Papel actual de la terapia combinada en los síntomas del tracto urinario inferior (stui) masculino

Treatment of Lower Urinary Tract Symptoms (LUTS) from Benign Prostatic Hyperplasia (BPH) has evolved from surgical therapy to medical monotherapy to com-bination therapy. First-line medical therapy for men with LUTS remains agents that decrease outlet resistance: α-adrenergic antagonists and 5α-reductase inhibitors. Al-pha-adrenergic agents decrease smooth muscle tone in the prostate and bladder neck. The mechanism of action of 5α-reductase inhibitors is reduction in prostate volume. First-line therapy for OAB symptoms are antimuscarinic agents. There has been reluctance to prescribe these agents to men with BPH due to the perceived risk of precipitating urinary retention. Alpha-adrenergic antago-nists, 5α-reductase inhibitors, and antimuscarinic agents have all been shown to be safe and effective when ad-ministered to men with BPH and LUTS. The combination of 5α-reductase inhibitors with α-adrenergic antagonists is effective in men with LUTS secondary to BPH. The combination of α-adrenergic antagonists plus antimus-carinic agents and the combination of 5α-reductase inhibitors with antimuscarinic agents are safe and effec-tive in patients with LUTS, evidence of BPH, and OAB symptoms. At present only combination therapy with 5α-reductase inhibitors with α-adrenergic antagonists is re-commended in clinical practice guidelines. MTOPS and ComBAT have demonstrated superiority of combination therapy over monotherapy in preventing disease pro-gression. Further studies are required to elucidate which specific patient population benefits most from particular combination therapies.