1. Management of Urinary Retention in Patients with Benign Prostatic Obstruction : A Systematic Review and Meta-analysis
- Author
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Karavitakis, Markos, Kyriazis, Iason, Omar, Muhammad Imran, Gravas, Stavros, Cornu, Jean-Nicolas, Drake, Marcus J., Gacci, Mauro, Gratzke, Christian, Herrmann, Thomas R. W., Madersbacher, Stephan, Rieken, Malte, Speakman, Mark J., Tikkinen, Kari A. O., Yuan, Yuhong, Mamoulakis, Charalampos, Department of Surgery, Urologian yksikkö, Clinicum, University of Helsinki, Department of Public Health, and HUS Abdominal Center
- Subjects
Urinary retention ,GENERAL MALE-POPULATION ,BIPOLAR ,ALFUZOSIN ,Prostate ,STANDARDIZATION SUB-COMMITTEE ,TAMSULOSIN ,RANDOMIZED CONTROLLED-TRIAL ,PERIOPERATIVE EFFICACY ,3126 Surgery, anesthesiology, intensive care, radiology ,TRACT FUNCTION ,Meta-analysis ,Randomized controlled trial ,CATHETER ,Benign prostatic obstruction ,Treatment outcome ,MONOPOLAR TRANSURETHRAL RESECTION - Abstract
Context: 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 nonpharmacological treatments included in the European Association of Urology guidelines on non-neurogenic male lower urinary tract symptoms. Evidence acquisition: Search was conducted up to April 22, 2018, using CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. This systematic review included randomized controlled trials (RCTs) and prospective comparative studies. Methods as detailed in the Cochrane handbook were followed. Certainty of evidence (CoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Evidence synthesis: Literature search identified 2074 citations. Twenty-one studies were included (qualitative synthesis). The evidence for managing patients with UR/BPO with pharmacological or nonpharmacological treatments is limited. CoE for most outcomes was low/very low. Only alpha 1-blockers (alfuzosin and tamsulosin) have been evaluated in more than one RCT. Pooled results indicated that a1-blockers provided significantly higher rates of successful trial without catheter compared with placebo [alfuzosin: 322/540 (60%) vs 156/400 (39%) (odds ratio {OR} 2.28, 95% confidence interval {CI} 1.55 to 3.36; participants = 940; studies = 7; I-2 = 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; I-2 = 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; I-2 = 0%; very low CoE)]. Nonpharmacological treatments have been evaluated in RCTs/prospective comparative studies only sporadically. Conclusions: There is some evidence that usage of alpha 1-blockers (alfuzosin and tamsulosin) may improve resolution of UR/BPO. As most nonpharmacological treatments have not been evaluated in patients with UR/BPO, the evidence is inconclusive about their benefits and harms. Patient summary: There is some evidence that alfuzosin and tamsulosin may increase the rates of successful trial without catheter, but little or no evidence on various nonpharmacological treatment options for managing patients with urinary retention secondary to benign prostatic obstruction. (c) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
- Published
- 2019