***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Emepronium bromide and flavoxate have both and separately been used with success in the treatment of detrusor instability . In this study we have combined the two drugs emepronium bromide and flavoxate and compared the results with emepronium bromide .  20 consecutive patients with an uninhibited bladder , 12 men and 8 women , were r and omly allocated to treatment with either emepronium bromide/flavoxate or emepronium bromide . In this trial we found that treatment with the combination is significantly better than treatment with emepronium bromide only To investigate the effect of flavoxate ( Urispadol ) treatment on patients with symptomatic benign prostatic hypertrophy ( BPH ) , with the main weight on the irritative symptoms , a r and omized , double-blind , parallel-group , placebo-controlled and multicenter investigation was carried out . Seventy patients entered the study , 37 were allocated to flavoxate treatment on a daily dose of 1,200 mg ( 400 mg t.i.d . ) for 12 weeks , and 33 patients were allocated to placebo treatment . In spite of a sufficient power , the study did not discriminate the two treatment groups in a statistically significant way ( p > 0.05 ) , when considering the main endpoints : the irritative symptom score and the global patient evaluation . Conservative treatment of micturition disorders accompanying BPH with flavoxate in doses of 1,200 mg/day can not be recommended for clinical use A detailed study and analysis of several hundred cases of motor urge incontinence in the female is presented and summarized . This includes the incidence , the history referring to a question naire with a new urge and stress score , the symptomatology , possible etiological factors , the cystometric manifestation and the responsiveness to several treatment modalities and medications . A comparison of flavoxate , emepronium , propantheline and a placebo for the treatment of urinary incontinence due to bladder instability is made , the results are discussed and recommendations are made Anticholinergics are commonly used for the treatment of frequency , urgency , and urge incontinence in women .  Alpha-blockers have been shown to have a modulating effect on bladder smooth muscle but are not commonly used clinical ly for this indication . To evaluate the clinical effectiveness of each treatment as well as the combination therapy , we performed an open prospect i ve study comparing these agents . Between September 1994 and October 1995 , 34 women aged 28 - 91 ( mean age , 62 ) received either 0.375 mg of sustained-release hyoscyamine twice a day or 2 mg doxazosin QHS prior to being crossed over to the other drug and /or the combination . Symptoms were assessed using an exp and ed American Urological Association ( AUA ) symptoms score , which included questions regarding incontinence at completion of each therapeutic phase . Evaluation included 6-channel urodynamics . All three therapies were noted to be effective in reducing AUA symptom scores . By urodynamic evaluation , a greater percentage of patients with increased voiding pressures or decreased compliance responded to doxazosin than hyoscyamine .  Side effects were noted to be less prevalent with doxazosin than with the other therapies . There appears to be a significant role for alpha-blockers in the treatment of voiding symptoms in women Detrusor instability occurs in approximately 10 % of the adult population , producing troublesome symptoms . The pharmacotherapy currently available is usually only partially effective and can not be adequately evaluated except under " blind " conditions because of the significant component attributable to placebo effects . The results of the present study revealed no advantage result ing from treatment with flavoxate , as assessed both subjectively and objective ly . We suggest that this therapy does not appear to be beneficial in the medical management of detrusor instability PURPOSE We evaluated the efficacy and safety of a therapeutic modality involving propiverine combined with doxazosin in patients with overactive bladder ( OAB ) and benign prostatic obstruction . MATERIAL S AND METHODS Men 50 years or older with OAB symptoms and urodynamically proven bladder outlet obstruction ( Abrams-Griffith score greater than 20 ) were r and omized ( 1:2 ) into 2 