Alfuzosin 10 mg Once Daily Increases the Chances of Successful Trial without Catheter after Acute Urinary Retention Secondary to Benign Prostate Hyperplasia

Abstract

Objective: To compare the efficacy of Alfuzosin XL 10 mg once daily for the acute management of acute urinary retention (AUR) with placebo in patients with benign prostatic hyperplasia (BPH) and to determine the predictors that impact this. Methods: 67 patients presenting with an initial episode of spontaneous AUR secondary to BPH were catheterized and were then prospectively randomized to receiving placebo or 10 mg Alfuzosin XL once daily for 2 days. The allocation and administration of treatment were double-blinded. The primary outcome measure was the rate of successful trial off catheter (TWOC) after 2 days. Clinical characteristics including intravesical prostatic protrusion (IPP) by transabdominal ultrasound were also assessed using uni- and multivariate analysis for their impact on successful TWOC. Results: Three patients withdrew from the study, 2 due to adverse effects of the trial medication. Analysis on an intention-to-treat basis showed a significantly greater proportion of patients in the Alfuzosin XL group (21 of 35 or 60%) had a successful TWOC compared with patients in the placebo group (11 of 32 or 34%) (p = 0.036). Patients with grade 3 IPP (>10 mm) had a significantly lower chance of successful TWOC (p = 0.04) compared to grade 1 (≤5 mm) and 2 (6–10 mm). It remained a significant independent predictor for failed TWOC after AUR (p = 0.034) on multivariate analysis. Conclusion: The administration of Alfuzosin XL prior to TWOC following AUR secondary to BPH increases the chance of successful catheter removal. Patients with IPP >10 mm are more likely to fail TWOC on Alfuzosin XL.

Management of urinary retention in patients with benign prostatic obstruction: A systematic review and meta-analysis

“…CoE for most outcomes was low or very low. All selective a1blockers (alfuzosin, tamsulosin, and silodosin) appear to be superior to placebo in terms of successful TWOC rates after a short period of catheterization [6,7,[9][10][11]31,34,38]. In contrast, no benefit has been revealed with the use of the nonselective a1-blocker doxazosin, and addition of sildenafil to tamsulosin does not offer additional benefit compared with tamsulosin monotherapy.…”

“…A total of 21 studies (18 RCTs [6][7][8][9][10][11][31][32][33][34][35][36][37][38][39][40][41][42] and three prospective comparative studies [43][44][45]) were included. Fig.…”

Hydronephrosis Predicts Successful Catheter Removal after Painful Urinary Retention - Preliminary Results of a Prospective Single Center Study

“…Patients with successful catheter removal were followed for 1 week after AUR and then monthly and further treated with an α-adrenoreceptor antagonist once a day [13]. When prostate volume was >40 ml, 5 mg of finasteride once a day was added as part of the treatment [5,16].…”

“…In addition, all patients were treated with a α-adrenoreceptor antagonist once a day and with antibiotic prophylaxis with sulfametrole-trimethoprim twice a day for 1 week [10,11,12,13]. …”

Systematic review and meta-analysis on management of acute urinary retention

“…27 Tamsulosin (400 mcg daily), alfuzosin (10 mg daily) and newer selective α-blockers such as silodisin (8 mg daily) and doxazosin (4 mg daily) have been shown to be effective in successful TWOC. [28][29][30][31][32][33][34][35][36][37][38][39][40] In a French cross-sectional study of 2618 men, 79% of subjects were treated with α-blockers during the time of catheter insertion and the TWOC success rate was significantly higher in men who received medical therapy before TWOC (53.0 vs 39.6%). 3 Similar findings are reported by Reten-World Study Group where prevalent use of α-blockers (86%) worldwide is noted with the result doubling success rate of TWOC.…”