From the Guidelines
The treatment of urinary retention should prioritize immediate bladder decompression with catheterization, and for long-term management, clean intermittent catheterization (CIC) every 4-6 hours is preferred over indwelling catheters to reduce infection risk, as supported by 1. The approach to treating urinary retention depends on its underlying cause and severity. For acute urinary retention, immediate bladder decompression with catheterization is necessary, typically using a 14-16 French Foley catheter.
- For benign prostatic hyperplasia (BPH)-related retention, alpha-blockers like tamsulosin (0.4 mg daily) or alfuzosin (10 mg daily) are first-line medications, often combined with 5-alpha-reductase inhibitors like finasteride (5 mg daily) for long-term management, as suggested by 1 and 1.
- Anticholinergic medications should be discontinued if causing retention.
- For neurogenic causes, clean intermittent catheterization (CIC) every 4-6 hours is the preferred method to reduce infection risk, as indicated by 1.
- Surgical interventions include transurethral resection of the prostate (TURP) for BPH, urethral dilation for strictures, or sacral neuromodulation for neurogenic cases, with surgery recommended for patients with renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections, recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to and/or unwilling to use other therapies, as stated in 1 and 1. Post-surgical retention may resolve spontaneously within 24-48 hours with supportive measures.
- Chronic retention management focuses on treating the underlying cause while maintaining bladder drainage. Prompt treatment is essential to prevent complications like urinary tract infections, bladder damage, or kidney injury, as prolonged high-pressure retention can lead to upper urinary tract deterioration.
From the FDA Drug Label
In A Long-Term Efficacy and Safety Study, efficacy was also assessed by evaluating treatment failures Treatment failure was prospectively defined as BPH-related urological events or clinical deterioration, lack of improvement and/or the need for alternative therapy. BPH-related urological events were defined as urological surgical intervention and acute urinary retention requiring catheterization.
Table 5: All Treatment Failures in A Long-Term Efficacy and Safety Study Acute Urinary Retention Requiring Catheterization 6.6 2.8 0. 43 (0.28 to 0.66) < 0.001
Treatment of Urinary Retention:
- Finasteride may be used to reduce the risk of acute urinary retention requiring catheterization in patients with BPH, with a 57% reduction in risk compared to placebo 2.
- There is no direct information in the provided drug labels to support the use of Tamsulosin for the treatment of urinary retention 3.
From the Research
Treatment Options for Urinary Retention
- Urinary retention can be treated with various medications and non-pharmacological interventions, including alpha-blockers, which have been shown to be effective in managing acute urinary retention secondary to benign prostatic hyperplasia (BPH) 4, 5, 6, 7.
- Alpha-blockers, such as alfuzosin, tamsulosin, and silodosin, work by relaxing the muscles in the prostate and bladder neck, making it easier to urinate 4, 5, 6, 7.
- Studies have demonstrated that alpha-blockers can increase the success rate of trial without catheter (TWOC) in patients with acute urinary retention secondary to BPH 5, 6, 7.
Efficacy of Alpha-Blockers
- A systematic review and meta-analysis found that alpha-blockers, particularly alfuzosin and tamsulosin, can significantly improve the rates of successful TWOC in patients with urinary retention secondary to BPH 5.
- Another study found that alpha-blockers can provide substantial benefit in increasing satisfactory micturition within 24 hours after TWOC for men with acute urinary retention due to BPH 6.
- A network meta-analysis compared the effects of different alpha-blocker regimes on acute urinary retention and found that alfuzosin plus tamsulosin was ranked first, followed by tamsulosin, silodosin, alfuzosin, and doxazosin 7.
Non-Pharmacological Interventions
- Non-pharmacological treatments, such as catheterization, have been evaluated in patients with urinary retention secondary to BPH, but the evidence is limited and inconclusive 5, 8.
- The management of urinary retention in patients with BPO varies widely and remains unstandardized, highlighting the need for further research and guidelines 5, 8.