groups , namely group 1-doxazosin controlled release gastrointestinal therapeutic system formulation ( 4 mg once daily ) only and group 2-propiverine hydrochloride ( 20 mg once daily ) plus doxazosin controlled release gastrointestinal therapeutic system formulation for an 8-week treatment regimen . RESULTS A total of 211 men , including 69 in group 1 and 142 in group 2 , were treated and 198 ( 93.8 % ) completed the 8 weeks of treatment . Significant improvements were noted in each group after treatment in urinary frequency , maximum flow rate , average micturition volume and International Prostate Symptom Score . Compared with group 1 improvement rates with regard to urinary frequency ( 23.5 % vs 14.3 % , p = 0.004 ) , average micturition volume ( 32.3 % vs 19.2 % , p = 0.004 ) , and storage ( 41.3 % vs 32.6 % , p = 0.029 ) and urgency ( p = 0.019 ) International Prostate Symptom Score symptoms were more significant in group 2 . Post-void residual urine was found to be significantly increased only in group 2 but this was not accompanied by urinary retention . Patient satisfaction rates were found to be significantly higher in group 2 than in group 1 ( p = 0.002 ) . Overall adverse event rates were higher in group 2 ( p = 0.002 ) , although discontinuation rates and discontinuation rates due to adverse events were not different between the 2 groups . CONCLUSIONS This study reveals that combination therapy consisting of alpha1-adrenoceptor antagonists with antimuscarinics represents an effective and relatively safe treatment modality in select patients with OAB coexisting with benign prostatic obstruction In a placebo-controlled , r and omized , double-blind , cross-over study , terodiline ( 50 mg/d ) was compared with emepronium ( 600 mg/d ) in 20 patients with motor urge incontinence . Evaluation of clinical efficacy was based on changes in micturition pattern , flow measurements , residual urine , cystometry and patient preferences , and safety on adverse reactions , blood chemistry , urine examinations and ECG . The number of voluntary micturitions decreased from a mean of 21.5 per 48 h on placebo by 1.6 on terodiline and 2.8 on emepronium .  Involuntary micturitions decreased from 3.6 per 48 h by 1.3 on both treatments ( p less than 0.05 ) . The maximal flow rate decreased from a mean of 24.5 ml/sec to 19.6 ml/sec on emepronium and increased to 25.4 ml/sec on terodiline .  Residual urine decreased from a mean of 54 ml to 49 ml on terodiline and increased to 60 ml on emepronium .  Volume at first desire to void in the supine position increased on emepronium by 44 ml ( p less than 0.05 ) and on terodiline by 3 ml , on the upright position by 11 ml and 18 ml , respectively . Bladder capacity increased in the supine position on emepronium by 32 ml and decreased on terodiline by 8 ml , in the upright position increased by 9 ml and 5 ml , respectively . The bladder pressure at first desire to void in the supine position increased on emepronium by 2 cmH2O , and decreased on terodiline by 2 cmH2O . The intravesical pressure at strong desire to void decreased on emepronium by 6 cmH2O and on terodiline by 7 cmH2O , in the upright position by 2 cmH2O and 1 cmH2O , respectively . 39 % of the patients preferred terodiline , 39 % emepronium and 22 % placebo . ( ABSTRACT TRUNCATED AT 250 WORDS A comparison was made of three drug regimens : imipramine (Tofranil)/propantheline , oxybutynin ( Ditropan ) and penthienate bromide ( Monodral ) . Two comparative trials were performed in prospect i ve studies , using a r and omization and cross-over design . All the drugs were found to improve the urinary symptoms and urodynamic changes associated with the unstable bladder , but penthienate was shown to be more effective than imipramine/propantheline . Its effect on the unstable bladder was equivalent to that of oxybutynin .  