Management of Urinary Retention in Patients with Benign Prostatic Obstruction: A Systematic Review and Meta-analysis

Markos Karavitakis, Iason Kyriazis, Muhammad Imran Omar, Stavros Gravas, Jean-Nicolas Cornu, Marcus J. Drake, Mauro Gacci, Christian Gratzke, Thomas R. W. Herrmann, Stephan Madersbacher, Malte Rieken, Mark J. Speakman, Kari A. O. Tikkinen, Yuhong Yuan, Charalampos Mamoulakiso (Corresponding Author)

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Abstract

Background: Practice patterns for the management of urinary retention (UR) secondary to benign prostatic obstruction (BPO) (UR/BPO) vary widely and remain unstandardized.

Objective: To review the evidence for managing patients with UR/BPO with pharmacological and non-pharmacological treatments included in the European Association of Urology Guidelines on Non-neurogenic Μale lower urinary tract symptoms.

Evidence acquisition: Search was conducted using CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and WHO ICTRP; searched up to 22 April 2018. This systematic review included randomized control trials (RCTs) and prospective comparative studies. Methods as detailed in the Cochrane Handbook were followed. Certainty of evidence (CoE) was assessed using GRADE approach.

Evidence synthesis: Literature search identified 2,074 citations. Twenty-one studies were included (qualitative synthesis). The evidence for managing patients with UR/BPO with pharmacological or non-pharmacological treatments is limited. CoE for most outcomes was low/very low. Only α1-blockers (alfuzosin, tamsulosin) have been evaluated in over one RCT. Pooled results indicated that α1-blockers provided significantly higher successful trial without catheter (TWOC) rates compared to placebo [alfuzosin:322/540 (60%) vs 156/400 (39%) (OR 2.28, 95%CI 1.55 to 3.36;participants=940;studies=7;I2 =41%;low CoE); tamsulosin:75/158 (47%) vs 40/139 (29%) (OR 2.40, 95%CI 1.29 to 4.45;participants=297; studies=3;I2 =30%;low CoE)] with rare adverse events. Similar rates were achieved with tamsulosin or alfuzosin [51/87 (59%) vs 45/84 (54%) (OR 1.28, 95%CI 0.68 to 2.41; participants=171;studies=2;I2 =0%;very low CoE)]. Non-pharmacological treatments have been evaluated in RCTs/prospective comparative studies only sporadically.

Conclusions: There is some evidence that usage of α1-blockers (alfuzosin and tamsulosin) may improve resolution of UR/BPO. As most non-pharmacological treatments have not been evaluated in patients with UR/BPO, the evidence is inconclusive about benefits and harms.

Patient summary: There is some evidence that alfuzosin and tamsulosin may increase successful trial without catheter rates but little or no evidence on various non-pharmacological treatment options for managing patients with urinary retention secondary to benign prostatic obstruction.
Original languageEnglish
Pages (from-to)788-798
Number of pages11
JournalEuropean Urology
Volume75
Issue number5
Early online date14 Feb 2019
DOIs
Publication statusPublished - May 2019

Keywords

  • Benign prostatic obstruction
  • Meta-Analysis
  • Prostate
  • Randomized controlled trial
  • Treatment outcome
  • Urinary Retention
  • PERIOPERATIVE EFFICACY
  • TAMSULOSIN
  • RANDOMIZED CONTROLLED-TRIAL
  • Urinary retention
  • BIPOLAR
  • Meta-analysis
  • MONOPOLAR TRANSURETHRAL RESECTION
  • GENERAL MALE-POPULATION
  • STANDARDIZATION SUB-COMMITTEE
  • TRACT FUNCTION
  • ALFUZOSIN
  • CATHETER

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  • Cite this

    Karavitakis, M., Kyriazis, I., Omar, M. I., Gravas, S., Cornu, J-N., Drake, M. J., Gacci, M., Gratzke, C., Herrmann, T. R. W., Madersbacher, S., Rieken, M., Speakman, M. J., Tikkinen, K. A. O., Yuan, Y., & Mamoulakiso, C. (2019). Management of Urinary Retention in Patients with Benign Prostatic Obstruction: A Systematic Review and Meta-analysis. European Urology, 75(5), 788-798. https://doi.org/10.1016/j.eururo.2019.01.046