Does tamsulosin decrease postoperative urinary retention in spine surgery? A double-blind, randomized controlled trial

Abstract

OBJECTIVE The authors’ objective was to determine whether preoperative administration of tamsulosin decreases postoperative urinary retention after spine surgery. METHODS In this randomized, double-blind, placebo-controlled clinical trial performed at a single institution between 2016 and 2019, eligible males aged 50 to 85 years were administered tamsulosin or placebo for 5 days prior to elective spine surgery. Patients were excluded if they were taking alpha adrenergic blocking drugs; were allergic to tamsulosin, lactose, or sulfa drugs; had a preexisting indwelling urinary catheter, orthostatic hypotension, history of urological surgery, or renal failure; or were scheduled for cataract surgery within 2 weeks. Screening identified 1051 eligible patients (140 declined participation, 150 did not meet the inclusion criteria, and 151 did not enroll for other reasons). A total of 610 patients were randomly assigned to receive 0.4 mg oral tamsulosin or an identical placebo capsule for 5 days preoperatively and 2 days postoperatively. RESULTS A total of 497 patients were included in the final statistical analysis. The overall rate of postoperative urinary retention was 9.7%, and tamsulosin had no observed effect on reducing the rate of postoperative urinary retention as compared with placebo (9.4% vs 9.9%, p = 0.96). There were no significant differences in the reported adverse events between groups. Multivariate logistic regression was performed to model the effects of patient, surgical, and anesthetic factors on postoperative urinary retention, and the study drug remained an insignificant factor. CONCLUSIONS This study did not detect an effect of perioperative tamsulosin on reducing the rate of postoperative urinary retention in male patients aged 50 to 85 years who underwent elective spine surgery. This study does not support the routine use of tamsulosin to reduce postoperative urinary retention in patients without a previous prescription. It is unknown if subpopulations exist for which prophylactic tamsulosin may reduce postoperative urinary retention.

Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis

“…Fifteen studies did not meet eligibility criteria. Five studies 10 , 11 , 0–2 were identified for qualitative and quantitative syntheses ( Fig. 1 ).…”

“…Five RCTs 10 , 11 , 1–3 included 878 patients (α1-antagonist, 434; placebo, 444) who were enrolled between 1987 and 2019 ( Table 1 ). Of the five RCTs, three 11 , 21 , 22 involved patients receiving primary arthroplasty and two 10 , 20 involved patients undergoing elective spine surgery. In the study by Petersen et al .…”

“…2 . Four included trials 10 , 11 , 20 , 21 were evaluated as having a low risk of bias throughout all domains. There was a high risk of bias in one study due to a bias in randomization.…”

Prophylactic tamsulosin can reduce the risk of urinary retention after surgery in male patients: A systematic review and meta-analysis

“…Five studies reported the data of adverse events, and the pooled analysis showed that tamsulosin administration was associated with a higher risk of adverse events [57/688 (8.3%) vs. 33/624 (5.3%); RR = 1.68; 95% CI: 1.13–2.48; P = 0.010; heterogeneity: I 2 = 33%; P = 0.20] ( 23 – 25 , 37 , 39 ) ( Figure 7 ). Dizziness and vomiting were the most frequently described adverse events, with a total of 15 episodes.…”

“…In the contrast, the randomized control trial (RCT) by Schubert et al observed no statistical significance in the rate of POUR whether tamsulosin was administrated or not ( 24 ). Given that there were also other publications with uncertain results ( 25 , 26 ), the evaluation of the prophylactic efficacy of tamsulosin against POUR in male patients is still of interest and subject to discussion. The present systematic review and meta-analysis aimed to evaluate the prophylactic efficacy of tamsulosin against POUR in male patients.…”