Tamsulosin in the Management of Patients in AUR from BPH

Malcolm G. Lucas, et al. BJU International, Vol 95, Issue 3, 2005. P 354-357.

Lucas and colleagues study the impact of tamsulosin compared to placebo in the management of acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH). In their randomized, double-blind, parallel-group, multicenter study, 141 men (mean age 69.4 years) with AUR were included. Each had been admitted through the emergency room with AUR and had been catheterized in the previous 72 hours. Those with catheter voided volumes of >1500 mL or <500 mL were excluded. Participants were assigned to receive either 0.4 mg tamsulosin hydrochloride once daily or a placebo. Duration of treatment was either 3 or 8 doses. The study was designed to allow the patient to return home after a successful TWOC (trial without catheter), defined as flow rate >5 mL/s, >100 mL voided volume and residual volume of ≤ 200 mL. Patients could take medication for up to 26 weeks but were withdrawn from the study if re-catheterization was needed. At the conclusion of the study but before coding was broken, the authors discovered that 120 men (81%) of the entire group had been withdrawn from the study, 89 (60%) due to need for re-catheterization. Using their primary criteria for defining a successful TWOC, 24 of the remaining men (34%) of the tamsulosin group passed a trial without catheter (TWOC), while 17 (24%) of the placebo group did. This result did not show significant benefit of tamsulosin over placebo (p=0.193). The authors then examined their data using secondary analysis including any two free-flow criteria, resulting in tamsulosin achieving a significantly better outcome than placebo. Patients who received tamsulosin were less likely to need re-catheterization than those who received placebo; 34 men who received tamsulosin and 18 who received placebo did not require re-catheterization (48% vs 26% success, p-0.011). The authors noted that those taking 8 doses were less likely to need re-catheterization than those taking 3 doses though the difference was not statistically significant. Also, because of the high loss rate, there were too few patients to analyze long-term efficacy after AUR. The authors conclude that the study was not powerful enough to predict which patients are likely to respond to alpha blockers. However, they recommend tamsulosin for treating patients after cathetherization for AUR and believe it can significantly reduce the likelihood of re-catheterization, at least acutely.

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