Antimuscarinics as the First-line Treatment for Male With IPSS-V/S≤1
Antimuscarinics as the First-line Treatment for Male With IPSS-V/S≤1
This study is a prospective randomized, open label, controlled, double arm, post-marketing
 study to compare the treatment efficacy of first-line antimuscarinics and α-blockers
 monotherapy for men with moderate to severe lower urinary tract symptoms (LUTS)
 (International Prostate Symptom Score (IPSS-T) ≥8) and IPSS voiding-to-storage subscore ratio
 (IPSS-V/S) ≤1.
1. STUDY PROCEDURE

 1.1.General Study Design This study is a prospective randomized, open label, controlled,
 double arm, post-marketing study to compare the treatment efficacy of first-line
 antimuscarinics and α-blockers monotherapy for men with moderate to severe LUTS (IPSS-T ≥8)
 and IPSS-V/S ≤1.

 1.2. Study Visits and Evaluations

 1.2.1 Screening Visit (Baseline, 1 day to 1 week of the first treatment day).

 1.2.1.1 Explain the nature of the study and have patients to read and sign an Informed
 Consent Form.

 1.2.1.2 Screen patients for inclusion/exclusion criteria. 1.2.1.3 Medical History of lower
 urinary tract symptoms and previous treatment modalities.

 1.2.1.4 Vital signs monitoring, general physical examinations of all systems (including
 digital rectal examination), serum prostatic specific antigen (PSA), and urinalysis.

 1.2.1.5 Record Patient Perception of Bladder Condition (PPBC), IPSS (IPSS-T, IPSS voiding
 (IPSS-V), and IPSS storage (IPSS-S)), Overactive Bladder Symptom Score (OAB-SS), and quality
 of Life index (QoL-I)scores.

 1.2.1.6 Obtain maximum flow rate (Qmax), voided volume, postvoid residual volume (PVR), total
 prostate volume (TPV), and transitional zone index (TZI).

 1.2.1.7 Randomized assigned patients into 2 groups; men in one group received Doxazosin 4 mg
 QD, and those in the other group received Detrusitol 4 mg QD.

 1.2.2 First Evaluation Visit (2 weeks after the initial treatment) 1.2.2.1 Vital signs
 monitoring and record adverse events. 1.2.2.2 Record PPBC, IPSS (IPSS-T, IPSS-V, IPSS-S),
 OAB-SS and QoL. 1.2.2.3 Check urinalysis for urinary tract infection if patient has symptoms
 suggestive of urinary tract infection.

 1.2.2.4 Check Qmax, voided volume, and PVR.

 1.2.3 Second Evaluation Visit (4 weeks after the treatment). 1.2.3.1 Vital signs monitoring
 and record adverse events. 1.2.3.3 Check urinalysis for urinary tract infection if patient
 has symptoms suggestive of urinary tract infection.

 1.2.3.4 Check Qmax, voided volume, and PVR.

 1.2.4 Third Evaluation Visit (3 months after the treatment). 1.2.4.1 Vital signs monitoring
 and record adverse events. 1.2.4.2 Record PPBC, IPSS (IPSS-T, IPSS-V, IPSS-S), OAB-SS and
 QoL. 1.2.4.3 Check urinalysis for urinary tract infection if patient has symptoms suggestive
 of urinary tract infection.

 1.2.4.4 Check Qmax, voided volume, and PVR.

 1.3. Withdrawal Criteria

 Patients with any of the following conditions may be withdrawn from the trial:

 1.3.1. Patients decide to withdraw their consent. 1.3.2. Patients indicate the status of lack
 of efficacy which is of clinical significance judged by the investigators that may lead to
 permanent damage to the patients.

 1.3.3. Investigators consider that there is of safety concerns for the patients to remain in
 the trial (such as development severe medical disease).

 1.3.4. Lost of follow-up or death. 1.3.5. PVR≥300 mL

 1.4. Concomitant Treatments Investigator will try to minimize the concomitant medications for
 the patients during the trial duration. However, patients are allowed to continue taking
 stable medication in stable dose for diseases other than genitourinary system.

 1.5. Prohibited medication

 Patients are not allowed to take any of the following medications during the study:

 1. Anticholinergics other than test drug

 2. Alpha-adrenergic receptor blockers

 3. Tricyclic anti-depressants

 4. Calcium channel blockers

 5. Skeletal muscle relaxant

 6. Cyclooxygenase-2 (COX-2) inhibitors
Inclusion Criteria:

 -  Men aged ≥40 years with lower urinary tract symptoms (IPSS ≥8)

 -  Patient or his/her legally acceptable representative has signed the written informed
 consent form

 Exclusion Criteria:

 -  Patients with severe cardiopulmonary disease and such as congestive heart failure,
 arrhythmia, poorly controlled hypertension, not able to receive regular follow-up

 -  Patients with urinary retention, urodynamically proven detrusor underactivity or PVR
 ≥250 mL

 -  Patients with known active urinary tract infection, urinary stone or malignancy

 -  Patients with history of urethral injury or transurethral surgery for prostate or
 bladder

 -  Patients have laboratory abnormalities at screening including:

 1. Aspartate aminotransferase (AST) >3 x upper limit of normal range

 2. Alanine aminotransferase (ALT) >3 x upper limit of normal range

 3. Patients have abnormal serum creatinine level >2 x upper limit of normal range

 -  Patients with any other serious disease or condition considered by the investigator
 not suitable for entry into the trial

 -  Patients participated investigational drug trial within 1 month before entering this
 study

 -  Patients with major psychiatric illness or drug abuse

 -  Patients taken medication such as alpha-blocker, antimuscarinic or 5 alpha-reductase
 (5AR) inhibitor within 6 months