From the FDA Drug Label
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). Compared with placebo, finasteride tablets was associated with a significantly lower risk for acute urinary retention or the need for BPH-related surgery [13.2% for placebo vs 6. 6% for finasteride tablets; 51% reduction in risk, 95% CI: (34 to 63%)]. Compared with placebo, finasteride tablets was associated with a significantly lower risk for surgery [10.1% for placebo vs 4.6% for finasteride tablets; 55% reduction in risk, 95% CI: (37 to 68%)] and with a significantly lower risk of acute urinary retention [6.6% for placebo vs 2. 8% for finasteride tablets; 57% reduction in risk, 95% CI: (34 to 72%)]
The treatment options for urinary retention due to pelvic floor dysfunction are not directly addressed in the provided drug label. However, the label does discuss the treatment of urinary retention in the context of Benign Prostatic Hyperplasia (BPH).
- Finasteride is associated with a significantly lower risk of acute urinary retention compared to placebo.
- The reduction in risk of acute urinary retention is approximately 57%. However, it is essential to note that pelvic floor dysfunction is not explicitly mentioned in the provided drug label, and therefore, no direct conclusion can be drawn regarding its treatment. 1
From the Research
Treatment for urinary retention due to pelvic floor dysfunction should prioritize pelvic floor physical therapy as the first-line approach, as it has been shown to improve symptoms and quality of life, as supported by the most recent and highest quality study 2. The goal of treatment is to alleviate symptoms, improve bladder function, and enhance overall quality of life. Pelvic floor physical therapy typically involves 8-12 weekly sessions with a specialized therapist who teaches proper muscle relaxation techniques, biofeedback training, and coordinated voiding strategies. Some key points to consider in the treatment plan include:
- Clean intermittent catheterization may be necessary temporarily to manage retention, using sterile technique every 4-6 hours.
- Medications such as alpha-blockers (e.g., tamsulosin 0.4mg daily or alfuzosin 10mg daily) can help relax the urethral sphincter, and muscle relaxants (e.g., baclofen 10-20mg three times daily or diazepam 2-5mg daily) can be used for severe muscle spasm.
- Botulinum toxin injections into the pelvic floor muscles can provide 3-6 months of relief for refractory cases.
- For patients who don't respond to conservative measures, surgical options such as urethral dilation, sacral neuromodulation, or suprapubic catheterization may be considered. It's essential to note that treatment effectiveness varies based on the underlying cause and severity of dysfunction, with most patients seeing improvement with consistent physical therapy and medication management, as highlighted in studies 3, 2.