Does anticholinergic medication have a role for men with lower urinary tract symptoms/benign prostatic hyperplasia either alone or in combination with other agents?

A substantial proportion of men with lower urinary tract symptoms have a combination of both 'storage' and 'voiding' symptoms, suggesting possible coexisting bladder outlet obstruction and bladder overactivity. Bladder overactivity is traditionally treated with anticholinergic drugs. However, guidelines from the European Association of Urologists make no mention of the possible therapeutic role of anticholinergic drugs for treating storage symptoms in such patients. It is a common perception that using an anticholinergic drug in men with bladder outlet obstruction runs the risk of inducing acute urinary retention, because of the inhibitory effect of anticholinergics on bladder contraction in the presence of outlet obstruction. This review focuses on recent data determining the efficacy of anticholinergic medication in men with lower urinary tract symptoms/benign prostatic hyperplasia and the associated risk of acute urinary retention. One recent study in men with urodynamically confirmed obstruction supports the assertion that anticholinergic drugs are safe in men with bladder outlet obstruction. Safety data from larger studies using anticholinergics in patients with overactive bladders supports these findings. Efficacy and safety studies of anticholinergic medication in men with lower urinary tract symptoms/benign prostatic hyperplasia are few and far between, but preliminary data suggests they are not associated with a substantial risk of urinary retention nor with a substantial increase in residual urine volume.