DOI: http://dx.doi.org/10.18203/2349-2902.isj20184072

Role of alpha blockers and 7-days catheterization in enhancing the success of trial void in acute urinary retention due to benign prostatic hyperplasia: a double-blind randomized control trial

Rohit Garagadahalli Rangaiah, Vilvapathy Senguttuvan Karthikeyan

Abstract


Background: Acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH) is common. This study evaluated the efficacy of three alpha-blockers with urethral catheterization for 7 days in trial without catheter (TWOC).

Methods: This was a prospective, randomized, double-blind, active-control study conducted between November 2013 and May 2016. Patients aged more than 50 years, presenting with first-time painful AUR due to BPH were enrolled in this study. Eligible patients were randomized (1:1:1) to one of the three treatment groups to receive tamsulosin 0.4 mg, alfuzosin 10 mg or silodosin 8 mg for one week. The primary outcome measure was successful TWOC at 7 days.

Results: A total of 118 patients were included in the study (tamsulosin, n=40; alfuzosin, n=38; and silodosin, n=40). The baseline parameters were comparable between the three groups. A total of 84 (71.2%) patients had successful TWOC at the end of 7 days (tamsulosin, n=30 (75%); alfuzosin, n=32 (84%); and silodosin, n=22 (55%)) and was significantly (p=0.015) different between three groups. Higher age, larger volume at retention and higher prostate volume were significantly (p<0.05) associated with the failure of TWOC.

Conclusions: Results from this study demonstrate that there is a definite role of 7-day catheterization with alpha blockers in improving the rates of success of TWOC in men presenting with AUR due to BPH. The success of TWOC is multifactorial.


Keywords


Acute urinary retention, Alfuzosin, Benign prostatic hyperplasia silodosin, Tamsulosin

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References


McNeill SA. The role of alpha-blockers in the management of acute urinary retention caused by benign prostatic obstruction. Eu Urol. 2004;45:325-32.

Fitzpatrick JM, Desgrandchamps F, Adjali K, Guerra GL, Hong SJ, Khalid ELS, et al. Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia. BJU Int. 2012;109:88-95.

Fisher E, Subramonian K, Omar MI. The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men. Cochrane Database Sys Rev. 2014;6:CD006744.

Roehrborn CG, Malice M, Cook TJ, Girman CJ. Clinical predictors of spontaneous acute urinary retention in men with LUTS and clinical BPH: a comprehensive analysis of the pooled placebo groups of several large clinical trials. Urol. 2001;58:210-6.

Emberton M, Anson K. Acute urinary retention in men: an age-old problem. BMJ. 1999;318:921-5.

Pickard R, Emberton M, Neal DE. The management of men with acute urinary retention. Br J Urol. 1998;81:712-20.

Maldonado-Ávila M, Manzanilla-García HA, Sierra-Ramírez JA, Carrillo-Ruiz JD, González-Valle JC, Rosas-Nava E, et al. A comparative study on the use of tamsulosin versus alfuzosin in spontaneous micturition recovery after transurethral catheter removal in patients with benign prostatic growth. Int Urol Nephrol. 2014;46:687-90.

Agrawal MS, Yadav A, Yadav H, Singh AK, Lavania P, Jaiman R. A prospective randomized study comparing alfuzosin and tamsulosin in the management of patients suffering from acute urinary retention caused by benign prostatic hyperplasia. Indian J Urol. 2009;25:474-8.

Tiong HY, Tibung MJ, Macalalag M, Li MK, Consigliere D. Alfuzosin 10 mg once daily increases the chances of successful trial without catheter after acute urinary retention secondary to benign prostate hyperplasia. Urol Int. 2009;83:44-8.

Zhengyong Y, Changxiao H, Shibing Y, Caiwen W. Randomized controlled trial on the efficacy of bladder training before removing the indwelling urinary catheter in patients with acute urinary retention associated with benign prostatic hyperplasia. Scand J Urol. 2014;48:400-4.

Lucas MG, Stephenson TP, Nargund V. Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia. BJU Int. 2005;95:354-7.

Hagiwara K, Koie T, Iwamura H, Imai A, Hatakeyama S, Yoneyama T, et al. Efficacy and safety of silodosin and dutasteride combination therapy in acute urinary retention due to benign prostatic hyperplasia: a single-arm prospective study. Bio Med Res Int. 2016:4975851.

Garibaldi RA, Mooney BR, Epstein BJ, Britt MR. An evaluation of daily bacteriologic monitoring to identify preventable episodes of catheter-associated urinary tract infection. Infect Control. 1982;3:466-70.

Saint S, Lipsky BA, Goold SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med. 2002;137:125-7.

Warren JW, Tenney JH, Hoopes JM, Muncie HL, Anthony WC. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis. 1982;146:719-23.

Desgrandchamps F, De La Taille A, Doublet JD, Reten France Study Group. The management of acute urinary retention in France: a cross-sectional survey in 2618 men with benign prostatic hyperplasia. BJU Int. 2006;97:727-33.

McNeill SA, Hargreave TB, Roehrborn CG; Alfaur study group. Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a double-blind placebo-controlled study. Urol. 2005;65:83-9.

Djavan B, Chariat S, Omar M, Roehrborn CG, Marberger M. Does prolonged catheter drainage improve the chance of recovering voluntary voiding after acute urinary retention? Eu Urol. 1998;33(1):110:A437.