A prospective randomized study comparing alfuzosin and tamsulosin in the management of patients suffering from acute urinary retention caused by benign prostatic hyperplasia

Abstract

Objective:Prospective randomized study to compare the efficacy and safety of alfuzosin and tamsulosin in patients suffering from acute urinary retention caused by benign prostatic hyperplasia (BPH).Methods:Patients with acute urinary retention (AUR) due to BPH (total 150) were catheterized and randomized into three groups: Group A: alfuzosin 10 mg (50 patients), Group B: tamsulosin 0.4 mg (50 patients), Group C: placebo (50 patients). After three days, catheter was removed, and patients were put on trial without catheter (TWOC). Patients with successful TWOC were followed up for three months, taking into account the prostate symptom score (AUA Score), post-void residual urine volume (PVRV), and peak flow rate (PFR). ANOVA was used for statistical analysis.Results:Both group A (alfuzosin) and group B (tamsulosin) had similar results of TWOC (group A – 66%, group B – 70%), which were significantly superior than group C (placebo) – 36%. In follow up, three (9.1%) patients in group A, three (8.6%) patients in group B and eight (44.4%) patients in group C had retention of urine, requiring recatheterization. These patients were withdrawn from the study. After three months, alfuzosin- or tamsulosin-treated patients showed a significant decrease in AUA score and PVRV; and a significant increase in PFR as compared to placebo.Conclusions:TWOC was more successful in men treated with either alfuzosin or tamsulosin and the subsequent need for recatheterization was also reduced. Tamsulosin was comparable to alfuzosin in all respects, except a small but significant side effect of retrograde ejaculation.

Management of urinary retention in patients with benign prostatic obstruction: A systematic review and meta-analysis

“…A total of 21 studies (18 RCTs [6][7][8][9][10][11][31][32][33][34][35][36][37][38][39][40][41][42] and three prospective comparative studies [43][44][45]) were included. Fig.…”

“…Adverse events, most commonly including dizziness, headache, and orthostatic hypotension, were generally rare, without any difference between arms. Tamsulosin was compared with placebo in three RCTs [6,9,34]. In two of them, patients were randomized to three arms (tamsulosin vs alfuzosin vs placebo) [6,34].…”

“…Several a1-adrenoceptor antagonists (a1-blockers) have been tested in patients with AUR to increase the rates of successful trial without catheter (TWOC), including alfuzosin [6][7][8], tamsulosin [6,9], and silodosin [10], most of which demonstrate a higher success rate than placebo. The alfuzosin in AUR (ALFAUR) study, the largest clinical trial to date, evaluated the role of alfuzosin 10 mg once daily (OD) administrated 2-3 d before TWOC and showed that alfuzosin almost doubled the successful TWOC rate [11].…”

Systematic review and meta-analysis on management of acute urinary retention

“…27 Tamsulosin (400 mcg daily), alfuzosin (10 mg daily) and newer selective α-blockers such as silodisin (8 mg daily) and doxazosin (4 mg daily) have been shown to be effective in successful TWOC. [28][29][30][31][32][33][34][35][36][37][38][39][40] In a French cross-sectional study of 2618 men, 79% of subjects were treated with α-blockers during the time of catheter insertion and the TWOC success rate was significantly higher in men who received medical therapy before TWOC (53.0 vs 39.6%). 3 Similar findings are reported by Reten-World Study Group where prevalent use of α-blockers (86%) worldwide is noted with the result doubling success rate of TWOC.…”

Hydronephrosis Predicts Successful Catheter Removal after Painful Urinary Retention - Preliminary Results of a Prospective Single Center Study

“…In addition, all patients were treated with a α-adrenoreceptor antagonist once a day and with antibiotic prophylaxis with sulfametrole-trimethoprim twice a day for 1 week [10,11,12,13]. …”