Twenty studies (n=1,409) were included: 5 RCTs (n=703) and 15 case series (n=706).
The results of the systematic quality assessment were not reported.
Effectiveness.
None of the 5 RCTs reported a significant difference for maximal urinary flow rate. A pooled analysis of the 3 trials that compared anticholinergics combined with alpha-adrenoceptor antagonists to alpha-adrenoceptor antagonists alone found no significant difference between treatments (WMD 0.07 mL/second, 95% CI: -0.56, 0.71).
Compared with placebo, anticholinergics were associated with a significant increase in PVR (WMD 11.6 mL, 95% CI: 4.5, 18.6; 3 studies) and volume at first contraction (WMD 47.12 mL, 95% CI: 21.94, 72.30; 2 studies).
Two studies reported that anticholinergics were associated with a significant increase in maximal cystometric capacity. Only one of these studies was placebo-controlled.
Three of the 5 studies assessing mean voided volume reported that anticholinergics were associated with a significant increase in mean voided volume compared with control; the other 2 studies reported no significant difference between treatments.
Three studies assessed LUTS and reported no significant difference between anticholinergics and placebo. Only one of these studies was placebo-controlled.
One of the 3 studies assessing QoL reported a significant increase in QoL in patients receiving anticholinergics compared with control; another reported no significant difference between treatments and one reported no change in most patients taking anticholinergics.
Adverse events (11 studies, n=847).
The most commonly reported adverse event was dry mouth (15.9% with anticholinergics versus 3.7% with control). Most cases were mild; 2% (14 patients) withdrew due to dry mouth.
Acute urinary retention was uncommon and rates were similar between treatments (0.8% with anticholinergics versus 0.6% with control). Difficulty in micturition or a raised PVR was reported in 4.9% (24 patients) and resulted in the withdrawal of 14 patients. Other adverse events included gastrointestinal symptoms, dizziness and blurred vision.
The authors stated that significant methodological flaws were found in 6 observational studies, so these were excluded from the review; a further three did not provide data on adverse events.