Tamsulosin for Postoperative Urinary Retention

Darren J. Hein, PharmD

Disclosures

February 04, 2019

Question

Can the BPH drug tamsulosin prevent postoperative urinary retention in male patients undergoing surgery?

Response from Darren J. Hein, PharmD
Assistant Professor, Department of Pharmacy Practice, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska

Postoperative urinary retention (POUR) refers to the inability to pass any urine despite a full bladder after surgery. It is a common complaint, occurring in up to 70% of surgical patients depending on the type of surgery. Individuals undergoing perineal, gynecologic, anorectal, inguinal, and lower urinary tract surgeries are at an increased risk for POUR. Additional risk factors include older age, male sex, prolonged surgery, spinal anesthesia, and early removal of urinary catheters.

The development of POUR has been associated with several negative outcomes, including pain, urinary tract infection (UTI), bladder dysfunction, kidney damage, increased length of hospital stays, elevated costs, and the need for additional surgeries. Urethral catheterization is the mainstay of management of POUR; however, catheterization alone can also increase the risk for UTI and extend hospital stays.[1,2,3,4,5,6,7,8] For these reasons, pharmacotherapeutic approaches to prevention of POUR are needed.

At least eight clinical trials evaluating the safety and effectiveness of tamsulosin, a selective alpha-1 adrenergic receptor blocker, for prevention of POUR in male patients undergoing different types of surgery have been published to date.[2,3,4,5,6,7,9,10] The results of these studies have been generally consistent, with six of the eight trials reporting a statistically significant reduction in the risk for POUR with tamsulosin versus placebo.[3,4,5,6,9,10] The type of surgical patient and tamsulosin regimen studied in each of the identified trials are listed in the Table below. Three observational studies also have found positive outcomes associated with the use of tamsulosin in surgical settings.[8,11,12]

Table. Characteristics of Clinical Research Assessing Tamsulosin Therapy for Prevention of POUR

Author (Year)

Tamsulosin Regimen

Surgery

Jang et al (2012)[2] 0.2 mg daily from day of operation to postop day 7 Rectal cancer surgery
Mohammadi-Fallah et al (2012)[3] 0.4 mg 6 hours before and 6-12 hours after surgery Inguinal herniorrhaphy
Ahmad et al (2014)[4] 0.4 mg 6 hours before and 6-8 hours after surgery Anorectal surgery
Bazzazi et al (2014)[9] 0.4 mg daily for 1 week before surgery Cataract surgery
Jeong et al (2014)[10] 0.4 mg daily from 1 day before operation to postop day 14 Robot-assisted laparoscopic radical prostatectomy
Madani et al (2014)[5] 0.4 mg 14 hours before, 2 hours before, and 10 hours after surgery Varicocelectomy, inguinal herniorrhaphy, or scrotal surgery
Akkoc et al (2016)[6] 0.4 mg 14 hours and 2 hours before surgery Urologic surgery
Basheer et al (2017)[7] 0.4 mg 48 hours before surgery and night before surgery Spinal surgery

Ghuman and colleagues[1] recently conducted a systematic review and meta-analysis on the use of alpha-1 blocking agents for prevention of POUR. Of the 15 clinical trials identified in this review, six addressed the use of tamsulosin. A subgroup analysis of data from five of these studies showed that tamsulosin decreased the risk for POUR by 64% compared with placebo (risk ratio, 0.36; 95% confidence interval, 0.16-0.80; P = .013). These researchers also found that alpha-1 blockers seem to have a larger effect on POUR incidence in patients who are younger than 65 years of age, without a Foley catheter at time of surgery, or undergoing spinal anesthesia.[1]

In addition to being highly efficacious, tamsulosin is well-tolerated. Most clinical research in this setting has found no significant increase in adverse effects or other complications with tamsulosin compared with control. When adverse effects were reported, they were generally rare and mild (eg, dizziness, vomiting) and did not lead to discontinuation of therapy.[5,6]

Although tamsulosin therapy is safe and provides a clinically meaningful reduction in the incidence of POUR, most of the research published to date has not been designed to evaluate the impact of tamsulosin therapy on length of hospital stay, costs, or other negative outcomes associated with POUR. In addition, questions remain as to the most appropriate timing of tamsulosin administration before or after surgery and whether tamsulosin has a larger effect in different types of surgery.

Despite these unknowns, the evidence is convincing enough to prompt action. Pharmacists and healthcare providers involved in surgical care should collaborate and apply the available evidence, clinical judgement, and patient- and institution-specific values to devise protocols for the use of tamsulosin for prevention of POUR in male surgical patients.

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