Effectiveness of the addition of tadalafil to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia: A randomized clinical trial

Aval, Hamidreza Baghani; Ameli, Zeinab; Ameli, Mojtaba

doi:10.1177/0391560317749427

Cited by 3 publications

(5 citation statements)

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“…The add‐on medication therapy includes phosphodiesterase 5 (PDE5) inhibitors, 5 alpha reductase inhibitors, herbal extract medications, or parasympathomimetics in male patients who received α1‐blockers at diagnosis of urinary retention and those utilities were not fully investigated. Currently, only one randomized controlled trial was available showing that addition of tadalafil to α‐blockers has no significant advantage in improving benign prostatic hyperplasia‐related acute urinary retention vs tamsulosin alone 10 …”

Section: Introductionmentioning

confidence: 99%

“…Currently, only one randomized controlled trial was available showing that addition of tadalafil to α-blockers has no significant advantage in improving benign prostatic hyperplasia-related acute urinary retention vs tamsulosin alone. 10 The primary purpose of this study was to investigate the outcomes of TWOC in men with acute urinary retention and determine the predictors of successful TWOC. Patients were divided according to medication status at the point of urinary retention as medicated and non-medicated (naïve) groups and may have different etiologies leading to urinary retention.…”

Section: Introductionmentioning

confidence: 99%

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Predictive factors for the success of trial without catheter for men with urinary retention

Takanashi

Ito

Fukazawa

et al. 2023

LUTS

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ObjectiveTo investigate the trial of spontaneous urination without catheter (TWOC) outcomes for men with acute urinary retention, determine successful TWOC predictors, and evaluate the impact of add‐on medication therapy on TWOC.MethodsThis retrospective study included men with acute urinary retention and post‐void residual (PVR) >250 mL who underwent TWOC between July 2009 and July 2019. Patients were divided into a medicated group who received alpha1 blocker on urinary retention diagnosis and a naïve group who did not. The trial was defined as unsuccessful if the PVR was >150 mL or if the patient experienced difficulty emptying their bladder with abdominal discomfort or pain, and a transurethral catheter was reinserted.ResultsAmong 576 men with urinary retention, 269 (46.7%) constituted the medicated group and 307 (53.3%) the naïve. The naïve group comprised more elderly patients (P = 0.010) with higher Eastern Cooperative Oncology Group performance status (PS) (P = 0.001) and smaller prostate volume (P = 0.028) than the other. In the medicated group, 153 men received additional oral medication before TWOC to increase the success rate. There were significant age differences (P = 0.041) in the medicated group and significant median PS differences (P = 0.010) in the naïve group between the successful and unsuccessful outcomes of TWOC. The multivariate logistic regression model demonstrated that age <80 years in medicated patients (P = 0.042, odds ratio [OR] 1.701) and PS <2 in naïve patients (P = 0.001, OR 2.710) were significant independent predictors of successful TWOC outcomes.ConclusionsThis is the first study classifying patients with urinary retention according to medication status. Both medicated and naïve groups had different patient backgrounds and TWOC outcome predictors, suggesting a discrepant etiology behind urinary retention. Hence, acute urinary retention management in men should vary based on medication status for male lower urinary tract symptoms when urinary retention is diagnosed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictive factors for the success of trial without catheter for men with urinary retention

Takanashi

Ito

Fukazawa

et al. 2023

LUTS

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“…15,16 In patients with AUR, such TWOC protocols have been offered like, different alpha-blockers, phosphodiesterase-5 (pde5) inhibitors, removing the catheter at night, or indwelling the catheter long duration. [17][18][19] However, limited success was reported to avoid re-catheterization while preventing catheter-associated urinary tract infection. 20 In this study, immediate TUR-P was offered to patients with AUR when the etiology was BPH.…”

Section: Discussionmentioning

confidence: 99%

The effect of acute urinary retention on the results of transurethral resection of the prostate

Baran

2023

Urologia

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Introduction: Acute urinary retention (AUR) is one of the most severe symptoms of Benign Prostatic Hyperplasia (BPH). There are some studies in the literature describing the risk factors for the development of AUR in BPH patients. However, the studies that summarize the effect of AUR on Transurethral resection of Prostate (TUR-P) surgery results are limited. The aim of this study is to assess the effect of AUR on TUR-P results. Methods: Between 2018 and 2020, patients who underwent TUR-P for AUR or lower urinary tract symptoms (LUTS) were included in the study. The inclusion criteria were, men over 50 years old with a BPH diagnosis and who underwent monopolar TUR-P by a single surgeon. The exclusion criteria were; patients who had prostate cancer, multiple sclerosis, or neurogenic bladder were diagnosed or had previous lower urinary tract surgeries such as TUR-P, TUR-Bladder, Urethrotomy, had a chronic indwelling catheter, and patients who did not accept immediate TUR-P and preferred trial without catheter (TWOC) protocol. The age, PSA, prostate volume, pre- and post-operative flow rates, duration of hospitalization, and complications were recorded. Two groups were constituted for comparison such as AUR and Elective Group and p values <0.05 were considered significant. Results: There were 14 and 46 patients for AUR and Elective Groups respectively. The age, pre-operative prostate volume, free and total PSA values, postoperative complication rate, and re-hospitalization rate were significantly higher in the AUR-Group. However, there were no differences between groups in terms of pre-operative medication, duration of hospitalization, and post-operative uroflow maximum flow rate. Discussion: Patients who underwent TUR-P after AUR have a higher risk for complications and re-hospitalization. Care should be taken in these patients and patients should be warned about the risks.

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“…Paralleling what has been proven successful in BPH medical treatment in general, several combination therapies have been proposed in patients with AUR. In a randomized, double-blind clinical trial, 80 patients with BPH-related AUR were randomly assigned to receive either tamsulosin þ placebo or tamsulosin þ tadalafil daily for 7 days [8]. Use of BPH drugs before AUR was similar between the placebo and tadalafil groups (50 versus 42.5% respectively, P ¼ 0.501).…”

Section: Acute Urinary Retenɵonmentioning

confidence: 99%

“…Use of BPH drugs before AUR was similar between the placebo and tadalafil groups (50 versus 42.5% respectively, P = 0.501). After catheter removal, 23 (57.5%) patients in the tamsulosin + placebo group and 26 (65%) in the Tamsulosin + tadalafil group voided successfully at 24 h without significance difference ( P = 0.491) [8]. One other randomized controlled trial (RCT) also failed to demonstrate a benefit of combination therapy based on tadalafil and tamsulosin over monotherapy [9].…”

Section: The Place Of Medical Therapy In the Management Of Acute Urin...mentioning

confidence: 99%

Best nonsurgical managements of acute urinary retention: what's new?

Baboudjian

Benoit

Boissier

et al. 2021

Current Opinion in Urology

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Purpose of reviewTo provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR). Recent findingsA recent meta-analysis confirmed that a-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (À89.68 min, 95% confidence interval À160.55, À18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR.

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Effectiveness of the addition of tadalafil to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia: A randomized clinical trial

Abstract: Addition of tadalafil to α-blockers has no significant advantage in improving benign prostatic hyperplasia-related acute urinary retention versus tamsulosin alone.

Cited by 3 publications

References 10 publications

Predictive factors for the success of trial without catheter for men with urinary retention

Predictive factors for the success of trial without catheter for men with urinary retention

The effect of acute urinary retention on the results of transurethral resection of the prostate

Best nonsurgical managements of acute urinary retention: what's new?

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