[Editorial comment on: Current role for combination therapy in male LUTS].

Treatment of Lower Urinary Tract Symptoms (LUTS) from Benign Prostatic Hyperplasia (BPH) has evolved from surgical therapy to medical monotherapy to combination therapy. First-line medical therapy for men with LUTS remains agents that decrease outlet resistance: alpha-adrenergic antagonists and 5alpha-reductase inhibitors. Alpha-adrenergic agents decrease smooth muscle tone in the prostate and bladder neck. The mechanism of action of 5alpha-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 antagonists, 5alpha-reductase inhibitors, and antimuscarinic agents have all been shown to be safe and effective when administered to men with BPH and LUTS. The combination of 5alpha-reductase inhibitors with alpha-adrenergic antagonists is effective in men with LUTS secondary to BPH. The combination of alpha-adrenergic antagonists plus antimuscarinic agents and the combination of 5alpha-reductase inhibitors with antimuscarinic agents are safe and effective in patients with LUTS, evidence of BPH, and OAB symptoms. At present only combination therapy with 5alpha-reductase inhibitors with alpha-adrenergic antagonists is recommended in clinical practice guidelines. MTOPS and ComBAT have demonstrated superiority of combination therapy over monotherapy in preventing disease progression. Further studies are required to elucidate which specific patient population benefits most from particular combination therapies.