What medication should be initiated in a 73-year-old lady with persistent urinary retention?

From the Guidelines

For a 73-year-old lady with persistent urinary retention, an oral alpha blocker, such as tamsulosin (Flomax) 0.4 mg daily, should be initiated prior to a voiding trial, as it has been shown to improve outcomes in patients with acute urinary retention related to benign prostatic hyperplasia (BPH) 1. The use of alpha blockers in this context is supported by the American Urological Association (AUA) guideline, which recommends prescribing an oral alpha blocker prior to a voiding trial to treat patients with acute urinary retention related to BPH, with a moderate recommendation and evidence level of Grade B 1. Some key points to consider when initiating alpha blocker therapy include:

• The patient should complete at least three days of medical therapy prior to attempting a trial without a catheter (TWOC) 1
• The patient should be informed that they remain at increased risk for recurrent urinary retention after a successful TWOC 1
• The use of alpha blockers may not be appropriate in patients with certain medical comorbidities, such as orthostatic hypertension or cerebral vascular disease, due to the potential risks associated with alpha-blocker therapy 1 It is also important to note that the long-term efficacy of alpha blocker therapy in treating acute urinary retention is unclear, and patients may require ongoing management and monitoring to prevent subsequent urinary retention and lower urinary tract symptoms (LUTS) 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Medication Options for Urinary Retention

In a 73-year-old lady with persistent urinary retention, the following medication options can be considered:

• Alpha blockers, such as tamsulosin, which can help relax the muscles in the prostate and bladder neck, making it easier to urinate 2
• Muscarinic receptor antagonists, such as tolterodine, may not be the first line of treatment for urinary retention, but can be used to treat overactive bladder symptoms that may be contributing to the retention 3

Important Considerations

When initiating medication for urinary retention, it is essential to:

• Assess the patient's overall health and medical history to determine the underlying cause of the urinary retention 4, 5
• Monitor the patient's response to treatment and adjust the medication as needed 2, 3
• Consider the potential side effects of the medication, such as dizziness and abnormal ejaculation with alpha blockers, and dry mouth with muscarinic receptor antagonists 2, 3

Additional Treatment Options

In addition to medication, other treatment options for urinary retention may include:

• Catheterization to relieve the obstruction and mitigate the underlying cause of retention 4, 6
• Voiding trials to help the patient regain the ability to urinate on their own 4
• Urodynamic testing to evaluate the patient's urinary function and determine the best course of treatment 5