What medication helps patients with urinary retention?

From the Guidelines

Alpha blockers, such as alfuzosin or tamsulosin, are the primary medications used to help patients with benign prostatic hyperplasia (BPH) urinate, with a successful trial without a catheter (TWOC) rate of 60% versus 39% for placebo, as seen in studies like 1. To manage lower urinary tract symptoms attributed to BPH, oral alpha blockers are prescribed prior to a voiding trial to treat patients with acute urinary retention (AUR) related to BPH, as recommended by the American Urological Association (AUA) guideline 1. Some key points to consider when using alpha blockers for AUR include:

• Patients should complete at least three days of medical therapy prior to attempting TWOC, as suggested by expert opinion 1
• Clinicians should inform patients who pass a successful TWOC for AUR from BPH that they remain at increased risk for recurrent urinary retention, with a moderate recommendation and evidence level of Grade C 1
• The long-term efficacy of alpha blocker therapy in treating AUR is unclear due to the lack of standardized follow-up in clinical trials, with many patients experiencing subsequent urinary retention and lower urinary tract symptoms (LUTS) after treatment 1
• Imaging and tests can be used to identify morphological aspects that affect natural history, treatment response, and treatment options, and further studies are needed to compare the efficacy of behavioral and lifestyle interventions versus medication, and medication versus minimally invasive therapies 1.

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. Patients in A Long-Term Efficacy and Safety Study had moderate to severe symptoms at baseline (mean of approximately 15 points on a 0 to 34 point scale). Patients randomized to finasteride tablets who remained on therapy for 4 years had a mean (± 1 SD) decrease in symptom score of 3.3 (± 5. 8) points compared with 1.3 (± 5.6) points in the placebo group. The improvement in BPH symptoms was seen during the first year and maintained throughout an additional 5 years of open extension studies. In the patients in A Long-Term Efficacy and Safety Study who remained on therapy for the duration of the study and had evaluable urinary flow data, finasteride tablets increased maximum urinary flow rate by 1.9 mL/sec compared with 0. 2 mL/sec in the placebo group.

Finasteride is a medication that can help patients with Benign Prostatic Hyperplasia (BPH) urinate by:

• Reducing the size of the prostate
• Improving urinary flow rates
• Decreasing the symptoms of BPH, such as:
  • Impairment of size and force of stream
  • Sensation of incomplete bladder emptying
  • Delayed or interrupted urination
  • Nocturia
  • Daytime frequency
  • Need to strain or push the flow of urine 2

From the Research

Medication Options for Urination Assistance

• Alpha-blockers (alfuzosin, doxazosin, tamsulosin, and terazosin) are used to relax prostatic smooth muscle cells, decreasing resistance to urinary flow 3, 4, 5.
• 5alpha-reductase inhibitors (5ARIs) (finasteride and dutasteride) can reduce the risk of long-term complications, such as acute urinary retention and enlarged prostate-related surgery 3, 5, 6.
• Combination therapy with an alpha-blocker and a 5ARI may be beneficial for patients requiring immediate relief of symptoms 3, 5, 6.

Efficacy and Safety of Medications

• Alpha-blockers have been shown to improve urinary symptoms, with a success rate of 60.2% in trials without catheter compared to 38.1% with placebo 4.
• 5ARIs have been found to reduce the risk of acute urinary retention and enlarged prostate-related surgery, with significant improvements in symptom scores and flow rates 3, 5.
• Combination therapy has been shown to be effective in reducing symptoms and preventing disease progression, with a low incidence of adverse effects 5, 6.

Specific Medication Combinations

• The combination of tamsulosin and finasteride has been found to be effective in improving lower urinary tract symptoms, maximum urinary flow rate, and prostate volume 6.
• The combination of doxazosin and finasteride has been shown to be significantly more effective than either component alone in reducing symptoms and lowering the rate of clinical progression 5.