Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia

Abstract

Purpose Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia.Materials and Methods A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded.Results There were 60 patients in each Group. Their mean age was 35.95±15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697).Conclusion This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.

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

“…There were no clear differences in effect based on type of alpha‐blocker or sex. There was moderate certainty for no evidence of a difference in effect of tamsulosin compared with alfuzosin (OR 0·74, 0·16 to 3·44; 1 trial).…”

“…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.…”

Selective Alpha Adrenoblocker and the Risk of Development of Acute Urine Retention

“…На сьогодні опубліковано щонайменше вісім клінічних досліджень, в яких оцінювали безпечність і ефективність тамсулозину як селективного блокатора альфа-1-адренергічних рецепторів для профілактики післяопераційної ГЗС у пацієнтів чоловічої статі після різних типів оперативного втручання [24,25]. Результати цих досліджень у цілому узгоджуються, у шести з восьми з них повідомляється про статистично значуще зниження ризику виникнення ГЗС при застосуванні тамсулозину порівняно з плацебо [24,25,26,27,28,29]. Три обсерваційних дослідження також виявили позитивні результати, пов'язані з використанням тамсулозину у хірургічних хворих після операції [30,31,32].…”