3 to -1.0 or 16 % improvement ) , respectively . The weighted mean difference in the mean change from baseline in peak urine flow was 1.1 ( 95 % CI 0.59 to 1.51 ) and 1.1 ml . per second ( 95 % CI 0.65 to 1.48 ) for 0.4 and 0.8 mg . , respectively . The 0.2 to 0.4 mg . tamsulosin dose was as effective as other alpha-antagonists for improving symptoms and the flow rate , although the doses of all alpha-antagonists evaluated may not have been optimal . Treatment withdrawals and adverse effects increased markedly as the tamsulosin dose increased . CONCLUSIONS Tamsulosin improves lower urinary tract symptoms and flow . Its effectiveness was similar to that of other alpha-antagonists , increasing slightly at higher doses . Adverse effects were generally mild but the incidence , including treatment withdrawals , increased substantially at higher doses OBJECTIVES Assess the efficacy and safety of once-daily tadalafil or tamsulosin versus placebo during 12 weeks on lower urinary tract symptoms ( LUTS ) in Korean men with benign prostatic hyperplasia ( BPH ) . METHODS Following a 4-week placebo run-in period , 151 Korean men were r and omly assigned to receive once-daily tadalafil 5 mg , tamsulosin 0.2 mg , or placebo for 12 weeks . RESULTS The International Prostate Symptom Score ( IPSS ) least squares mean changes from baseline to endpoint were numerically but not significantly improved in the tadalafil ( -5.8 ) and tamsulosin ( -5.4 ) groups compared with placebo ( -4.2 , P > 0.05 ) . Decreases in IPSS obstructive and irritative subscores , IPSS Quality of Life score , and BPH Impact Index from baseline to endpoint were largest in the tadalafil group followed by tamsulosin , though none separated significantly from placebo . Increases in maximum urinary flow rate were small and not significantly different than placebo ; the increase was largest in the tadalafil group ( 2.5 mL/sec ) , followed by the placebo ( 2.3 mL/sec ) and tamsulosin ( 2.1 mL/sec ) groups . The percentage of subjects reporting at least one treatment-emergent adverse event was 26.5 , 13.7 and 3.9 % in the tamsulosin , tadalafil and placebo groups , respectively . CONCLUSIONS In this pilot study in Korean men , those with BPH and treated with tadalafil 5 mg or tamsulosin 0.2 mg once daily experienced a reduction in LUTS , which was numerically ( but not statistically ) significant compared with the placebo . Tadalafil was well tolerated and few subjects discontinued the study due to treatment-emergent adverse events . Larger studies in Asian men with BPH and LUTS treated with phosphodiesterase type 5 inhibitors are needed BACKGROUND Silodosin is a new selective therapy with a high pharmacologic selectivity for the α(1A)-adrenoreceptor . OBJECTIVE Our aim was to test silodosin 's superiority to placebo and noninferiority to tamsulosin and discuss the findings in the context of a comprehensive literature review of the new compound silodosin . DESIGN , SETTING , AND PARTICIPANTS We conducted a multicenter double-blind , placebo- and active-controlled parallel group study . A total of 1228 men ≥50 yr of age with an International Prostate Symptom Score ( IPSS ) ≥13 and a urine maximum flow rate ( Q(max ) ) > 4 and ≤15 ml/s were selected at 72 sites in 11 European countries . The patients were entered into a 2-wk wash-out and a 4-wk placebo run-in period . A total of 955 patients were r and omized ( 2:2:1 ) to silodosin 8 mg ( n=381 ) , tamsulosin 0.4 mg ( n=384 ) , or placebo ( n=190 ) once daily for 12 wk . MEASUREMENTS We calculated the change from baseline in IPSS total score ( primary ) , storage and voiding subscores , quality of life ( QoL ) due to urinary symptoms , and Q(max ) . Responders were defined on the basis of IPSS and Q(max ) by a decrease of ≥25 % and an increase of ≥30 % from baseline , respectively . RESULTS AND LIMITATIONS The change from baseline in the IPSS total score with silodosin and tamsulosin was significantly superior to that with placebo ( p<0.001 ) : difference active placebo of -2.3 ( 95 % confidence interval [ CI ] , -3.2 , -1.4 ) with silodosin and -2.0 ( 95 % CI,-2.9 , -1.1 ) with  tamsulosin . Responder rates according to total IPSS were significantly higher ( p<0.001 ) with silodosin ( 66.8 % ) and tamsulosin ( 65.4 % ) than with placebo ( 50.8 % ) . Active treatments were also superior to  placebo in the IPSS storage and voiding subscore analyses , as well as in QoL due to urinary symptoms . Of note , only silodosin significantly reduced nocturia versus placebo ( the change from baseline was -0.9 , -0.8 , and -0.7 for silodosin , tamsulosin , and placebo , respectively ; p=0.013 for silodosin vs placebo ) . An increase in Q(max ) was observed in all groups . The adjusted mean change from baseline to end point was 3.77 ml/s for silodosin , 3.53 ml/s for tamsulosin , and 2.93 ml/s for placebo , but the change for silodosin and tamsulosin was not statistically significant versus placebo because of a particularly high placebo response ( silodosin vs placebo : p=0.089 ; tamsulosin vs