Preventive effect of tamsulosin on postoperative urinary retention in neurosurgical patients

Abstract

Background:Postoperative urinary retention (POUR) is common in neurosurgical patients. The use of alpha-blockade therapy, such as tamsulosin, has benefited many patients with a history of obstructive uropathy by decreasing lower urinary tract symptoms such as distension, infections, and stricture formation, as well as the incidence of POUR. For this study, we targeted patients who had undergone spinal surgery to examine the prophylactic effects of tamsulosin. Increased understanding of this therapy will assist in minimizing the morbidity of spinal surgery.Methods:We enrolled 95 male patients undergoing spine surgery in a double-blind, randomized, placebo-controlled trial. Patients were randomly assigned to receive either preoperative tamsulosin (N = 49) or a placebo (N = 46) and then followed-up prospectively for the development of POUR after removal of an indwelling urinary catheter (IUC). They were also followed-up for the incidence of IUC reinsertions.Results:The rate of developing POUR was similar in both the groups. Of the 49 patients given tamsulosin, 16 (36%) developed POUR compared to 13 (28%) from the control group (P = 0.455). In the control group, 5 (11%) patients had IUC re-inserted postoperatively, whereas 7 (14%) patients in the tamsulosin group had IUC re-inserted postoperatively (P = 0.616). In patients suffering from axial-type symptoms (i.e., mechanical back pain), 63% who received tamsulosin and 18% from the control group (P = 0.048) developed POUR.Conclusion:Overall, there was no statistically significant difference in the rates of developing POUR among patients in either group. POUR is caused by a variety of factors, and further studies are needed to shed light on its etiology.

Medical and non-medical interventions for post-operative urinary retention prevention: network meta-analysis and risk–benefit analysis

“…DMA was performed according to five outcomes, that is, POUR (39 studies, n = 4,697), PVRU (five studies, n = 490), UTI (four studies, n = 326), LUTS (three studies, n = 437) and AE (19 studies, n = 1949). For POUR, 39 studies were included with 4/6 pairs of interventions 17 , 18 , 20 , 21 , 23 , 26 , 28 , 30 – 32 , 35 – 56 , 60 – 63 which were significant in the incidence of POUR relative to PLA, that is, AMB ( n = 398), ACU ( n = 325), OPI ( n = 429) and ALP ( n = 5206) with the pooled RR [95% confidence interval (CI)] of 0.44 (0.32, 0.61), 0.32 (0.11, 0.94), 0.62 (0.40, 0.95) and 0.55 (0.40, 0.76), respectively ( Supplemental Figure 2 ). The heterogeneity was varied with the I 2 ranged from 63.54 to 73.34.…”

“…Forty-four 17 , 18 , 20 , 21 , 23 – 26 , 28 , 30 – 53 , 55 , 56 , 58 – 63 RCTs with 12 interventions and 5338 patients were included; see the network map in Figure 2 . Although all interventions reduced POUR, only AMB, ACU, ALP and NSD were statistically significant compared with placebo, but none of the indirect comparisons was significant; see Table 2 .…”

Systematic review of interventions for the prevention and treatment of postoperative urinary retention

“…After removal of duplicate records, 6415 reports were identified of which 48 studies (5644 participants) were included in the review ( Fig . ).…”

“…Eleven , , , , were judged at high risk of bias; these studies evaluated pharmacological (7 studies) and non‐pharmacological (3) interventions for the prevention of PO‐UR, and a pharmacological intervention (1 study) for the treatment of PO‐UR. There were 27 studies , , , , , , , rated as having some concerns; these studies evaluated pharmacological (16 studies) and non‐pharmacological (5) interventions for the prevention of PO‐UR, and pharmacological (2) and non‐pharmacological (4) interventions for treating PO‐UR.…”

“…0·14 to 0·41; I 2 = 57·6 per cent; 12 trials). Studies compared tamsulosin (5 trials) , , , phenoxybenzamine (3) , , prazosin (3) , , alfuzosin (1 trial) and dibenzyline (1 trial) with placebo or no treatment. Two of the phenoxybenzamine trials were restricted to women.…”