To assess the clinical efficiency and safety of combination pharmacotherapy of antimuscarinics and α-blockers vs α-blockers monotherapy on patients with moderate to severe lower urinary tract symptoms (LUTS).

We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, the Cochrane Database of Systematic Review, and Web of Science from their inception until June 2013 to identify all eligible studies that compare the 2 pharmacotherapy strategies on LUTS. The Cochrane Collaboration's RevMan 5.2 software was used for data analysis, and the fixed or the random effect model was selected depending on the proportion of heterogeneity.

Eighteen eligible randomized controlled trials were included in this systematic review, including 2106 (51.57%) in cotherapy group and 1978 (48.43%) in monotherapy group. Synthetic data showed that there were significant improvements on Storage International Prostate Symptom Score (mean difference [MD] = −1.51; 95% confidence interval [CI] −2.10 to −0.91, P <.00001), quality of life score (MD = −0.53; 95% CI −0.89 to −0.17, P = .004), micturitions per 24 hours (MD = −1.14; 95% CI −1.84 to −0.45, P = .001), and urgency episodes per 24 hours (MD = −0.99; 95% CI −1.46 to −0.51, P <.0001) in the cotherapy group. There were no significant difference regarding maximum flow rate (MD = −0.05; 95% CI −0.27 to 0.17, P = .64), Total International Prostate Symptom Score (TIPSS) (MD = −0.88; 95% CI −1.64 to −0.12, P = .02), and Voiding International Prostate Symptom Score (VIPSS) (MD = 0.40; 95% CI −0.34 to 1.15, P = .29). As to postvoid residual volume, however, a worse condition was showed in the cotherapy group (MD = −6.53; 95% CI 3.06-10.00, P <.0002).

Antimuscarinics could and should be added to the drug regimen for patients with LUTS attributed to benign prostatic hyperplasia/bladder outlet obstruction, particularly are dominated by storage symptoms. For patients with increased acute urinary retention risk, they should be carefully monitored.