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Treatment of Men With Lower Urinary Tract Symptoms and Overactive Bladder
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To the Editor: Although Dr Kaplan and colleagues1 provide evidence of the safety of anticholinergic medication for men with bladder overactivity secondary to bladder outflow obstruction, we have concerns about the method used to reach other conclusions. The trial appears to be underpowered to detect any difference between monotherapy and combination tamsulosin and tolterodine, with statistical significance only found when compared with placebo. The justification for using combination treatment seems to be that some patients with lower urinary tract symptoms have bladder outflow obstruction while some simply have overactive bladder, and therefore both should be empirically treated.
Patient selection in this trial is biased by the requirement of a quality of life score of 3 or higher because storage urinary symptoms may be more bothersome to patients than voiding symptoms.2 The mean maximum urinary flow was around 13 mL/s, with standard deviations of around 7, suggesting that many, if not . . . [Full Text of this Article]
James G. Young, MA, PhD, FRCS(Urol)
james.g.young@uhb.nhs.uk
Kesavapilla Subramonian, MS, FRCS(Urol)
Department of Urology
University Hospital
Birmingham, England
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Treatment of Men With Lower Urinary Tract Symptoms and Overactive Bladder—Reply
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