Eur Urol. 2000 ; 38 Suppl 1(): 18-24.

Medical treatment modalities for lower urinary tract symptoms: what are the relevant differences in randomised controlled trials?

Zimmern P.

UT Southwestern Medical Center at Dallas, Department of Urology, Dallas, Tex 75390-9110, USA. [email protected]

OBJECTIVES: Relevant differences in efficacy and tolerability will be reviewed among medical treatment modalities for lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). Available data on the long-term effectiveness of these treatments will be also discussed. METHODS: Information reviewed here comes mainly from published scientific articles and abstracts describing direct comparative trials among alpha1-adrenoceptor antagonists, finasteride, and/or phytotherapy. RESULTS: Direct comparative trials demonstrated alpha1-adrenoceptor antagonists to be more effective than finasteride in improving symptoms and increasing urinary flow. Moreover, finasteride did not perform better than placebo in those studies that included a placebo arm. While finasteride treatment appears more beneficial in patients with an enlarged prostate volume (>50 ml), the efficacy of alpha1-adrenoceptor antagonists is not related to prostate size. To study the efficacy of plant extracts, adequately performed placebo-controlled and direct comparative trials are needed. Medical treatment modalities generally have a low incidence of adverse events. Regarding long-term effectiveness of medical treatment, the few available data show that finasteride can reduce the risk of acute urinary retention (AUR) and surgery. Short-term, direct comparative studies suggest that, like finasteride, alpha1-adrenoceptor antagonists have a comparable positive effect on disease progression. CONCLUSION: More comparative information is needed on the long-term efficacy, tolerability, and effectiveness of medical treatments for LUTS. Information on disease progression (i.e., long-term complications related to BPO) and treatment outcomes (i.e., switch to other therapy or surgery) is necessary because such information directly effects a treatment's cost-effectiveness.