To the Editor: In their randomized controlled trial, Dr Kaplan and colleagues1 found that use of tolterodine (an antimuscarinic) and tamsulosin (an α blocker) significantly improved outcomes in men with lower urinary tract symptoms and overactive bladder. Lower urinary tract symptoms in older men have often been attributed to benign prostatic hyperplasia (BPH). Because most of the men in this trial were older than 60 years and because their prostate volumes were not measured, a question that remains unanswered is whether a 5α-reductase inhibitor could have similarly decreased symptoms of urgency or urge incontinence. It would be informative to have a trial comparing antimuscarinics to a 5α-reductase inhibitor; it is quite possible that overactive bladder plays more of role than BPH in men with complaints of urinary urgency or urge incontinence.
Chai TC. Treatment of Men With Lower Urinary Tract Symptoms and Overactive Bladder. JAMA. 2007;297(11):1191–1193. doi:10.1001/jama.297.11.1191-b
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