Preventive effects of tamsulosin for postoperative urinary retention after lower limb arthroplasty: A randomized controlled study

Abstract

Purpose This prospective, randomized, controlled study investigated the use of tamsulosin, a selective alpha-blocker, as a prophylactic medication to prevent postoperative urinary retention (POUR) following lower limb arthroplasty. Materials and Methods The criterion for diagnosing POUR was used a postoperative bladder volume over 400 mL with incomplete emptying. Patients who underwent primary total hip or knee arthroplasty were randomly assigned at a 1:1 ratio to tamsulosin treatment and non-treatment groups at a single center from September 2018 to November 2018. The treatment group received 0.2 mg of tamsulosin orally once at night for 3 days starting on postoperative day 1. During this 3-day period, an indwelling Foley catheter was maintained. The incidence of POUR according to tamsulosin treatment following lower limb arthroplasty was the primary outcome. Results In total, 100 patients were enrolled, of whom 5 discontinued participation. POUR was diagnosed in 20 of the remaining 95 patients (21.1%). The treatment group contained 48 patients, of whom 6 (12.5%) developed POUR, whereas POUR occurred in the 14 of the 47 patients (29.8%) in the non-treatment group. Tamsulosin treatment reduced the risk of POUR by two-thirds (odds ratio [OR], 0.337; 95% confidence interval [CI], 0.117–0.971; p=0.044). The risk reduction associated with tamsulosin treatment remained robust post-adjustment for potential covariates (OR, 0.250; 95% CI, 0.069–0.905; p=0.038). Conclusions Tamsulosin administration immediately after lower limb arthroplasty reduced the incidence of urinary retention and diminished the need for long-term catheterization.

Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis

“…Five RCTs 10 , 11 , 1–3 included 878 patients (α1-antagonist, 434; placebo, 444) who were enrolled between 1987 and 2019 ( Table 1 ). Of the five RCTs, three 11 , 21 , 22 involved patients receiving primary arthroplasty and two 10 , 20 involved patients undergoing elective spine surgery. In the study by Petersen et al .…”

“…Throughout the literature review, many criteria have been proposed for the diagnosis of POUR (for example patient discomfort from palpable distended bladder 35 , 36 , micturition score 37 , inability to void with bladder distention 22 , or inability to void 8 h after Foley removal 38 ), bladder catheterization, and ultrasound assessment using post-void residual (PVR) volume cut-off, with no single one considered to be the standard. Most studies included in our analysis, except for Petersen et al , utilized PVR volume after the voiding trial.…”

“…All studies in our meta-analysis, except for Choi et al . 22 only included male patients, which may also compromise the generalizability to the orthopaedic population.…”

Prophylactic doxazosin reduces urinary retention and promotes recovery after total joint arthroplasty: A randomized controlled trial

“…A retrospective study recruiting 559 TJA male patients found that patients who received alpha adrenoreceptor blockers perioperatively had significantly lower risk of POUR and reduced LOS ( Schubert et al, 2020 ). Though some randomized controlled trials have compared the efficacy of tamsulosin and placebo to prevent POUR after TJA, the results seemed controversial ( Schubert et al, 2019 ; Choi et al, 2021 ). Schubert et al found no difference in POUR incidence between prophylactic tamsulosin and placebo after TJA (4), while Choi et al (2021) drew an opposite conclusion.…”

“…Though some randomized controlled trials have compared the efficacy of tamsulosin and placebo to prevent POUR after TJA, the results seemed controversial ( Schubert et al, 2019 ; Choi et al, 2021 ). Schubert et al found no difference in POUR incidence between prophylactic tamsulosin and placebo after TJA (4), while Choi et al (2021) drew an opposite conclusion. Although Choi et al (2021) ’s study is more recent than Schubert et al (2019) ‘s study, both investigations were of high quality and cannot be ignored.…”