Combination therapy for the treatment of lower urinary tract symptoms in men

Recent interest in the coadministration of approved pharmaceutical agents has resulted in a wealth of emerging data on the safety and efficacy of dual pharmacological treatment for lower urinary tract symptoms (LUTS). Much evidence supports the coadministration of α-blockers with 5-alpha-reductase inhibitors (5-ARIs) in patients at risk for clinical progression. The use of phosphodiesterase-5 inhibitors (PDE5Is) in combination with 5-ARIs has also demonstrated a good safety and efficacy profile, providing early symptomatic relief and reduction of sexual side effects associated with 5-ARI use, although longer-term studies are needed. Studies investigating the combination of PDE5Is with α-blockers have shown additive effects on each of the individual agents with respect to the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF), which holds promise for patients who have shown a poor response to monotherapy. The coadministration of α-blockers and antimuscarinic agents provides an alternative for treatment of storage symptoms in patients who have failed to respond to monotherapy. This review aims to summarize and comment on available evidence regarding the safety and efficacy of combination treatment for LUTS.