NEW YORK (Reuters Health) - Antimuscarinic therapy with the drug tolterodine is a well-tolerated treatment for overactive bladder in men with bladder outlet obstruction and does not seem to cause urinary retention, according to a report in the Journal of Urology for March.

Antimuscarinic agents are typically not given to elderly men with bladder outlet obstruction, due to the theoretical concern that inhibition of detrusor contractility could exacerbate voiding difficulties. However, few studies have actually examined the safety of antimuscarinic therapy in this patient population.

The present study, conducted by Dr. Paul Abrams, from the Bristol Urologic Institute in the UK, and colleagues, involved 221 men with bladder outlet obstruction and detrusor overactivity who were randomized to receive tolterodine (2 mg twice daily) or placebo for 12 weeks.

Urodynamic testing revealed that tolterodine had significant beneficial effects on the urinary obstruction, detrusor overactivity, and bladder capacity compared with placebo.

Treatment with tolterodine was well tolerated and, except for dry mouth, was not associated with an increased risk of side effects, including urinary retention.

"The inhibitory effect of tolterodine on detrusor contractions did not aggravate voiding difficulties or precipitate urinary retention in this urodynamically obstructed population," the investigators conclude.

Dr. Rodney A. Appell, from Baylor College of Medicine in Houston, comments in a related editorial that the current findings "should allay those fears of urologists that treating the overactive bladder component by using an antimuscarinic agent in men with lower urinary tract symptoms will tip the scale so that the residual urine will drastically increase, or worse, the patient will end up in frank urinary retention."

The study was funded by Pharmacia, which markets tolterodine as Detrol.

J Urol 2006;175:999-1004

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