Letters Section Editor: Robert M. Golub, MD, Senior Editor.
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.
Young JG, Subramonian K. Treatment of Men With Lower Urinary Tract Symptoms and Overactive Bladder. JAMA. 2007;297(11):1191-1193. doi:10.1001/jama.297.11.1192-b