If pt chooses pharmacotherapy offer monotherapy w antimuscarinic or 3 agonist or combo tx w an blocker an antimuscarinic or 3 agonist CR B nbsp nbsp If OAB predominant LUTS Assess relative contribution of BOO secondary to BPH Evaluate presence and severit

If pt chooses pharmacotherapy, offer monotherapy w/ antimuscarinic or β3 agonist, or combo tx w/ an α-blocker + an antimuscarinic or β3 agonist. [CR/B]<br>
&nbsp;&nbsp;◦ If OAB-predominant LUTS: Assess relative contribution of BOO secondary to BPH. Evaluate presence and severity of urinary sx w/ AUA’s <a href=https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline><u>Mgmt of LUTS Sx Attributed to BPH guideline</u></a>.<br>
&nbsp;&nbsp;◦ While antimuscarinics may slightly &uarr; PVR volumes, they don’t seem to be assoc w/ significantly &uarr;risk of urinary retention in pts w/ coexisting BOO. Discuss retention risk w/ pts w/ &uarr;PVR values. Antimuscarinics’ effects on pts w/ residual volumes >200 mL aren’t well studied.<br>
&nbsp;&nbsp;◦ No strong evidence or agreed-upon order in which to initiate monotherapy or combo tx for OAB-predominant LUTS w/ BPH<br>
&nbsp;&nbsp;◦ RCTs of individual antimuscarinics (e.g., <a href=https://online.epocrates.com/e/deeplink/drugs/10a4913/fesoterodine><u>fesoterodine</u></a>, <a href=https://online.epocrates.com/e/deeplink/drugs/10a624/tolterodine><u>tolterodine ER</u></a>) and β3 agonists (e.g., <a href=https://online.epocrates.com/e/deeplink/drugs/10a6433/mirabegron><u>mirabegron</u></a>) show efficacy for each in pts w/ predominant OAB sx.<br>
&nbsp;&nbsp;◦ Combo tx w/ an α-blocker (e.g., <a href=https://online.epocrates.com/e/deeplink/drugs/10a755/tamsulosin><u>tamsulosin</u></a>) + an antimuscarinic or β3 agonist (e.g., <a href=https://online.epocrates.com/e/deeplink/drugs/10a6433/mirabegron><u>mirabegron</u></a>) improves OAB sx to a significantly greater extent than does an α-blocker alone in pts w/ OAB-predominant LUTS.