Effects of Tamsulosin Combined With Solifenacin on Lower Urinary Tract Symptoms: Evidence From a Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials.

Yuxuan Song,Xiaoqiang Liu,Guangyuan Chen,Cong Hu,Peng Huang

doi:10.3389/fphar.2020.00763

Abstract

This study is aimed to systematically evaluate the efficacy of tamsulosin combined with solifenacin and provide clinical evidence for treatment of benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang data information service platform were searched to select randomized controlled trials (RCTs) of tamsulosin combined with solifenacin in the treatment of BPH with LUTS. After extraction of the data, the statistical information was calculated by means of STATA 12.0. The publication bias was calculated using Egger's test and Begg's funnel plot. A total of 17 articles contained 1,870 patients treated with tamsulosin in combination with solifenacin and 1,897 patients treated with tamsulosin only were included in this study. Results show that tamsulosin combined with solifenacin therapy was more effective in reducing the Total International Prostate Symptom Score (TIPSS), Storage International Prostate Symptom Score (SIPSS), Quality of life (QOL), and Overactive bladder symptom score (OABSS) in comparison with tamsulosin monotherapy treatment. However, it was found that the combination therapy may increase levels of prostate-specific antigen (PSA) and the maximal urinary flow rate (QMAX). Differences between the combination therapy and tamsulosin monotherapy were not statistically significant for urgency episodes per 24 h, micturitions per 24 h, Voiding International Prostate Symptom Score (VIPSS), and postvoid residual volume (PVR). Tamsulosin combined with solifenacin therapy is more effective than tamsulosin monotherapy for the treatment of BPH concurrent with LUTS and won't increase the risk of dysuria.

Highlights

Benign prostatic hyperplasia (BPH) is the most common cause of dysuria in middle-aged and elderly men (Porst et al, 2017)
We found that tamsulosin/solifenacin therapy might increase the level of prostate-specific antigen (PSA) in patients with PSA compared with tamsulosin monotherapy, which may increase the risk of prostate cancer (WMD = 0.192, 95% confidence interval (95% CI): 0.132 to 0.253, P < 0.001, Figure 12)
Our results indicated that the combination therapy was associated with decreased scores for Total International Prostate Symptom Score (TIPSS), Quality of life (QOL), and Overactive bladder symptom score (OABSS) compared with tamsulosin monotherapy

Summary

Introduction

Benign prostatic hyperplasia (BPH) is the most common cause of dysuria in middle-aged and elderly men (Porst et al, 2017). According to recent epidemiological reports, there is a very high occurrence of BPH among men over 50 years old in China with more than 50% of BPH patients having associated lower urinary tract symptoms (LUTS) (Lee et al, 2014). LUTS is usually associated with bladder dysuria including frequent urination, urgency, urinary dysfunction, poor urination, and poor urine flow. LUTS is recognized as adversely affecting the quality of life (QOL) as well as having other serious consequences such as urinary retention due to urinary tract obstruction (Lytton et al, 1968). LUTS affects the male patients and the spouse and might pose difficulties to the family's daily life and family relationships

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