Treatment Of Benign Prostatic Hyperplasia With Bladder Hyperactivity By Using Useless And Combined

Background:Overactive bladder (OAB) is a kind of urgency, with or without urge incontinence, which usually accompanied by an increase in urinary frequency and nocturia symptoms. It also can be other forms of the urethra-bladder dysfunction. The latest epidemiological study showed that the number of OAB patients has reached810million in the people who were greater than40-year-old. For the male patients, scholars pay more and more attention on the OAB caused by benign prostatic hyperplasia (BPH). Study confirmed that nearly half of the patients can achieve bladder outlet obstruction (BOO) from BPH, and these patients appear more chance to have OAB symptoms. So far, the major therapeutic method for this symptom is alpha-blocker. On the other hand, competitive cholinergic receptor blockers have a role in the process of inhibiting bladder involuntary contraction. In this study, we conducted a prospective study concerning on the role of doxazosin plus tolterodine versus doxazosin alone for OAB which followed by BPH. We also evaluated the efficacy and safety of competitive cholinergic receptor blockers on the OAB through a systematic literature review and comprehensive analysis.Methods:Part Ⅰ:We prospectively collected88patients who have BPH with OAB in our hospital from September2011to December2012in The People’s Hospital of Shanghai,Fudan University. The basic inclusion criteria were:age was between50and80years, the international prostate symptom score (IPSS) greater than or equal to8points, overactive bladder symptom score (OABSS) was greater than or equal to3points, quality of life score (QOL) was greater than or equal to3points, post-void residual (PVR) was less than or equal to100ml,disease duration was longer than3months.Patients were randomly divided into two groups. There were44cases in the combined group, they received doxazosin (Cardura Zhunzi J20040073, the United States Pfizer)4mg qn plus tolterodine (had been Zhunzi H20040408, Pfizer Inc., USA)4mg qn, There were44cases in another group (Single-drug group) received doxazosin4mg qn. All the therapeutic duration was4weeks. The outcome indicators were average of24hours of frequency of urination, urgency, frequency, incontinence episodes, nocturia, residual urine, IPSS OABSS, maximum urinary flow rate (Qmax). Statistical methods were used in all the patients between the two groups.Part Ⅱ:We evaluated the efficacy and safety of competitive cholinergic receptor blockers on the OAB through a systematic literature review and comprehensive analysis. We selected the literature published between1966.1and2012.12which met the inclusion criteria. The computer retrieval databases included PubMed, CNKI, Ovid, EMBASE and Science Direct, All search strategy were in accordance with the requirements of the Cochrane Collaboration Handbook.Results:A total of88patients were included (44cases in single-drug group and44cases in combined group). One patient of combined group withdrawaled due to acute urinary retention.As a result, there were87patients have completed our trial actually.The average age of single-drug group was67.36±7.74years old, while the combine group were70.53±7.11years old. During the therapeutic period, there were3cases have mild dizziness, two cases have dry mouth. We have not any treatment for the above adverse reactions and patients recover normal grandually. There were significant statistical difference between the pre-treatment and post-treatment on the indicator of IPSS score (including total score, voiding symptom score, urinary storage symptoms score), OABSS (including total score, urgency symptom score), QOL, PVR and Qmax (p<0.01). There were significant improvement in combined group on the above indicators when compared with single-drug group (p<0.05). We also performed a meta analysis based on the literature mentioned the effect of competitive M receptor antagonist on OAB. Our study resulted that tolterodine IR have lower adverse effects than oxybutynin IR, while there were similar effects and safety between the extended realease tye of two drugs. Whatever on the therapeutic effects or on the safety aspect, extended type was superior than immidately type in all the included drugs (tolterodine ER vs. oxybutynin ER, tolterodine IR vs. tolterodine ER, oxybutynin IR vs. oxybutynin ER, tolterodine IR vs. oxybutynin ER, oxybutynin IR vs. darifenacin ER).Conclusions:There were significant effect on the therapy of OAB with BPH whatever on the single doxazosin or on the combined with tolterodine, however, the effect of doxazosin plus tolterodine is superior than single use of doxazosin. Immediate release tolterodine can benefit a lower adverse event rate when compared with Oxybutynin and other competitive the M receptor blockers, and there was a dose-response effect among the incidence of adverse reaction rate and increasing drug dose. Additionally, for any M receptor blockers, extended release ones have a better effect when compared with immediate release.