Korean J Urol.  2014 Apr;55(4):260-264. 10.4111/kju.2014.55.4.260.

Tolterodine to Relieve Urinary Symptoms Following Transurethral Resection of the Prostate: A Double-Blind Placebo-Controlled Randomized Clinical Trial

• Tehranchi
• Rezaei Y
• Shojaee R

• KMID: 1885607
• DOI: http://doi.org/10.4111/kju.2014.55.4.260

Abstract

PURPOSE
To evaluate the effect of tolterodine on early storage symptoms following transurethral resection of the prostate.
MATERIALS AND METHODS
Seventy patients over 55 years of age who underwent transurethral resection of the prostate owing to benign prostatic hyperplasia were randomly assigned to receive either 2 mg of tolterodine twice daily (treatment group) or matched placebo during a 1-month study period. Before and 1 month after the procedure, they were asked to complete the International Prostate Symptom Score (IPSS) questionnaire and quality of life subscale to assess their symptoms. Also, analgesic use and adverse drug events were determined at follow-up.
RESULTS
Of 70 allocated patients, 64 patients (91.4%), including 33 in the treatment group and 31 in the placebo group, completed the study. The mean age of the patients was 67 years. None of the patients' basic clinical characteristics were significantly different. At the end of the follow-up period, the total IPSS and quality of life score had significantly improved in the patients receiving tolterodine compared with those receiving placebo (p=0.001 and p=0.036, respectively). The treatment group compared with placebo demonstrated significant improvements in frequency and urgency but not in nocturia. The amount of consumed painkiller was also significantly lower in the tolterodine group than in the placebo group (p=0.0001). The rate of side effects was not significantly different between the groups.
CONCLUSIONS
Administering 2 mg of tolterodine twice daily is an effective and well-tolerated regimen to relieve early storage symptoms, quality of life, and the amount of analgesic consumption following transurethral resection of the prostate.

Keyword

Cholinergic antagonists; Complications; Transurethral resection of prostate

MeSH Terms

Cholinergic Antagonists
Drug-Related Side Effects and Adverse Reactions
Follow-Up Studies
Humans
Nocturia
Prostate*
Prostatic Hyperplasia
Quality of Life
Questionnaires
Transurethral Resection of Prostate
Cholinergic Antagonists

Figure

• 

  FIG. 1 Study flow diagram.

Reference

1. Thorpe A, Neal D. Benign prostatic hyperplasia. Lancet. 2003; 361:1359–1367.

2. Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010; 58:384–397.

3. Tanaka Y, Masumori N, Itoh N, Furuya S, Ogura H, Tsukamoto T. Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity? Int J Urol. 2006; 13:1398–1404.

4. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP): incidence, management, and prevention. Eur Urol. 2006; 50:969–979.

5. Iselin CE, Schmidlin F, Borst F, Rohner S, Graber P. Oxybutynin in the treatment of early detrusor instability after transurethral resection of the prostate. Br J Urol. 1997; 79:915–919.

6. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008; 180:246–249.

7. Mohammadi-Fallah M, Hamedanchi S, Tayyebi-Azar A. Preventive effect of tamsulosin on postoperative urinary retention. Korean J Urol. 2012; 53:419–423.

8. Abrams P, Freeman R, Anderstrom C, Mattiasson A. Tolterodine, a new antimuscarinic agent: as effective but better tolerated than oxybutynin in patients with an overactive bladder. Br J Urol. 1998; 81:801–810.

9. Chapple CR, Rechberger T, Al-Shukri S, Meffan P, Everaert K, Huang M, et al. Randomized, double-blind placebo- and tolterodine-controlled trial of the once-daily antimuscarinic agent solifenacin in patients with symptomatic overactive bladder. BJU Int. 2004; 93:303–310.

10. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol. 2004; 46:547–554.

11. Alagiakrishnan K, Valpreda M. Ultrasound bladder scanner presents falsely elevated postvoid residual volumes. Can Fam Physician. 2009; 55:163–164.

12. Kuo HC. Analysis of the pathophysiology of lower urinary tract symptoms in patients after prostatectomy. Urol Int. 2002; 68:99–104.

13. Izard J, Nickel JC. Impact of medical therapy on transurethral resection of the prostate: two decades of change. BJU Int. 2011; 108:89–93.

14. Chapple CR, Roehrborn CG. A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol. 2006; 49:651–658.

15. Yoshimura K, Ohara H, Ichioka K, Terada N, Matsui Y, Terai A, et al. Nocturia and benign prostatic hyperplasia. Urology. 2003; 61:786–790.

16. Homma Y, Yamaguchi T, Kondo Y, Horie S, Takahashi S, Kitamura T. Significance of nocturia in the International Prostate Symptom Score for benign prostatic hyperplasia. J Urol. 2002; 167:172–176.

17. Blanker MH, Bohnen AM, Groeneveld FP, Bernsen RM, Prins A, Ruud Bosch JL. Normal voiding patterns and determinants of increased diurnal and nocturnal voiding frequency in elderly men. J Urol. 2000; 164:1201–1205.

18. Chapple CR, Khullar V, Gabriel Z, Muston D, Bitoun CE, Weinstein D. The effects of antimuscarinic treatments in overactive bladder: an update of a systematic review and meta-analysis. Eur Urol. 2008; 54:543–562.

19. Sexton CC, Notte SM, Maroulis C, Dmochowski RR, Cardozo L, Subramanian D, et al. Persistence and adherence in the treatment of overactive bladder syndrome with anticholinergic therapy: a systematic review of the literature. Int J Clin Pract. 2011; 65:567–585.