placebo : p=0.221 ) . At end point , the percentage of responders by Q(max ) was 46.6 % , 46.5 % , and 40.5 % in the silodosin , tamsulosin , and placebo treatment groups , respectively . This difference was not statistically significantly ( p=0.155 silodosin vs placebo and p=0.141 tamsulosin vs placebo ) . Active treatments were well tolerated , and discontinuation rates due to adverse events were low in all groups ( 2.1 % , 1.0 % , and 1.6 % with silodosin , tamsulosin , and placebo , respectively ) . The most frequent adverse event with silodosin was a reduced or absent ejaculation during orgasm ( 14 % ) , a reversible effect as a consequence of the potent and selective α(1A)-adrenoreceptor antagonism of the drug . The incidence was higher than that observed with tamsulosin ( 2 % ) ; however , only 1.3 % of silodosin-treated patients discontinued treatment due to this adverse event . CONCLUSIONS Silodosin is an effective and well-tolerated treatment for the relief of both voiding and storage symptoms in patients with lower urinary tract symptoms suggestive of bladder outlet obstruction thought to be associated with benign prostatic hyperplasia . Its overall efficacy is not inferior to tamsulosin . Only silodosin showed a significant effect on nocturia over placebo . TRIAL REGISTRATION Clinical Trials.gov Identifier NCT00359905 INTRODUCTION Safety and efficacy of tamsulosin and vardenafil are well established : however , there is no report regarding combined therapy with these drugs for  lower urinary tract symptoms ( LUTSs ) secondary to benign prostatic hyperplasia ( BPH ) . AIM To compare the safety and efficacy of tamsulosin 0.4 mg/day vs. tamsulosin 0.4 mg/day plus vardenafil 10 mg/day in patients with LUTS/BPH in a r and omized trial with 12-week follow-up . METHODS We conducted a r and omized , double-blind , placebo-controlled study on 60 men with persistent storage LUTS after 2-week run-in with tamsulosin .  MAIN OUTCOME MEASURES International Prostate Symptom Score ( IPSS ) , IPSS-bother , International Index of Erectile Function , Version 5 ( IIEF-5 ) and Over Active Bladder question naire ( OAB-q ) scores , uroflowmetry data ( Qmax , Qave ) , and postvoiding residual urine were recorded after run-in ( baseline ) , and 2 and 12 weeks after treatment . Differences between vardenafil and placebo at different times were calculated with unpaired sample s t-test . Between-group differences in change from baseline to 2 and 12 weeks were evaluated with analysis of variance . RESULTS We found a between-group significant difference from baseline to 12 weeks in the following : ( i ) Qmax ( placebo : + 0.07 , vardenafil : + 2.56 , P = 0.034 ) ; ( ii ) Qave  ( placebo : -0.15 , vardenafil : + 1.02 , P = 0.031 ) ; ( iii ) irritative-IPSS subscores ( placebo : -1.67 , vardenafil : -3.11 , P = 0.039 ) ; and ( iv ) IIEF ( placebo : + 0.06 , vardenafil : + 2.61 , P = 0.030 ) . No patient reported any serious ( grade ≥ 2 ) adverse event ( AE ) . There were no differences in the incidence of common , treatment-related AEs between men undergoing combined therapy or tamsulosin alone . CONCLUSIONS The combination of tamsulosin and vardenafil for 12 weeks was well tolerated and more effective to improve both LUTS and erectile function , as compared with tamsulosin alone . Further studies are needed to assess the role of combined therapy of phosphodiesterase type 5 inhibitors and alpha blockers in treating LUTS/BPH PURPOSE Medical treatment for men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia is 5α-reductase inhibitor monotherapy or coadministration with an α-blocker . We assessed the effects of tadalafil 5 mg coadministered with finasteride 5 mg during 26 weeks on lower urinary tract symptoms and sexual symptoms . MATERIAL S AND METHODS In an international , r and omized , double-blind , parallel study of men 45 years old or older who were 5α-reductase inhibitor naïve and had an I-PSS ( International Prostate Symptom Score ) of 13 or greater and prostate volume 30 ml or greater , 350 were treated with placebo/finasteride  and 345 received tadalafil/finasteride for 26 weeks . Changes in lower urinary tract symptoms secondary to benign prostatic hyperplasia were assessed with the I-PSS , erectile dysfunction improvements were assessed with the IIEF-EF ( International Index of Erectile Function-Erectile Function ) in sexually active men and safety was assessed by evaluating adverse events . RESULTS Least squares mean changes from baseline in I-PSS after 4 , 12 and 26 weeks of tadalafil/finasteride coadministration were -4.0 , -5.2 and -5.5 , respectively . Corresponding values for placebo/finasteride coadministration were -2.3 , -3.8 and -4.5 ( p ≤ 0.022 at all visits favoring tadalafil/finasteride  coadministration ) . I-PSS subscores ( storage and voiding ) and quality of life index were also numerically improved with tadalafil/finasteride coadministration . Least squares mean changes from baseline in IIEF-EF  with tadalafil/finasteride coadministration were 3.7 after 4 weeks , and 4.7 after 12 and 26 weeks . Corresponding values for placebo/finasteride coadministration were -1.1 , 0.6 and -0.0 ( p < 0.001 at all visits favoring tadalafil/finasteride coadministration ) . Tadalafil/finasteride coadministration was well tolerated and most adverse events were mild/moderate . CONCLUSIONS The coadministration of tadalafil/finasteride provides early improvement in lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement . Tadalafil/finasteride coadministration also improves erectile function in men who have comorbid erectile dysfunction BACKGROUND Short-term trials have demonstrated the efficacy and safety of combination therapy using antimuscarinics and α-blockers in men with lower urinary tract symptoms ( LUTS ) . The Study of Solifenacin Succinate and Tamsulosin Hydrochloride OCAS ( oral controlled absorption system ) in Males with Lower Urinary Tract Symptoms ( NEPTUNE ) II is the first long-term study using solifenacin ( Soli ) and the oral controlled absorption system formulation of tamsulosin ( TOCAS ) . OBJECTIVE To evaluate long-term ( up to 52 wk ) safety and efficacy of flexible dosing of two fixed-dose combinations ( FDC ) of Soli plus TOCAS in men with moderate to severe storage symptoms and voiding symptoms . DESIGN , SETTING , AND PARTICIPANTS Patients with both storage and voiding LUTS , maximum urinary flow rate of 4.0 - 12.0 ml/s , prostate size < 75 ml , and postvoid residuals ≤ 150 ml , who completed the 12-wk , double-blind NEPTUNE study could continue in the 40-wk , open-label NEPTUNE II study . INTERVENTION FDC of Soli 6 mg plus TOCAS 0.4 mg , or Soli 9 mg plus TOCAS 0.4 mg ; patients could switch between doses in NEPTUNE II . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Safety and efficacy data from NEPTUNE and NEPTUNE II were combined to cover a 52-wk period . Primary efficacy end points were total International Prostate Symptom Score ( IPSS ) and total urgency and frequency score ( TUFS ) ; secondary end points included IPSS storage and voiding subscores , micturition diary variables , and quality of life parameters . RESULTS In all , 1066 men completed NEPTUNE and received one dose or more of study medication in NEPTUNE II . Treatment-emergent adverse events were reported in 499 ( 46.8 % ) patients who participated in NEPTUNE II ; most were mild or moderate . Urinary retention occurred in 13 of 1208 ( 1.1 % ) patients receiving one or more FDCs in NEPTUNE and /or NEPTUNE II ; 8 ( 0.7 % ) required catheterisation ( acute urinary retention [ AUR ] ) . Reductions in total IPSS and TUFS during NEPTUNE were maintained for up to 52 wk of FDC treatment , with mean reductions of 9.0 ( st and ard deviation [ SD ] : 5.7 ) and 10.1 ( SD : 9.2 ) , respectively , from baseline to end of treatment . Clinical ly relevant improvements were also observed for secondary efficacy end points . CONCLUSIONS Long-term treatment with FDC Soli plus TOCAS was well tolerated and efficacious in men with storage and voiding LUTS , with a low incidence of AUR . PATIENT SUMMARY Treatment with solifenacin plus tamsulosin in a fixed-dose combination tablet was well tolerated by men with lower urinary tract symptoms . Improvements in symptoms were achieved after 4 wk of treatment , with further improvements at week 16 maintained for up to 52 wk throughout the study
target: Based on improvement of mean International Prostate Symptom Score and quality of life scores , the effectiveness of the newer ABs was not different from the older ABs ( moderate strength of evidence [ SOE ] ) , but had more AEs ( low SOE ) .
  Antimuscarinics/AB combination therapy had similar outcomes  as AB monotherapy ( all moderate SOE ) , but often had more AEs .
  Phosphodiesterase type-5 inhibitors alone or in combination with ABs had similar or inferior outcomes than ABs alone .
  Evidence was insufficient for the beta-3 adrenoceptor agonist .
  For all newer agents , the evidence was generally insufficient to assess long-term efficacy , prevention of symptom progression , or AEs .
  None of the drugs or drug combinations newly used to treat LUTS attributed to BPH showed outcomes superior to traditional AB treatment .
  Given the lack of superior outcomes , the studies ' short time-horizon , and less assurance of their safety , their current value in treating LUTS attributable to BPH appears low .
  We found none of the new drugs to be better but there was more concern about side effects
background: CONTEXT Alpha-blockers ( ABs ) and 5-alpha reductase inhibitors have an established role in treating male lower urinary tract symptoms ( LUTS ) attributed to benign prostatic hyperplasia ( BPH ) .
  Recently , newer drugs have shown promise for this indication .
  OBJECTIVE To assess the comparative effectiveness and adverse effects ( AEs ) of newer drugs to treat LUTS attributed to BPH through a systematic review and meta- analysis .
  PATIENT SUMMARY In this paper , we review ed the evidence of newer drugs to treat men with urinary problems attributable to an enlarged prostate .