Alpha-blockers may assist successful catheter removal after acute urinary retention

January 01, 0001

Alpha-blockers may assist successful catheter removal after acute urinary retention

Clinical Question:How effective are alpha-blockers in increasing the success rates of trial without a catheter (TWOC) after an episode of acute urinary retention in men?

Bottom line: The limited available evidence suggests that, compared to placebo, alpha-blockers increase success rates of TWOC (NNT* 12). Two different alpha-blockers were tested (tamsulosin and alfuzosin). Alpha-blocker side effects were low and comparable to placebo. It is uncertain whether alpha-blockers reduce the risk of recurrent urinary retention and need for prostate surgery. The cost-effectiveness and recommended duration of alpha-blocker treatment after successful TWOC remains unknown. * NNT = number needed to treat to benefit 1 individual

Caveat: There is a lack of internationally agreed outcome measures for what constitutes successful TWOC. This makes meta-analysis difficult. Treatment was given for 1 to 3 days (and in 1 study up to a maximum of 8 days) before the catheter was removed.

Context: Acute urinary retention is a urological emergency in men and requires urgent catheterisation. Any intervention which increases the rates of successful TWOC following an acute urinary retention episode would be potentially beneficial. Alpha-blockers relax prostatic smooth muscle cells, thereby decreasing the resistance to urinary flow and by doing so improve urinary symptoms.

Cochrane Systematic Review: Zeif H-J and Subramonian K. Alpha blockers prior to removal of a catheter for acute urinary retention in adult men. Cochrane Reviews 2009, Issue 4. Article No. CD006744. DOI: 10.1002/14651858.CD006744.pub2. This review contains 5 studies involving 696 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 245, April 2010.
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: U. Urinary System. Keywords: urinary retention, urinary catheter, alpha-blockers
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 10 August 2010

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.