Side-effects were common and most common with oxybutynin . However , the inability of these drugs to prevent the uninhibited detrusor contractions of the unstable bladder consistently and objective ly was demonstrated PURPOSE We evaluated the efficacy and safety of tamsulosin in patients with neurogenic lower urinary tract dysfunction secondary to suprasacral spinal cord lesions in a 4-week r and omized controlled trial ( RCT ) followed by a 1-year , open label , long-term study . MATERIAL S AND METHODS A total of 263 patients were r and omized to 4-week double-blind therapy with placebo , or 0.4 or 0.8 mg tamsulosin once daily . Of these , 244 patients completed the RCT , 186 continued long-term tamsulosin therapy  ( 0.4 or 0.8 mg once daily ) and 134 completed 1-year treatment . The primary efficacy parameter was maximum urethral pressure ( MUP ) . RESULTS Although the mean decrease in MUP at 4 weeks in the RCT did not reach statistical significance over the placebo , it was more pronounced with 0.4 ( -12.2 cm H2O or -10 % ) and 0.8 mg ( -9.6 cm H2O or -9 % ) tamsulosin than placebo ( -6.5 cm H2O or -3 % ) . In the long-term study there was a statistically significant mean decrease in MUP ( -18.0 cm H2O , p < 0.001 or -15 % ) from baseline to end point . In the long-term study tamsulosin also decreased maximum urethral closure pressure , improved several cystometry parameters related to bladder storage and emptying , and increased to a statistically significantly degree , from baseline to end point , mean voided volume based on the micturition diary . There was statistically significant improvement for the International Prostate Symptom Score Quality of Life , as well as several questions about symptoms related to urinary leakage , and 1 question on bladder emptying and frequency , bother and severity of symptoms of autonomic dysreflexia . Finally , 71 % of patients improved according to investigators ( 44 % slightly and 27 % much improved ) . Both doses were effective and well tolerated . CONCLUSIONS Long-term tamsulosin treatment ( 0.4 and 0.8 mg once daily ) seems to be effective and well tolerated in patients with neurogenic lower urinary tract dysfunction . The results suggest that it improves bladder storage and emptying , and decreases symptoms of autonomic dysreflexia Clinical efficacy and adverse effects of oxybutynin and propantheline in the treatment of symptoms related to detrusor hyperactivity were studied in a r and omized , controlled , double-blind multicenter trial . Of 169 patients entered into the study 154 were evaluable for statistical analysis . Mean grade of improvement ( visual analogue scale ) was significantly higher with oxybutynin ( 58.2 % ) versus propantheline ( 44.7 % ) and placebo ( 43.4 % ) . Mean bladder volume at first involuntary cystometric contraction was significantly increased with oxybutynin ( + 57.0 ml . ) versus placebo ( -9.7 ml . ) . Mean maximum cystometric bladder capacity was also significantly increased with oxybutynin ( + 80.1 ml . ) versus placebo ( + 22.5 ml . ) . Rate of inquired possible adverse effects was significantly higher for oxybutynin ( 63 % ) versus propantheline ( 44 % ) and placebo ( 33 % ) . However , only 5 patients dropped out of the study because of adverse effects  ( oxybutynin 2 and propantheline 3 ) . No serious or lasting adverse effects were encountered with dryness of the mouth being the major complaint . Oxybutynin has statistically significant effects on subjective symptoms and objective urodynamic parameters in patients with detrusor hyperactivity compared to propantheline Tolterodine is a potent antimuscarinic agent specifically developed for the treatment of urinary urge incontinence and other symptoms related to the overactive bladder . In order to assess the optimum dosage for use in future clinical studies , a double-blind , r and omized , placebo-controlled , parallel-group , multicenter study was performed in 90 patients with detrusor hyperreflexia and symptoms of urinary urgency , frequency , and /or urge incontinence .  Urodynamic variables , micturition diary variables , and subjective urinary symptoms were measured before and after 2 weeks ' treatment with either placebo or tolterodine 0.5 , 1 , 2 , or 4 mg twice daily ( bd ) . Serum drug concentrations , electrocardiogram recordings , blood pressure , and incidence of adverse events were also ass 
    Output:
    
There was no evidence of a difference in cure rates between anticholinergics and flavoxate .
There was no strong evidence to favour either anticholinergic drugs or the comparators .
Many of the drugs considered in trials in this review are no longer used in clinical practice ( and this includes the most commonly tested - flavoxate ) .
There is inadequate evidence as to determine whether any of the available drugs are better or worse than anticholinergic medications .