Background on the condition
Acute urinary retention in men is a medical emergency characterised by the sudden and often painful inability to pass urine. There are many known causes including prostate obstruction (because of enlargement of the prostate or cancer), urethral strictures (a narrowing of the urethra due to scar tissue), urine infection, constipation and neurological conditions. A narrow drainage tube (urinary catheter) is temporarily inserted into the bladder through the penis to allow drainage of urine. Once the catheter is removed, some men fail to pass urine again and need to be re-catheterised. In these men, continued use of catheters or prostate surgery are the standard treatment options. Catheters are associated with risks flomax such as infection and can harm quality of life. Measures for increasing the rate of successful catheter removal, that is, enabling patients to urinate spontaneously again, are therefore potentially beneficial. Alpha blockers (for example tamsulosin, alfuzosin) are a group of drugs known to have positive effects on urinary symptoms such as poor urinary flow. It is believed that their relaxing effect on the prostate may also increase the chance to void again after catheter removal. This review evaluated the evidence available to support this practice.
The main findings of the review
In nine clinical trials men were either given a dummy tablet (placebo, inactive drug), an alpha blocker for one to three days (in one study up to a maximum of eight days and in another for 32 days) or no treatment before the catheter was removed. In ideal circumstances, neither patients nor doctors knew which type of tablet was given, to prevent the bias in reporting the results. The results suggested that alpha blocker treatment increased the chances of successful catheter removal and return to urination although the overall scientific evidence available to support this was limited. Four different alpha blockers were tested (alfuzosin, tamsulosin, doxazosin and silodosin). Their results were similar except for doxazosin which did not seem to make a significant difference.
Side effects caused by alpha blockers were few and comparable to placebo or no treatment, though this evidence was limited. They included retrograde ejaculation, dizziness, low blood pressure, fainting, sleepiness, feeling unwell and headache.
There was some evidence to say that alpha blockers also reduce the risk of suffering another (recurrent) episode of urinary retention after successful catheter removal, though it remains unclear whether they reduce the need for future surgery on the prostate. It is therefore unclear whether, or for how long, alpha blocker treatment should be continued after successful catheter removal and whether the costs of alpha blocker treatment in such situations are justified. Further research is needed to answer these questions.
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