From the Guidelines
For urinary retention, alpha-blockers such as tamsulosin (Flomax) 0.4 mg daily or alfuzosin (Uroxatral) 10 mg daily should be prescribed prior to a voiding trial, and combination therapy with 5-alpha reductase inhibitors like dutasteride 0.5 mg daily may be considered for long-term management, as it reduces the risk of acute urinary retention and the need for surgery, as shown in the most recent study 1. The choice of medication depends on the underlying cause of retention, patient comorbidities, and potential side effects.
- Alpha-blockers are the first-line treatment for urinary retention, as they relax the smooth muscle in the prostate and bladder neck, improving urine flow 1.
- For acute urinary retention, immediate catheterization is necessary, followed by alpha-blocker therapy.
- If retention is due to an enlarged prostate, 5-alpha reductase inhibitors like finasteride 5 mg daily or dutasteride 0.5 mg daily may be added for long-term management, as they work by shrinking the prostate over 3-6 months 1.
- The combination of alpha-blockers and 5-alpha reductase inhibitors has been shown to be superior to either monotherapy in reducing the risk of AUR or the need for surgery, with a number needed to treat of 13 patients for 4 years to prevent one case of urinary retention and/or surgical treatment 1.
- Other medications like bethanechol (Urecholine) 10-50 mg three to four times daily or anticholinergics like oxybutynin 5 mg twice daily may be considered in specific cases, but their use is limited by potential side effects and variable efficacy.
From the FDA Drug Label
The results of MTOPS are consistent with the findings of the 4-year, placebo-controlled study A Long-Term Efficacy and Safety Study [see CLINICAL STUDIES (14. 1)] in that treatment with finasteride tablets reduces the risk of acute urinary retention and the need for BPH-related surgery. In MTOPS, the risk of developing acute urinary retention was reduced by 67% in patients treated with finasteride tablets compared to patients treated with placebo (0.8% for finasteride tablets and 2. 4% for placebo).
Finasteride is a medication that can be used to treat urinary retention. The medication has been shown to reduce the risk of acute urinary retention by 67% compared to placebo.
- Key benefits of finasteride for urinary retention include:
From the Research
Urinary Retention Medications
The following medications have been studied for the treatment of urinary retention:
- Alpha-1 A adrenoceptor antagonists, such as tamsulosin, have been shown to be effective in treating benign prostatic hyperplasia (BPH) patients with acute urinary retention 3
- Double dose alpha-blocker therapy, combining tamsulosin and alfuzosin, has been found to be more effective than single dose therapy in managing patients with acute urinary retention due to BPH 4
- Antimuscarinic agents, which target the bladder, may also be used to improve storage urinary symptoms in patients with BPH-related urinary retention 5
- Five-alpha reductase inhibitors, such as finasteride, can reduce prostate size and improve urinary symptoms in patients with BPH, but may have side effects such as impotence and decreased libido 6
Treatment Options
Treatment options for urinary retention due to BPH include:
- Alpha-blocker monotherapy, such as tamsulosin or doxazosin
- Combination therapy with alpha-blockers and antimuscarinic agents
- Five-alpha reductase inhibitors, such as finasteride
- Surgical intervention, which may be necessary in severe cases of urinary retention
Patient Profile
The choice of treatment for urinary retention due to BPH depends on the individual patient profile, including:
- Severity of symptoms
- Prostate size
- Presence of other medical conditions
- Patient preferences and lifestyle 7