The role of anticholinergics in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis
Article first published online: 9 OCT 2006
Volume 99, Issue 1, pages 85–96, January 2007
How to Cite
Blake-James, B. T., Rashidian, A., Ikeda, Y. and Emberton, M. (2007), The role of anticholinergics in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis. BJU International, 99: 85–96. doi: 10.1111/j.1464-410X.2006.06574.x
- Issue published online: 7 NOV 2006
- Article first published online: 9 OCT 2006
- Accepted for publication 16 August 2006
- bladder outlet obstruction;
Authors from the UK present a systematic review of publications on the safety and efficacy of anticholinergics in men with LUTS; they found them to be safe, but suggested that further studies are required to establish precisely their efficacy.
Authors from the USA studied the correlation between risk factors for vascular disease and the AUA symptom score; there was a possible association between vascular disease and the development and severity of LUTS in men.
To assess the safety and efficacy of anticholinergics in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) by a systematic review of published reports and a meta-analysis of the reported outcomes.
We searched Medline, Embase and Cochrane databases (1966–2006), and hand-searched relevant reference lists and conference proceedings, for studies on the use of anticholinergics in men with BPH or bladder outlet obstruction. Eligible studies were assessed for quality and foreign language studies were translated. We collected data on all reported outcomes, conducted meta- analyses on the maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR) and volume at first contraction, and calculated the acute urinary retention (AUR) rate. We used sensitivity analysis to confirm the findings.
We identified five randomized controlled trials (RCTs) and 15 observational studies. Four RCTs incorporating 633 patients were included in the meta-analyses. Anticholinergics did not significantly alter Qmax (0.1 mL/s, 95% confidence interval, CI, 0.6–0.7). The PVR was increased by 11.6 mL (95% CI 4.5–18.6) although there was no significant difference between AUR rates. The total International Prostate Symptom Scores (IPSS) were not significantly different, but there were improvements for IPSS storage subscores in one RCT. The AUR rate was 0.3% at the 12-week follow-up in 365 men in the RCTs and observational studies.
Anticholinergic use in men with LUTS suggestive of BPH appears to be safe. Further studies are required to establish efficacy with a suitable precision.