Monotherapy versus combination therapy in the treatment of benign prostatic hyperplasia: A single center study

Wishyar Jamal Al-Bazzaz; Omar W. Alkhayat; Ali W. AlKhayat W. AlKhayat

doi:10.15218/zjms.2020.039

Authors

Wishyar Jamal Al-Bazzaz Rizgari Teaching Hospital, Erbil, Iraq.
Omar W. Alkhayat Erbil Teaching Hospital, Erbil, Iraq.
Ali W. AlKhayat W. AlKhayat Erbil Teaching Hospital, Erbil, Iraq.

DOI:

https://doi.org/10.15218/zjms.2020.039

Keywords:

Benign prostatic hyperplasia, Acute urinary retention, Benign prostatic hyperplasia related surgery, Prostate volume, Prostate specific antigen

Abstract

Background and objectives: Most benign prostatic hyperplasia patients do not present obvious indicators for surgical intervention, so most of these patients are treated initially with medical therapy. This study aimed to compare the incidence of acute urinary retention after treatment with monotherapy with the incidence after combination therapy and determine the need for surgery in both methods.

Methods: This is a retrospective study of the medical records of 248 benign prostatic hyperplasia patients who had attended Rizgary Teaching Hospital from May 2012 to June 2017. These patients were divided into two groups of 138 and 110 patients who have been treated by 0.4 mg tamsulosin capsule once daily and 0.4 mg tamsulosin capsule plus 5mg finasteride tablet once daily, respectively. Benign prostatic hyperplasia outcomes (acute urinary retention, benign prostatic hyperplasia related surgery) were compared between these two groups according to prostate volume and serum prostate specific antigen.

Results: The combined treatment had significantly reduced the incidence of acute urinary retention and benign prostatic hyperplasia related surgery than monotherapy (P = 0.006 and 0.044, respectively). Similarly, when prostate volume and prostate specific antigen were above the cutoff value, both acute urinary retention and benign prostatic hyperplasia related surgery were lower in the combination therapy group than the monotherapy group.

Conclusion: Combined therapy (0.4 mg tamsulosin plus 5mg finasteride) was significantly superior to 0.4 mg tamsulosin alone in the reduction of the incidence of acute urinary retention and benign prostatic hyperplasia related surgery among benign prostatic hyperplasia patients.

Metrics

Metrics Loading ...

References

Odusanya BO, Tijani KH, Jeje EA, Ogunjimi MA, Ojewola RW. Short-term effect of tamsulosin and finasteride monotherapy and their combination on Nigerian men with benign prostatic hyperplasia. Niger J Surg 2017; 23(1):5–10.

Deters LA. Benign Prostatic Hyperplasia (BPH) treatment and management. Jan 2019. (Accessed March 3, 2019, at https://emedicine.medscape.com/article/437359-treatment).

Rensing AJ, Kuxhausen A, Vetter J, Strope SA. Differences in the treatment of benign prostatic hyperplasia: Comparing the primary care physician and the urologist. Urol Pract 2017; 4(3):193–9.

Shin TJ, Kim CI, Park CH, Kim BH, Kwon YK. Α-blocker monotherapy and α-blocker plus 5-alpha-reductase inhibitor combination treatment in benign prostatic hyperplasia; 10 years’ long-term results. Korean J Uro 2012; 53(4):248–52.

Joo KJ, Sung WS, Park SH, Yang WJ, Kim TH. Comparison of α-blocker monotherapy and α-blocker plus 5α-reductase inhibitor combination therapy based on prostate volume for treatment of benign prostatic hyperplasia. J Int Med Res 2012; 40:899–908.

Roehrborn CG, Siami P, Barkin J, Damilao R, Walker K, Nandy I, et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia:4-year results from the Comb AT study. Eur Urol 2010; 57(1):123–31.

Roehrborn CG, Siami P, Barkin J, Damilao R, Becher E, Milnana B, et al. The influence of baseline parameters on changes in international prostate symptom score with dutasteride, tamsulosin, and combination therapy among men with symptomatic benign prostatic hyperplasia and an enlarged prostate: 2-year data from the Comb AT study. Eur Urol 2009; 55(2):461–71.

Sabbagh AJ, Khalighinezhad M. The survey of effect of combination therapy with tamsulosin – finasteride compared with tamsulosin alone on symptom improvement of benign prostatic hypostatic. Immunopathol Persa 2018; 4(2):e20

Kang D, Hu C, Fu Y, Wang D. Combination of alpha blocker and 5 alpha reductase inhibitor for treatment of benign prostatic hyperplasia. Clin Invest Med 2017; 40(5):e200–10.

Chi-Fong L, Chun-You C, Liang-Ming L, Ke-Hsun L, Yung-Wei L, Chi-Hao H, et al. Do 5α-reductase inhibitors prevent secondary benign prostate hyperplasia-related urinary retention? Urol Sci 2018; 29(2):86–90.

Cindolo L, Pirozzi L, Sountoulides P, Fanizza C, Romero M, Castellan P, et al. Patient’s adherence on pharmacological therapy for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS) is different: is combination therapy better than monotherapy? BMC Urology 2015; 15:96–102.

Roehrborn CG, Barkin J, Siami P, Tubaro A, Wilson TH, Morrill BB, et al. Clinical outcomes after combined therapy with dutasteride plus tamsulosin or either monotherapy in men with benign prostatic hyperplasia (BPH) by baseline characteristics: 4-year results from the randomized, double-blind Combination of Avodart and Tamsulosin (CombAT) trial. BJU International 2011; 107:946–54.